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What is Stiff Person Syndrome?

by Pain Doc | Dec 19, 2023 | Neuromusculoskeletal Disorders

The singer Celine Dion, whose glorious singing career spanned the last four decades, was recently diagnosed with a condition called Stiff Person Syndrome. Unfortunately, the condition is prevening her from performing, due to its debilitating effect on muscle control, including the vocal cord muscles.

Stiff Person Syndrome (SPS) is a rare, progressive neurological disorder characterized by significant muscle rigidity and spasms, often leading to debilitating physical and psychological symptoms. This article provides an overview of SPS, delving into its causes, symptoms, diagnosis, and current treatment options, as informed by medical research and trusted medical resources.

What is Stiff Person Syndrome?

SPS is an autoimmune neurological disorder primarily causing muscle stiffness and painful spasms. These spasms can worsen over time and vary in symptoms, including an unsteady gait, double vision, or slurred speech, depending on the SPS type. The condition can be severely disabling, often leading to hunched over postures and frequent falls due to impaired reflexes.

Causes of Stiff Person Syndrome

While the exact cause of SPS is unknown, it is believed to be an autoimmune reaction where the immune system attacks glutamic acid decarboxylase (GAD) in the brain and spinal cord. GAD is crucial for producing gamma-aminobutyric acid (GABA), a neurotransmitter controlling muscle movement. Neurotransmitters are protein molecules released from the ends of neurons, which then attach to other neurons causing them to continue the nerve impulse until it reaches the muscle. Disruption in GABA production can lead to continuous neuron firing, contributing to muscle rigidity and spasms seen in SPS. Low GABA levels are also associated with anxiety and depression. Interestingly, SPS often occurs alongside other autoimmune diseases like type-I diabetes, thyroiditis, vitiligo, and pernicious anemia.

Symptoms of Stiff Person Syndrome

The primary symptoms of SPS include progressive muscle rigidity and painful spasms, often triggered by stimuli such as noise, touch, and emotional distress. Initial symptoms typically manifest between the ages of 30 and 60 and can vary in severity and progression. Common initial signs include muscle stiffness and pain, especially in the lower back and legs, potentially leading to difficulty in walking and performing daily activities. Severe cases may require wheelchair use, and there’s an increased risk of anxiety and depression.

Diagnosis of Stiff Person Syndrome

Diagnosing SPS is challenging due to its rarity and symptom overlap with other conditions like Parkinson’s disease, multiple sclerosis, and fibromyalgia. A definitive diagnosis is often made via a blood test measuring GAD antibodies. Most people with SPS show elevated GAD antibody levels. Electromyography (EMG) tests can also be employed to measure muscle electrical activity and assist in diagnosis and monitoring treatment response.

Treatment Options for Stiff Person Syndrome

While there is no cure for SPS, symptoms can be managed through personalized treatment plans focusing on pain management, muscle relaxation, and immune response suppression. Common medications include pain relievers, muscle relaxants, anti-seizure and anti-anxiety drugs, sedatives, and steroids. Non-medication treatments like physical therapy, heat therapy, red light therapy, and pulsed EMF are also beneficial. In cases where medications are ineffective, treatments like Botox, intravenous immunoglobulin (IVIg), and stem cell therapy have shown promise in symptom improvement.

Additionally, a narrative review of available medication treatments for SPS suggests starting with benzodiazepines as a first-line treatment, adding medications like levetiracetam or pregabalin if symptoms persist. For second-line therapy, oral baclofen is preferred over rituximab and tacrolimus. In cases of refractory symptoms, treatments like intrathecal baclofen, IVIG, or plasmapheresis can be effective, with intrathecal baclofen and IVIG being more effective than plasmapheresis.

Conclusion

Stiff Person Syndrome presents a complex clinical challenge due to its rarity, varied symptomatology, and the intricate interplay of autoimmune responses. Understanding its underlying causes, symptom patterns, and current treatment modalities is crucial for effective management. Ongoing research continues to shed light on this condition, offering hope for more effective treatments in the future. For individuals diagnosed with SPS, a collaborative approach involving neurologists, rheumatologists, and physical therapists, alongside personalized treatment strategies, is key to managing this condition and improving quality of life.

And lastly, when your body is struggling with disease, give it assistance by providing it with nutrients, water, sunlight and mild exercise when possible. Mind-body approaches including meditation, flotation therapy, biofeedback, yoga, tai-chi, deep breathing and so on, may provide some relief as well.

Sources:

Johns Hopkins Online

https://www.hopkinsmedicine.org/

National Institute of Neuromuscular Disorders and Stroke

https://www.ninds.nih.gov/

American Brain Foundation

https://www.americanbrainfoundation.org/

Tips for Protecting Your Mental Health During Bad Times

by Pain Doc | Oct 18, 2023 | healthy mindset

We’re living in a world where news never takes a break, and thanks to that ubiquitous smart phone, is a second away from our attention. Unfortunately, negative news gets a lot more attention than positive news; not to mention peoples’ own personal struggles. Just as the pandemic was starting to end, war breaks out in Ukraine and now Israel and Gaza. This barrage of negative, unhealthy emotions on the psyche can affect anyone’s mental health, in different ways, in different people.

An unwell mind can breed dysfunction in the body, thanks to the mind-body connection. It can lead to ulcers, high blood sugar, high blood pressure, depression and so on. It is well known that negative mental states are a risk factor for cardiovascular disease.

So if life starts to overwhelm you, take action. Do not let it brew; nip it in the bud. And, engage in practices that make you resilient to anxiety and depression. Here are some suggestions:

15 Habits and Practices to Nurture Mental Health and Wellness

1. Stay Informed but Limit Media Exposure: While it’s important to stay informed about the crisis, excessive exposure to news can increase stress and anxiety. Set specific times to check for updates and avoid constant news consumption.

2. Maintain Routine: Try to establish a daily routine to provide a sense of normalcy and stability. This includes regular sleep, meals, and exercise.

3. Stay Connected: Social support is vital during crises. Stay in touch with friends and family through calls, video chats, or social media. Share your feelings and concerns with trusted individuals. Talking about it with others is like releasing toxic pressure. Give it a try.

4. Practice Mindfulness and Relaxation Techniques: Mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce stress and anxiety. These techniques can be practiced daily to promote relaxation.

5. Exercise Regularly: Physical activity releases endorphins, which can boost your mood and reduce stress. Even a short walk or home workout can be beneficial. Here’s an example of one that doesn’t require much prep: 25 squats, 50 jumping jacks, and 25 pushups. Just doing that will get your heart rate up, more oxygen to your brain, and even a shot of endorphins.

6. Eat a Balanced Diet: Stress can drive one to reach for junk food and sweets. This can make your stress worse, as you’re not getting essential vitamins and minerals. Proper nutrition has a significant impact on your mental health. Eat a balanced diet with plenty of fruits, vegetables, lean proteins, good fats and whole grains. Try a whey or pea protein shake, too. But, a chocolate chip cookie once in a while is fine, as well as occasional comfort food that doesn’t necessarily quality as “balanced.” Just do in moderation. The “feel good” emotions are worth the calorie hit; just don’t overdo it because you’ll get diminishing returns.

7. Limit Alcohol and Substance Use: Avoid excessive alcohol or drug use, as they can worsen mental health issues. Instead, seek healthier coping mechanisms such as nature walks, hobbies like learning a musical instrument, cooking and gardening.

8. Set Realistic Goals: Break down tasks into smaller, manageable steps. Setting achievable goals can give you a sense of accomplishment and control.

9. Seek Professional Help: If you’re struggling to cope with a crisis, don’t hesitate to reach out to a mental health professional. Many therapists offer remote sessions, making it easier to access support. If you feel your situation is at a crisis-level, the Crisis Text Line is a free service staffed by crisis volunteers.

10. Volunteer or Help Others: Helping others during a crisis can provide a sense of purpose and fulfillment. It can also strengthen your own resilience. There are opportunities for volunteering in just about every town; check with your city hall. Helping others is a nice way to tap into present time consciousness in a world that has many distractions; most of them insignificant.

11. Limit Exposure to Stressors: If possible, try to reduce exposure to stressors that you can control. This might involve temporarily distancing yourself from toxic relationships, social media or other places that cause you to generate negative emotions.

12. Practice Self-Compassion: Be kind to yourself and acknowledge that it’s okay to have moments of difficulty. Avoid self-criticism and negative self-talk.

13. Maintain a Journal: Writing down your thoughts and feelings can be a therapeutic way to process emotions and gain perspective on your situation. Check out this short video by Dr. Benjamin Hardy, an expert on personal growth, where he addresses the mental health benefits of keeping a journal.

14. Stay Creative: Engaging in creative activities like art, writing, or music can be a constructive way to express emotions and distract from stress.

15. Focus on Positivity: Try to find moments of gratitude and positivity each day. This can help shift your perspective and improve your overall outlook.

How Pulsed EMF can benefit Mental Health

Practicing these fifteen habits can help most people keep anxiety and depression at bay indefinitely. For those who feel they need more, you may want to ask your health professional about getting pulsed electromagnetic transcranial therapy (Pulsed EMF for the brain). Studies show that pulsed EMF can be helpful in treating anxiety and depresson, as well as insomnia and mental fogginess.

Many people are having success self-treating with pulsed EMF, as the products are so safe they can be purchased directly by consumers. You can find examples of pulsed EMF device here. The Diamag is the upper end machine that is specially designed for the head/ brain.

Remember that everyone’s response to crises is unique. If you can’t get support from people you know, there’s no shame in seeking professional help. Your mental health is important, and seeking help is a sign of strength, not weakness.

What is the Best Home Air Filter?

by Pain Doc | Oct 16, 2023 | air filtering for health

The air you breathe every day greatly influences your current and future health. In an ideal world, you would only breathe in pure air; however, that’s not the case. The air outside and in our homes are full of various kinds of coarse and fine particulate matter. Fine particulate matter (particles 2.5 microns and smaller) can make it all the way to the alveoli– the microscopic structure where blood gases are exchanged, and some can even jump into your bloodstream and get carried to all your organs, where they accumulate to dangerous levels.

Unfortunately, particulate pollution is not going to go away. Industry, construction and manufacturing will continue to pour billions of pounds of it into our air every day. Cars and commercial jets put out soot and fuel mist that can make it into our homes. In fact, a shocking study found that perchlorate, a toxic component of rocket fuel, was
contaminating virtually all samples of women’s breast milk and its levels were found to be, on average, five times greater than in cow’s milk.

Wildfires all over the planet produce fine soot, which can cross entire oceans and reach populated areas. Droughts produce fine clay dust particles, some containing lead, that travel with the wind from places far from your home.

Because of this constant onslaught of pollution, it is wise to invest in an air purifier. Place one in your bedroom, living room, automobile, and place of work– the places where you spend the most time. You’re not going to be able to escape all of it, but if you can cut your pollutant ingestion down 80%, it’s going to benefit your health significantly. For those who live in a high risk area like downwind of an industrial zone or construction site, the change will be even more dramatic.

There are currently eight main technologies of consumer air purification technology; some that have been around for over 25 years and some relatively newer. Let’s break down the most common types of air purifiers and their key features:

Mechanical Filters (HEPA filters)

How they work: These use a dense web of fibers to trap particles as air flows through.
Key features:
- Can capture particles as small as 0.3 microns (like pollen, dust, and some mold spores).
- Need regular replacement.
- Can be combined with other types of filters/technologies for comprehensive air purification.
Pros: Effective at capturing large to small particles, especially true HEPA filters.
Cons: Doesn’t neutralize odors, chemicals, or gases; filters need replacement.

Activated Carbon Filters

How they work: Made from porous charcoal, these filters absorb gases and odors.
Key features:
- Effective for odors and smoke.
- Often combined with other filter types (like HEPA) for broader effectiveness.
Pros: Great for removing odors, smoke, and some gases.
Cons: Doesn’t trap particulate matter; needs periodic replacement.

Ionic Purifiers (or Ionizers)

How they work: Emit negative ions that bond with positive ions (like dust, pollen) to form larger particles, which settle and are removed from the air.
Key features:
- Some models collect ionized particles on plates, while others let them settle on surfaces.
Pros: Quiet operation, can remove very small particles from the air.
Cons: May produce ozone, which can irritate the lungs and is harmful to the environment; settled particles need to be cleaned.

Ozone Generators

How they work: Intentionally produce ozone to “purify” the air.
Key features:
- Claimed to deodorize, disinfect, and kill/remove contaminants.
Pros: Can neutralize certain odors and contaminants.
Cons: Ozone is harmful to human health and can exacerbate respiratory issues; not recommended for general air purification.

Ultraviolet (UV) Light Purifier

How they work: Use ultraviolet light to kill germs, bacteria, and viruses.
Key features:
- Often used in combination with other filter types.
Pros: Effective at killing microorganisms.
Cons: Only targets microorganisms; effectiveness depends on exposure time.

Photocatalytic Oxidation (PCO)

How they work: Uses a UV light along with a catalyst (usually titanium dioxide) to break down gases into harmless substances.
Key features:
- Targets VOCs (volatile organic compounds), bacteria, and viruses.
Pros: Can neutralize harmful gases and microorganisms.
Cons: Limited in effectiveness against larger particulate matter; some units might produce small amounts of ozone.

Electronic Air Cleaners

How they work: Use electrostatic attraction to trap charged particles.
Key features:
- Can be filterless or use filters.
Pros: Effective at capturing various particle sizes.
Cons: Some models may produce ozone.

TPA (Tesla Plasma Array) Technology:

How it works: Uses an electric field to capture particles, much like an ionic purifier but without producing ozone.
Pros:
- Typically filterless or has washable filters, leading to lower maintenance costs.
- Can effectively capture very small particles.
- Quiet operation as it doesn’t require powerful fans.
Cons:
- The electric plates require regular cleaning.
- May not be as effective against certain gases or odors compared to activated carbon filters.

Be aware that medium to high end air purifiers typically combine several of these technologies, such as the AirDog line of air purification systems.

When comparing specific models or technologies, read the product description and get a sense of what the product is designed to address, such as allergies, asthma, smoke, pets, or chemical sensitivities, and operational features. Some people might prioritize filter replacement costs, while others might look for the most effective particle removal.

Also, pay attention to the room size recommendations, maintenance requirements, and any certifications (like from the Association of Home Appliance Manufacturers, AHAM, or California Air Resources Board, CARB) that validate the purifier’s effectiveness and safety.

Lastly, a final consideration: when it comes to spending on your and your loved ones’ health, it is wise to view purchases not as an expense, but as an investment; especially if it can provide your body the purest air possible. While there are relatively cheap HEPA air purifiers, there are also higher-end air purifiers that offer multiple-stage filtration to extract even the smallest fine particulate matter and harmful gases. Like a home mortgage, this expense is amortized over your remaining life. The more you use it over time, the cheaper its daily cost is.

Disclaimer: Some links used on this site are affiliate links to products that are mentioned in the article. If you purchase the product from the link, it may result in a small commission to our company. This covers the costs of researching and producing free content. Rest assured that all products mentioned on this site and YouTube channel have been carefully researched for quality, safety and efficacy.

What Does Fine Particulate Matter Do to Your Lungs?

by Pain Doc | Sep 30, 2023 | air filtering for health

What Happens in the Lungs When You Breathe in Fine Particulate Matter?

Breathing is a natural process that ensures our body gets the oxygen it needs to function. Oxygen’s main function is to convert your food to energy inside each cell, which needs a constant, uninterrupted supply.

fine particulate matter illustrated t to scale The quality of the air we breathe can have significant effects on our health, particularly when it contains fine particulate matter (abbreviated “PM2.5”). Understanding the consequences of inhaling PM2.5 can underscore the importance of maintaining air quality and safeguarding our respiratory health.

What is Fine Particulate Matter?

Fine particulate matter, or PM2.5, refers to tiny particles or droplets in the air that are 2.5 micrometers (also called microns) in diameter or smaller, which is one millionth of a meter, and which can be man-made or natural.

To put it into perspective, a human hair has a diameter of about 70 micrometers, making PM2.5 particles nearly 30 times narrower than a human hair. These particles can originate from various sources, including vehicle emissions, industrial processes, power plants, wood-burning, and certain natural processes such as wildfires and volcanic eruptions.

fine particulate matter from wildfires, San Francisco in August 2020 In late summer of 2020, the Bay Area of California experienced very dangerous levels of PM2.5 due to wildfires; so bad that people were instructed to remain indoors. And on the day of and weeks following the 9-11 terrorist attacks on the World Trade Center, thousands of people, especially first responders, breathed in the tons of fine particulate matter that were produced from the destruction. Many are suffering from chronic lung problems, and many have died from ingesting these toxins into their lungs.

Air Dog™: Discover the Next Generation of Home and Office Air Purifiers

How Does PM2.5 Enter the Lungs?

When we breathe, air travels through our nose or mouth, down the trachea, and into our lungs via a network of progressively smaller tubes called bronchi. These further divide into tiny air sacs called alveoli, where the exchange of oxygen and carbon dioxide takes place between your blood and the atmosphere.

alveoli of lungs

Due to their minuscule size, PM2.5 particles can bypass the body’s natural defense mechanisms, such as nasal hairs and the mucociliary escalator: the constant upflow of a thin layer of mucus lining the upper and lower respiratory tract, done by cilia, a hair like structure on the surface of all respiratory tract cells. Foreign debris entering with the air gets trapped on this moving layer of mucus, and triggers you to spit it out, or swallow. However, P2.5 is so light and tiny, many of them escape the mucus layer and make it all the way deep into your lungs, down to the alveoli.

Effects of PM2.5 on the Lungs

Inflammation: Once PM2.5 particles reach the alveoli, they can cause inflammation. The body recognizes these particles as foreign invaders and activates immune responses. Inflammatory cells rush to the site, releasing various chemicals that can damage lung tissues.
Aggravation of Respiratory Diseases: People with pre-existing respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), can experience exacerbations when exposed to high PM2.5 levels. The inflammation and irritation caused by the particles can constrict airways, leading to symptoms like wheezing, shortness of breath, and coughing.
Decreased Lung Function: Chronic exposure to PM2.5 can lead to a decline in lung function over time. The damage and inflammation can lead to scarring of lung tissues, which reduces the lungs’ efficiency in oxygen exchange.
Deep Systemic Effects: PM2.5 doesn’t just stay in the lungs. Some particles, especially those carrying toxic substances or heavy metals, can enter the bloodstream through the alveoli. This means that the effects of PM2.5 can be systemic, impacting other organs and systems like the heart and the vascular system.
Increased Risk of Respiratory Infections: The inflammation and damage caused by PM2.5 can weaken the lungs’ defense mechanisms, making individuals more susceptible to respiratory infections like pneumonia.
Lung Cancer: Extended exposure to high levels of PM2.5 has been linked to an increased risk of lung cancer. Some particulate matter can carry carcinogenic substances, which, when inhaled over time, can lead to DNA damage and cancerous growths.

Protecting Yourself from PM2.5

Given the potential risks associated with PM2.5 inhalation, it’s crucial to take steps to minimize exposure, especially in areas with frequent high PM2.5 levels.

Monitor Air Quality: Stay informed about local air quality levels through apps, websites, or local news.
Stay Indoors: During days with high PM2.5 levels, limit outdoor activities, especially strenuous ones like jogging or cycling.
Air Purifiers: Consider investing in air purifiers with HEPA filters that can effectively remove fine particles from indoor air. Even better, get the higher performing models that also include charged electrical fields to trap dangerous, cancer-causing fine particulate matter.
Ventilation: Ensure that homes and offices are well-ventilated. Use exhaust fans, especially when cooking, to reduce indoor PM2.5 levels.
Masks: In severely polluted environments, consider wearing masks like N95 respirators that can filter out fine particulate matter. I would recommend using masks whenever you do things around the house that stir up fine particles, such as sawing wood, spray painting, cleaning up a dusty area, and even working with flour and finely ground spices.

Conclusion

The presence of fine particulate matter in the air poses a genuine health concern. If you live in an area that gets wildfires, or downwind of an industrial zone, or a building demolition site, chances are, you are ingesting more P2.5 than the average person. These tiny particles can deeply penetrate the lungs, and depending on their nature, can lead to a range of health problems from immediate respiratory symptoms to long-term conditions like lung cancer and emphysema. As global urbanization and industrialization continue, understanding the implications of PM2.5 and taking protective measures become increasingly vital for maintaining public health.

Could This be the Best Home Air Purifier Ever Made?

Understanding Impingement Syndrome in the Shoulder: Causes and Rehabilitation

by Pain Doc | Sep 25, 2023 | Chronic Pain, Joint Pain, Shoulder Pain

The shoulder is a marvel of human anatomy, offering an impressive range of motion. However, this mobility comes at a cost, as the shoulder joint is highly susceptible to various conditions and injuries, one of the most common being impingement syndrome. In this article, I will discuss the causes, symptoms, diagnosis, and treatment options for shoulder impingement syndrome, with a primary focus on rehabilitation techniques to help individuals recover and regain full shoulder functionality.

Introduction to Shoulder Impingement Syndrome

Shoulder impingement syndrome is a painful and often debilitating condition that occurs when the tendons of the rotator cuff and the subacromial bursa become pinched or impinged between the bones of the shoulder, primarily the acromion (a part of the scapula or shoulder blade) and the humerus (the upper arm bone). This impingement leads to inflammation, pain, and restricted shoulder movement.

Anatomy of the Shoulder

Before delving into the causes and rehabilitation of shoulder impingement syndrome, it’s crucial to understand the intricate anatomy of the shoulder joint. The shoulder comprises three bones: the humerus, the clavicle (collarbone), and the scapula (shoulder blade). The glenohumeral joint, where the head of the humerus articulates with the shallow socket of the scapula, allows for the remarkable range of motion in the shoulder.

Rotator Cuff and Subacromial Bursa – The rotator cuff is a group of four tendons and muscles that stabilize the shoulder joint and facilitate its movement. These four muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. They work in unison to control arm movements and maintain joint integrity. The subacromial bursa is a fluid-filled sac that reduces friction between the rotator cuff tendons and the acromion, promoting smooth shoulder motion.

Causes of Shoulder Impingement Syndrome

Understanding the underlying causes of shoulder impingement syndrome is crucial for effective rehabilitation. Several factors contribute to the development of this condition.

Anatomical Factors

Shape of the Acromion

The shape of the acromion can vary from person to person. Some individuals have a flat or curved acromion, while others have a hooked or pointed acromion. A hooked acromion is more likely to impinge on the underlying tendons, increasing the risk of impingement syndrome.

Bone Spurs

Over time, the formation of bone spurs (osteophytes) on the acromion or the clavicle can reduce the space within the subacromial space, making impingement more likely.

Overuse and Repetitive Movements

Overhead Activities

Engaging in repetitive overhead activities, such as painting, swimming, or throwing, can lead to overuse of the shoulder joint. This overuse can irritate and inflame the rotator cuff tendons, increasing the risk of impingement.

Poor Posture

Poor posture, especially slouching or forward-leaning positions, can alter the biomechanics of the shoulder joint, narrowing the subacromial space and leading to impingement over time.

Muscle Imbalances

Muscle imbalances in the shoulder girdle can also contribute to impingement syndrome. Weakness or tightness in certain muscles can alter the mechanics of the shoulder joint, leading to impingement.

Trauma and Injuries

Shoulder injuries, such as falls or accidents, can damage the structures within the shoulder joint, leading to inflammation and impingement syndrome. Additionally, dislocated shoulders or fractures can alter the joint’s anatomy, increasing the risk of impingement.

Signs and Symptoms of Shoulder Impingement Syndrome

Recognizing the signs and symptoms of shoulder impingement syndrome is essential for early diagnosis and prompt treatment. Common symptoms include:

Pain

Pain is the hallmark symptom of shoulder impingement syndrome. The pain is typically located at the front or side of the shoulder and may radiate down the arm. It is often aggravated by overhead movements or reaching behind the back.

Weakness

Individuals with impingement syndrome often experience weakness in the affected shoulder. This weakness can affect the ability to lift objects or perform daily activities.

Limited Range of Motion

Impingement syndrome can restrict shoulder mobility. Individuals may find it challenging to raise their arms overhead or reach behind their back.

Night Pain

Many people with shoulder impingement syndrome report pain at night, particularly when lying on the affected shoulder. This can disrupt sleep and lead to chronic fatigue.

Clicking or Popping

Some individuals may hear clicking or popping sounds when moving their shoulder. These noises can indicate underlying structural issues.

Diagnosis of Shoulder Impingement Syndrome

Diagnosing shoulder impingement syndrome involves a combination of clinical evaluation, patient history, and imaging studies. Healthcare providers typically follow these steps:

Medical History

The doctor will ask about the patient’s symptoms, including when the pain started, its location and severity, and any exacerbating factors like specific movements or activities. Oftentimes, impingement syndrome can gradually appear with no obvious cause, but if you look at the long term history of the patient’s work and/or recreational activities, aggressive shoulder movements are typically included (repetitive lifting above the shoulder; contact sports, tennis, baseball pitcher, etc.).

Physical Examination

During a physical examination, the healthcare provider will assess the range of motion in the affected shoulder, strength, and any signs of inflammation or tenderness. The cardinal sign is pain with shoulder abduction (raising the arm from the side causes a deep, sharp pain inside the shoulder joint; patient has difficulty raising his/her arm above shoulder level due to mechanical restriction and acute pain.

Imaging Studies

Imaging studies, such as X-rays, ultrasound, or MRI, may be ordered to visualize the structures within the shoulder joint. X-rays can reveal bone abnormalities, while ultrasound and MRI can provide detailed images of soft tissues like tendons and the subacromial bursa. However, this is usually only done if rest, physical therapy, and home care do not produce desired results after a week.

Cortisone injection

In some cases, an injection of a local anesthetic into the subacromial space may be performed. If the pain is alleviated shortly after the injection, it can confirm the diagnosis of impingement syndrome. This is because with impingement syndrome, there is swelling and inflammation, and cortisone is a quick-acting anti-inflammatory medication. So, if the pain is alleviated following a cortisone shot, it confirms there is localized swelling, which is likely coming from either the bursae or a tendon.

Non-Surgical Rehabilitation for Shoulder Impingement Syndrome

The treatment of shoulder impingement syndrome typically begins with non-surgical interventions, such as physical therapy and lifestyle modifications. The goals of rehabilitation are to alleviate pain, improve shoulder function, and prevent recurrence.

Rest and Activity Modification

Resting the affected shoulder and avoiding activities that worsen symptoms are essential in the early stages of rehabilitation. This may include temporarily ceasing activities that involve repetitive overhead motions.

Physical Therapy

Physical therapy is a cornerstone of non-surgical treatment for shoulder impingement syndrome. A qualified physical therapist will design a personalized exercise program to address muscle imbalances, improve strength, and enhance shoulder mobility. Common physical therapy techniques include:

Stretching Exercises

Stretching exercises target tight muscles in the shoulder girdle and surrounding areas. This can help improve flexibility and reduce tension that contributes to impingement (see video below).

Modalities

You can use a red light therapy wrap to reduce pain and swelling of your impingement syndrome. Red light therapy wraps use light in the therapeutic wavelengths of red and infrared to accelerate tissue healing and deep heat tissues to increase blood flow and oxygen. See below for an example:

SUMMARY:

Shoulder impingement syndrome occurs when a swollen tendon and/or bursa inside the glenohumeral joint, where your humerus articulates with your scapula, impedes movement of the joint by rubbing against hard structures, particularly the acromion. The goal is to shrink the swollen tendon so that proper movement is restored, and then correct any biomechanical deficiencies in the shoulder complex, such as weak or tight muscles, and subluxated joints affecting the shoulder movements, using exercise rehabilitation, joint mobilization and red light therapy.