Diagnosis Explanation:

Impingement syndrome occurs when the rotator cuff tendons and bursa become compressed between the acromion (top of the shoulder blade) and the humerus (upper arm bone) during arm movements. This leads to pain, inflammation, and limited range of motion, especially with overhead activities, reaching behind the back, or lifting. It is common in athletes, weightlifters, and individuals with repetitive overhead motion jobs.

Specific Work Modifications:

• If your job requires standing or walking: Avoid repetitive overhead reaching, and take breaks to stretch and rest the shoulder.
• If your job involves lifting: Avoid lifting objects above shoulder height or repetitive pushing and pulling. Lift with both arms when possible.
• If your job is desk-based: Keep shoulders relaxed, ensure proper arm support, and adjust the monitor to eye level to prevent slouching.
• Avoid: Overhead movements, repetitive arm lifting, and prolonged static positions that cause discomfort.

Specific Activity Modifications:

• If you play sports: Avoid throwing, swimming strokes, and repetitive overhead movements until pain subsides.
• If you do weightlifting: Avoid overhead presses, dips, bench presses, and pull-ups; instead, focus on controlled, pain-free movements.
• If you do yoga or Pilates: Modify poses to avoid deep shoulder extension and excessive arm weight-bearing.
• Avoid: Repetitive overhead movements, sudden jerky arm motions, and activities that cause pain.

Recommended Supplements:

• Collagen Peptides – 10g daily for tendon and joint repair.
• Vitamin C – 500mg daily to promote collagen synthesis.
• Glucosamine & Chondroitin – 1500mg/1200mg daily for joint health.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Turmeric (Curcumin) – 500-1000mg daily for natural pain relief.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, tofu, eggs) to support tendon repair.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain tendon flexibility.
• Limit Processed Foods & Sugars to prevent inflammation.
• Hydration: Drink 8-10 cups of water daily to support tendon recovery.

Home Exercise Prescription (Rehabilitation for Shoulder Impingement)

Early Phase (0-2 Weeks, Reducing Pain & Inflammation):

• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression, Elevation.
• Pendulum Exercises – Lean forward, let the arm hang, gently swing in small circles, 10 reps, 2x/day.
• Shoulder Blade Squeezes – Pinch shoulder blades together, hold 5 seconds, repeat 10 reps, 2x/day.
• Wall Walk (Forward) – Face a wall, use fingers to "walk" the arm up as high as comfortable, hold 5 seconds, repeat 10 reps, 2x/day.

Strengthening Phase (2-6 Weeks, Improving Stability & Function):

• Isometric Shoulder Holds – Press palm against a wall without moving the shoulder, hold 5 seconds, repeat 10 reps, 2x/day.
• External Rotation with Resistance Band – Keep elbow at 90 degrees, rotate forearm outward, 10 reps, 2x/day.
• Wall Slides (Lateral Movement) – Stand sideways to a wall, slide affected arm up and down, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Restoring Strength & Preventing Recurrence):

• Lateral Arm Raises (Light Resistance) – Raise arms to shoulder height, 10 reps, 2x/day.
• Scapular Stability Exercises (Resistance Band Rows) – Pull resistance band toward chest, 10 reps, 2x/day.
• Modified Push-Ups (Wall or Knees) – Maintain control, 10 reps, 2x/day.

Helpful Books:

1. The Shoulder Pain Solution: Simple Exercises to Prevent and Recover from Injury – John M. Kirsch, MD.
2. Overcoming Shoulder Pain: A Guide to Rehabilitation and Recovery – Peter T. J. Barrett.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.