Dr. Ubedullah U Khatri

Shoulder impingement occurs when there is impingement or change in the position of the tendons or a bursa (fluid filled sac or cavity, which causes friction in the joints) in your shoulder. Repeated overhead exercises or intense physical activity concentrated around your shoulder is a common risk factor for shoulder impingement. The examples of such activity would include playing outdoor sports like tennis, swimming etc. or painting for long hours.

How it may affect your daily life?
Shoulder impingement pain is severe in many cases and may affect your everyday activities. In fact, any activity, which involves your shoulders can cause intense pain. You should consult a doctor or a professional medical facility to get relief from pain as well as to avoid aggravating the injury.

Symptoms of shoulder impingement:
1. You will have difficulty in completing tasks which involve your back.
2. There may be a weakness in your shoulder muscles.
3. Pain associated with overhead use of your arm. Anytime you lift your arm there would be pain and would make many day to day activities difficult.
4. Intense injury to the tendons can cause them to tear into two and would result in a rotator cuff injury and would make your arm movements next to impossible.

Diagnosis of shoulder impingement:
Physical exam and review of medical injury previously sustained on some other occasion is the first step of treatment. Your doctor may also diagnose shoulder impingement by X-rays or MRI of shoulder to see changes in the bone that may indicate any injury. Other changes in the normal contour of the bone may also be checked which may help in further diagnosis and treatment.

Treatment of shoulder impingement:

NSAIDs are anti-inflammatory medicines that are commonly prescribed for shoulder impingement syndrome. These are prescribed for two weeks. Shoulder impingement requires a long time to heal and would require regular consultation with your doctor. If the medications fail to provide any relief in a span of maximum two weeks it may compel your doctor to change the course of treatment. Shoulder impingement is a serious injury and requires proper rest for your shoulder as well as patience as it may take quite some time to come back to normal.

Physiotherapy for Impingement:

Physiotherapy is usually the first line of treatment for subacromial impingement (tendonitis, bursitis) of the shoulder; along with anti-inflammatories and analgesia. It is very successful in treating shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

1. Pain Management
2. Manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving properly.
3. You will learn exercises and stretches to help your shoulder and shoulder blade move properly.
4. Strengthening Exercises
5. The therapist will teach you the proper posture which is an important part of rehabilitation

Mobility for a person is very important, and when you look through, the hip is a very important component to this. It connects the upper and lower parts of the body and helps in movement. It is a ball and socket joint, where the hip bone provides a socket, into which the upper part of the thighbone (femur) sits into, allowing for free movement.

Like any other human organ, the hip also is prone to damage. Be it natural ageing, infection, injury, or diseases, hip movement can be affected, leading to limited movement and increased pain and stiffness. For these people, being able to get back a hip which will allow them to be back on their feet is a boon for sure. It helps in relieving pain and improving mobility, almost giving people a second lease of life.

Reasons for hip replacement:

1. With natural ageing, the hip joint can lose its ability to move, due to normal wear and tear of the hip and thigh bones
2. Diseases of the hips (infectious or autoimmune) can also lead to hip replacement
3. Injury or trauma is another major cause that requires hip replacement
4. Joint problems, leading to repeated dislocations
5. Tumours of the relevant bones

Understanding the procedure in detail

1. The affected bones (whether diseases or worn out) are replaced with a prosthesis which is compatible with the normal body tissue.
2. While some materials fuse to the natural bone, others do not and are simply placed as a separate unit
3. This is a surgery which requires hospitalisation and stays for up to 5 days depending on patient’s overall health condition
4. The entire procedure may take a couple of hours and is usually done under general anaesthesia
5. An incision is made through the side of the hip
6. Both the hip and the thigh joints are prepared, diseased tissue removed, re-shaped, etc. to make way for the prosthesis
7. The prosthesis is introduced through the same incision and positioned into place
8. As noted earlier, there are two types. The ones which fuse to the bone have pores in them into which normal bone eventually grows.
9. The other variety is the cemented version, and a glue is used to keep it in place
10. Most doctors now use a combination, that is cement a porous prosthesis, into which bone will grow, and the incisions are closed
11. The patient stays in the hospital for 1 to 4 days depending on overall health
12. Once discharged, infection and pain control are continued
13. Exercise and physiotherapy play a major role in restoring normal function
14. Weight management is also very important

In case you have a concern or query you can always consult an expert & get answers to your questions!

If you have a desk job that involves sitting right in front of your computer throughout the day or for a major part of the day, you could be unknowingly putting yourself at augmented risk of reduced hip mobility. The hips are one of the major muscles in your body that are used in a number of activities you do everyday.

Causes of Hip Immobility-

1. Sitting for long hours at the same place and working. This is common to people who work in front of the computer screens for extended hours continuously.

2. Toxic Synovitis, which is an inflammation of the hip joint. It causes pain and stiffness.

3. Juvenile Arthritis

4. Rheumatoid arthritis

5. Tendinitis or inflammation of the tendons that causes severe discomfort in movement

6. Ankylosing spondylitis that mainly affects the spine. It can cause extreme pain and discomfort in the movement of the hips. This makes it difficult to sit, stand or lie down.

7. Injuries

8. Fractures and breakage

9. Muscle and tissue ruptures near the hip region

10. Sprains and strains

11. Lack of proper blood circulation

12. Pain and injuries in the lower back region which can spread to the hip, causing stiffness and swelling

Physiotherapy for Hip Mobility-

Physiotherapy alias physical therapy is considered as one of the fastest growing allied areas of present generation medicine. Being an important rehabilitative service needed in a community and a vital therapeutic supplement of the medical profession, it's the treatment of diseases and disabilities using physical exercises, heat radiations, cold therapy, hydrotherapy, acupuncture and therapeutic massage.

As doctors, physiotherapists or physical therapists are essential in helping the patient to recover and rehabilitate from a state of incapacity, due to genetic defect or the result of an accident or an illness. Physiotherapy for Hip Mobility involves certain exercises. Below give are some of the most common exercises for hip mobility-.

1. Lying Hip Rotations. One has to lie on the back on a padded mat, then put one leg over the other, exactly over the knee on one’s lower thigh. Now, use either a towel or the hands to get to the leg that is placed below and without hyperextending, slowly pull this leg’s knee closer to the chest.

2. Butterfly Movements and The Frog Posture.

3. The Kneeling Lunge. Here, one has to lunge forward with one knee on a padded mat. Then position the foot carefully beyond the knee that is put forward. Place your hands over the knees; straighten hip of the rear leg while leaning with the hips forward. Hold this particular stretch and repeat with the opposite side.

4. The Squatting Position.

5. The Pigeon Posture. In this, your knees need to be right below the hip on the padded mat. Then lower the outer side of the right buttock to the mat. You have to position your right heel in such a manner that it is exactly in front of the left hip. Hold this stretch for about 5-6 breaths and exhale deeply through the nose.

6. Bending forwards or backwards, guided and assisted by a physiotherapist.

7. Stretching Exercises.

8. Hot compresses on the area of inflammation.

9. Ice packs can also be applied alternately on the spot of injury.

10. Massage helps to regulate blood circulation and is an important part of physiotherapy.