b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE UpdateRotator CuffMedicareQ&AMedicare Update Impingement:OUR HEALTHBy Dr. Gregory H. Doerr Complicated?Rotator cuff impingement is one of the most common injuriesRotator cuff imbal-chiropractors will see in their office.Frequently, shoulderances are another complaints make chiropractors nervous and are treated withreason for subacromial the manipulation of the thoracic and cervical spine and A-Pimpingement.thrusts to the shoulder.While manipulation to the thoracicImbalances in rotator and cervical spines can have important components tocuff strength alter the shoulder impingement, especially the thoracic spine associ- dynamic stabilization ated with postural disorders, it is important to understandof the glenohumeral the common causes of shoulder impingement. Wall Angels joint.When we lose There are six common causes of subacromial shoulderthe balance in the impingement.Tensile failure of rotator cuff fibers, poorrotator cuff, with scapular mechanics, rotator cuff imbalance, anterior capsularrare exception, the laxity, posterior capsule contracture, and supraspinatusER of the shoulder outlet narrowing are the common reasons for this type ofbecomes weaker injury.Of these reasons for impingement, the one that isthan the IR, the head most commonly handled by chiropractors is poor scapularof the humerus is no mechanics. longer balanced in the glenoid allowing for a narrowing of the subacromial space.Scapular dyskinesis involves so many common situationsIn order to treat this component of subacromial impinge-that chiropractors deal with on a daily basis.Increased TSment, the doctor should focus on rebalancing the weakened kyphosis, poor thoracic spine mobility, weakness in scapularrotator cuff with exercises. stabilizers (especially lower and medial scapular stabilizers)Tensile failure of the rotator cuff involves a little more expe-create altered scapular mechanics leading to impingement. rience with shoulder injuries.Although rare, single event Maintenance of scapular dynamic stability with mobility oftraumas may cause rotator cuff injury.More commonly, the glenohumeral joint keeps humeral head in constraint withrepetitive micro-traumas are the cause.An example of this is glenoid throughout full range of motion of the shoulder. the deceleration phase of overhead pitching.The eccentric The scapula is protracted laterally and then anteriorly aroundcontraction of the superior and posterior rotator cuff can the thoracic wall during throwing motions (arm accelerationresult in tensile failure over continuous repetitive strain.and follow through) which is controlled by eccentricTreatment of the rotator cuff includes a more aggressive soft contraction of medial and lower stabilizers.In abduction,tissue treatment to the involved tendons for the purpose the scapula moves laterally through first 30-50 degrees thenof increasing fibroblastic activity and eccentric loading to rotates around a fixed axis until full elevation.Without thisincrease collagen synthesis.Higher pressure soft tissue rotation acromion lift does not occur, treatments increase the number of fibroblasts to the tissue resulting in impingement. and eccentric loading has been found to drastically increase In order to treat scapular dyskinesis, several treatmentcollagen synthesis in injured tendons.By combining the two methods must be implemented.First, manipulation of thetherapies, we can drastically increase the healing process thoracic spine and mobilization of the scapula are critical inof injured tendons.In the athletic situation, the doctor may assisting in restoring proper motion.Second, the musclesalso be involved in getting the patient to a coach who may involved in scapular motion must be neurologically balanced. properly restore or improve the athletes mechanics to help This can be accomplished by doing soft tissue treatmentsprevent future injuries.over the entire upper quadrant.The goal is to simplyThe next reason for impingement is associated with the develop a hyperemia in the skin of the upper quadrant. capsule of the shoulder.Anterior laxity and posture capsule Once a hyperemia has been created, the neurologic resetcontracture can frequently present at the same time.Ante-should have occurred.Third, strengthening of the medialrior laxity can easily be diagnosed using Relocation Test, and and lower scapular stabilizers as well as the serratus anteriorposterior capsule contracture can easily be discovered by are critical for long term stabilization.Finally, we can usewatching for early and excessive anterior translation during taping techniques for postural correction to assist the patientsupine passive IR.When the shoulder translates anteriorly between treatments. either due to laxity or being pushed forward from a 18 I Spring 2021 www.anjc.info'