Shoulder Impingement in the Overhand Athlete: A Chiropractic Approach

The American Journal of Medicine & Sports for Primary Care Physicians

Dale J. Buchberger, DC; Sandra J. Hartwell-Ford, DC
The New York Chiropractic College, Seneca Falls, NY

In today’s health care environment more and more primary care physicians are being asked to assess and manage athletes of varying ages and abilities with sports related injuries of all types. Shoulder pain is one of the most common chief complaints of an athlete. It is also one of the most unique joints of the body. Consequently, its assessment, diagnosis, and management must be equally unique.

The shoulder is the most complex joint in the body. The excessive range of motion is accompanied by inherent instability. The structure of the glenohumeral joint has been characterized as a golf tee (the glenoid) with an oversized ball (the humeral head) sitting on it. Jobe and Iannotti have calculated that at any given time, approximately 28% of the humeral head is in contact with the bony glenoid cavity. This arrangement places the demand of stabilization on the soft tissue restraints of the shoulder girdle. These are the glenohumeral capsule and ligaments as well as the four rotator cuff, or SITS muscles, (supraspinatus, infraspinatus, teres minor, and subscapu- laris). As a result of the demands placed on the soft tissue structures, various impingement injuries can occur.