Shoulder Impingement (Care of the Young Athlete)

1. Limit overhead activity
or anything that causes pain.

• a.
  Pitchers—Limit pitching; may try playing
  first or second base.

• b.
  Tennis—Limit serves and overhead shots.

• c.
  Swimmers—Limit butterfly, freestyle, and hand
  paddles.

2. Ice, NSAIDs.

1. The other phases of
rehabilitation will not be effective until pain is
controlled.

2. Swelling inside the
shoulder may worsen the pain and contribute to further
injury.

3. Pain may be reduced by
limiting activities or changing technique for painful
activities.

Therapeutic exercise

1. Correct poor posture.

2. Restore strength to
scapular stabilizers.

1. Stretch anterior chest
wall muscles; strengthen inter-scapular muscles with
rowing-type exercises (Figure 1), and strengthen scapular
stabilizers with shoulder protraction exercises (Figure
2).

2. Use elastic tubing or
weights to strengthen external rotators of shoulder.

1. Continue with aspects of
the sport that don’t require overhead motion or cause
pain.

2. General conditioning,
including aerobic exercise (running, cycling, kicking drills
for swimmers).

3. Lower extremity and trunk
strengthening.

1. Resume overhead motion
gradually as symptoms permit.

2. Correct technique or
training.

1. For pitchers, follow a
graded return-to-throwing program.

2. Consider biomechanical
assessment if technique errors are suspected in a pitcher,
swimmer, or tennis player.