Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Treating Coracoid Impingement Syndrome
The next series of posts will be “translations” for laypersons of articles that appear in Volume 22, Number 2 (2011) of the journal Wilderness & Environmental Medicine, which is published by Elsevier for the Wilderness Medical Society. Much of what we learn about how to take care of people in the outdoors, prevent injuries and illnesses, and properly plan for outdoor adventures comes from adapting technical literature and discoveries into practical information that can be applied by the general public. So, in the spirit of enlightenment, let’s begin with the first applicable article from this issue of the journal.
Volker Schoffl and colleagues presented a case report entitled “Coracoid impingement syndrome due to intensive rock climbing training,” in which they described a female climber who trained so vigorously that she developed a coracoid impingement from a hypertrophied subscapularis tendon and muscle. They noted that this was unusual diagnosis, in comparison to the more frequently observed conditions of subacromial impringement, shoulder dislocation, hyperlaxity, or irritation of the long biceps tendon.
What exactly is coracoid impingement syndrome? It is a situation where the subscapularis tendon is squeezed between the coracoid and the lesser tuberosity of the humerus. The symptoms are predominately shoulder pain with exercise and for a few hours after the exercise. No particular shoulder maneuver on testing is diagnostic. In the case described by Dr. Schoffl and colleagues, the diagnosis was made (as is often the case with shoulder injuries) with a magnetic resonance imaging (MRI) scan. The patient improved with a therapeutic regimen of specific physiotherapy to detone the hypertrophied muscle, stretch her shoulder rotator and abductor muscles, train the antagonist muscles, improve her posture, and lengthen her pectoralis muscles. In addition, she was given nonsteroidal anti-inflammatory medications. The cure was successful.
What can be learned here? First, extreme training that emphasizes specific muscle groups can create imbalances and musculoskeletal syndromes that might not be anticipated. The body is designed to be in balance and to not have undue emphasis placed on any particular muscle group. Second, specific shoulder malfunctions may present to the examiner with similar clinical features, and are often difficult to differentiate without the benefit of an MRI. Third, physiotherapists are quite skilled at providing non-pharmaceutical remedies to treat overuse syndromes—remedies that may not be obvious, or perhaps even be unknown, to doctors and the public at large. Skilled practitioners can get you back in the game faster than you might have believed possible.
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