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.