Principles of physiotherapeutic management of shoulder impingement syndrome.

BACKGROUND: The study aimed to assess changes in shoulder joint mobility and symmetry as well as changes in the bioelectrical activity of selected muscles important for the functioning of the shoulder complex in order to determine optimal physiotherapeutic management in patients with shoulder impingement syndrome. MATERIAL AND METHOD: The study involved 58 persons aged 24-85 years treated for shoulder impingement syndrome from 2004 to 2006. Symptoms had been present for 40 months on average. The examination of patients included in each case measurement of active mobility ranges using the SFTR method, photogrammetry-based assessment of shoulder symmetry and an examination of the bioelectrical activity of muscles using surface electromyography. RESULTS: The results demonstrated that the degree of limitation of external rotation, which considerably affects the other motion ranges, is the most important index of shoulder joint dysfunction. The decrease in the bioelectrical activity of the deltoid muscle is caused by pain avoidance, with high activity of the pectoralis major and latissimus dorsi muscles indicating the development of compensatory mechanisms. A spatial displacement of the scapula referred to as a wing-like position impairs the scapulobrachial rhythm. CONCLUSIONS: Therapeutic management should firstly aim to eliminate pain, then to restore shoulder joint stability by instructing the patient on how to properly centre the humeral head, and, subsequently, to restore normal movement patterns and the scapulobrachial rhythm, and finally to gradually increase the range of active mobility, in particular of external rotation.