Shoulder complaints due to calcifications

The cause of shoulder impingement can often be traced back to two causes:

• Shoulder strain complaints. This is also called primary impingement. This usually involves working a lot above the head or repeatedly raising the arm. This can lead to minor damage in:
• Bursa (subdeltoid bursitis)
• Cuff muscles (This is a group of four muscles that stabilize the shoulder), especially the m. supraspinatus but also the m. biceps brachii

Instability of the shoulder due to poor functioning of the cuff. This is also called secondary impingement

Shoulder complaints mainly occur when raising the arm and when turning the arm inwards. The cause lies in the fact that the structures between the roof of the shoulder (formed by two projections of the shoulder blade (acromion and coracoid) and the band between the two projections (the coraco acromial ligament) and the head of the arm are reduced. This space is called the sub(=under)acromial space.

Tensing of the muscles, inflammation of these muscles or a bursitis cause swelling in this space. Raising the arm is then the straw that breaks the camel's back, especially if the muscles also have to tense to lift something, for example.

Recent studies have shown that posture also plays an important role in the development of shoulder impingement. This posture is called the forward head carriage or upper cross syndrome. Here there is an increased curvature of the back and the carrying of the head in relation to the torso.

What is the progression?

Complaints usually develop slowly. Usually there is pain at the side of the arm at the beginning, when lifting the elbow above the shoulder or when turning the arm inwards.

We will initially provide you with information on how to reduce the complaint. This can possibly be supported with the help of anti-inflammatories. [Ibuprofen, Diclofenac: NOTE: not at the same time as blood thinners!!

If the complaints persist despite physiotherapy treatment, we will consider additional research. In many cases, this will consist of ultrasound examination or taking an X-ray. If there are indications, a referral will follow to an orthopedic surgeon.

The orthopedic surgeon will decide on further treatment based on the examination. This treatment may include:

• Physiotherapy
• Injections, where affected structures are directly injected with an anti-inflammatory agent.
• Surgical intervention, usually according to the Neer method, or Barbotage (suction away the calcium plug, if possible)

What does the physiotherapist do?

The diagnosis of an impingement can be determined by Physiotherapy Doetinchem by means of ultrasound examination.

For the treatment of a shoulder impingement, a combination of one of the following components is used:

ESWT Shockwavetherapie

In impingement complaints we often see calcification in the supraspinatus tendon. This can be remedied by ESWT Shockwave therapy.

Exercise therapy

Exercise therapy focuses on improving the mobility of the shoulder and improving the function of the muscles around the shoulder joint and the shoulder blade. Exercise therapy under the supervision of a physiotherapist has been shown to be as effective as surgery for primary impingement. Exercise therapy according to Bang and Deyle or according to McClure are the best-known treatment methods for shoulder impingement.

Manual Therapy/Mobilizations:

However, the freedom of movement of the shoulder and the functioning of the arm is not only dependent on the shoulder weight and shoulder blade. The mobility and stability of the entire movement chain – neck, back, ribs, collarbone and sternum is important. Attention to the function of the entire movement chain with manual therapy in combination with exercise therapy has also been shown to be more effective than exercise therapy alone in patients with shoulder impingement syndrome.

Posture and movement instructions:

During our lives we all develop our own posture and movement patterns. These are not always efficient and can even cause complaints. By removing the stressful factors from such a pattern, stressful postures and movements can be minimized. The design of the workplace is also very important. If one adopts an incorrect posture during the performance of the profession, this can have far-reaching consequences. For example, by leaving the computer screen in the wrong place, serious neck and shoulder complaints can arise.

What can you do yourself to reduce the symptoms?

• Try to move the arm as much as possible without provoking the pain. This usually means that you should not move the elbow above the shoulder and that you should be careful with rotating movements of the arm.
• Perform the exercise program you have been given daily.
• If the symptoms are very annoying, you can try to treat it with ice. Place the ice pack in a damp tea towel on the shoulder and leave it for 20 minutes. Repeat this procedure an hour later.