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Impingement (subacromial impingement syndrome)

Every time the upper arm is lifted overhead, a narrowing of the space between the humeral head and acromion occurs. This space, (the subacromial space) is where tendons of the rotator cuff are located, protected by the bursa. 

Performing sports, or everyday activities which require repetitive overhead movements, rotator cuff muscle imbalances, or irregularities in the acromion profile may all cause increased friction inside this space, which can lead to the formation of calcium deposits within the subacromial space. Pain usually occurs at night. This series of events inevitably provokes the non use of the superior limb, causing the arising of intra-articular adherences and a worsening of the clinic condition.

Quick and correct diagnosis followed by an early start to rehabilitation is key here, as stopping the vicious cyrcle mentioned above ensures rehabilitation is faster and more effective. 
Adopting this approach negates the need for prolonged courses of anti-inflammatory drugs, as well as preventing secondary damage to the joint through the adoption of bad postures. 
In case investigations show the presence of relevant anatomic alterations, such as almost complete tear of tendons of the rotators cuff or the localisation of large calcific deposits, surgery may be required together with a following rehabilitation.

Impingement - Rehabilitation

The main cause of impingement is imbalance of the muscles underlying the movements of the shoulder, for both traumatic and overstress reasons. This combined with a laxity of the ligaments of the glenohumeral joint can cause this condition of the shoulder pain.

In case of impingement the rehabilitation program should be individualized and targeted to muscle balance. The goal of the first phase of the rehabilitation program is the reduction of pain, through the use of physical therapies (TENS, laser, ultrasound), and the recovery of the full ROM through active and passive mobilization, capsular and muscle stretching and relaxing and stress relieving massage. Once you have fulfilled the objectives of this first phase it is necessary to proceed to the main phase of the rehabilitation program, the recovery and rebalancing of force by respecting the rule to relax the antagonist muscle (through massage and stretching) before reinforcing the agonist.

The rehabilitation program also involves for the recovery of the muscles of the shoulder girdle, especially the supraspinatus, the stabilizing muscles of the shoulder blade (rhomboid), the depressor of the humeral head (latissimus dorsi), the external rotation and intra-rotators headphone. Reached the tone and optimal muscle balance the rehabilitation program ends in the field through the execution of proprioceptive exercises and recovery coordination up to the sports specific gestures trying not to overload.

At the end you will be given a program of maintenance exercises to perform after discharge to maintain the muscle balance.

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