Issue link: https://www.massageandbodyworkdigital.com/i/135515
Impingement Syndrome Acromion process As the humerus (shown here at 30 degrees) rises toward 90 degrees, the head of the humerus approaches the acromion process. Use the Hawkins-Kennedy Impingement Test if you suspect impingement syndrome. the acromion process and, of course, it too suffers from irritation and inflammation when impinged. As for the long head of the biceps, habitual internal rotation will cause that tendon to rub against either the lesser or greater tubercles, causing microtearing, impingement, and inflammation. If you suspect impingement syndrome, you can test for it easily using the Hawkins-Kennedy Impingement Test (Image 3). Flex the client's shoulder to 90 degrees. From that position, internally rotate and horizontally adduct the humerus across the chest as far as it will go. This brings the greater tuberosity of the humerus up under the coracoacromial arch, and it will press on the soft-tissue structures under the arch (the supraspinatus tendon, long head of the biceps, and subacromial bursa). If impingement syndrome is present, this test will reproduce the pain and discomfort. The Likely Culprits The shoulder girdle and shoulder joint dance a lovely duet, called the scapulohumeral rhythm. In order for the humerus to move beyond 30 degrees of abduction and 45–60 degrees of flexion, the scapula must move in order to accommodate the humerus. Upward and downward rotation of the scapula happens when the humerus is abducted more than 30 degrees or flexed more than 60 degrees. We'll use abduction as our model. Image 4 shows the humerus abducted to 30 degrees and the scapula in neutral. As the humerus rises toward 90 degrees, the head of the humerus approaches the acromion process. In order to abduct the humerus Scapula in neutral Scapula upwardly rotated more than 90 degrees, the scapula must get out of the way or else the head of the humerus will collide with the acromion process. Image 5 shows the scapula upwardly rotated, leaving a clear pathway for the head of the humerus. The dark gray scapula shows the scapula in neutral. Upward rotation refers to the acromion process, clavicle, and glenoid fossa rotating upward. I 84 massage & bodywork july/august 2013