Tennis Shoulder: Impingement Syndrome of the Shoulder

IMPINGEMENT SYNDROME OF THE SHOULDER

A friend of one of our coaches came to see me yesterday with left shoulder pain.  He had shoulder issues with his right arm last year that I helped him resolve so I’m taking it as a compliment that he came back to see me when the left shoulder caused him problems!

His medical case is quite typical and I think it will prove to be a helpful example of how to quickly manage acute Tennis Shoulder.

The Athlete:

  • Approximately 38 yrs old
  • Active military, excellent health, excellent overall strength and conditioning.
  • Right hand dominant although he plays tennis with the left arm with a Hx of impingement syndrome of the shoulder on the right.

The Symptoms:

  • Significant sharp shoulder pain on the left AC joint.
  • Approximately 50% strength loss with functional activities such as turning the steering wheel in car and holding anything away from his body.
  • Shoulder pain lifting arm and an inability to sleep on the left shoulder.

The History:

  • No falls, accidents or episodes that would create shoulder symptoms.
  • The athlete has a history of being a competitive tennis player in his youth and he has recently been playing a significant amount of tennis with his daughter.
  • Over the past 2 weeks, localized shoulder pain lifting arm has increased and point tenderness on the AC joint or tip of shoulder has become intense.

The Examination:

  • Point tenderness, approximately the size of a dime, was easily found at the end of the left collarbone on the front of the AC joint.
  • Intense pain with active motion with an attempt to reach across the body with the left hand to touch the back of the right shoulder.
  • Passive extension of the shoulder with the elbow extended and the wrist pronated which maximizes the stretch on the longhead of the biceps brachii muscle.
  • Manual muscle tests to assess his shoulder strength for motions such as external rotation, flexion, abduction, supraspinatus elevation and extension demonstrated left shoulder strength of approximately 70% of the right shoulder.
  • Other tests to rule-out issues such as shoulder joint instability, an AC joint separation, nerve pathologies, and an SC joint sprain were normal and symptom-free.

The Diagnosis:

Acute Impingement Syndrome of shoulder or Tennis Shoulder

The Plan:

  • Discontinue tennis and all activities that create any shoulder symptoms for 2 weeks.
  • Consistent pendulum swings with light weight.
  • Implement an aggressive strengthening routine for external rotation (ER) for 1 week.
  • If strength of ER returns to approximately 90 in 1 week, return to painfree weight training while continuing to avoid all overhead lifting and any exercises involving the left arm acrossing the midline of the body.
  • Improving posture with painfree stretches of the chest and anterior shoulders.
  • Consistent massage of chest muscles immediately followed by exercising the upper-mid back with shoulder blade retraction or “pulling together” exercises.
  • Icing the shoulder 3-5 times per day.
  • Only if needed for pain, consuming an over the counter anti-inflammatory medicine for a short period of time.
  • Avoid sleeping on left shoulder for 2 weeks.
  • Determine a successful pre-tennis routine that will:

> Warm-up the shoulder joint, AC joint and surrounding musculature.

> Allow for normal mechanics and patterns for movement.

> “Fire up” the shoulder external rotators to help decelerate the arm during the follow-through phase of the tennis swing.

It was a pleasure working with this gentleman and I believe he will do very well with this action plan.   I expect him to be able to return to his normal activities as an active military specialist within 3 weeks.  He may need to permanently limit his overhead lifting and consistently focus on the strength of his external rotators bilaterally based on his history.

Author: Mike Ryan

After 26 seasons as a full-time certified athletic trainer and registered physical therapist in the National Football League, Mike Ryan has outstanding first-hand experience. His unique professional and athletic background has sharpened his skills in the arts of sports injury management, elite rehabilitation, performance enhancement and injury prevention. Mike is now taking his experience to mainstream America. His mission is simple: Sports Medicine advice that is easy to use and brings fast results. Learn more about Mike Ryan

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