We are going to focus on the shoulder in this column. This last couple of weeks has seen an increase in the number of shoulder patients, probably due to Wimbledon getting people back to tennis when they haven't played in a while.

There are many conditions which affect the shoulder but our focus is on Impingement Syndrome.

To understand the condition, we need to take a quick look at the anatomy.

The shoulder joint is formed by the humerus, (upper arm bone), the scapula (shoulder blade) and the clavicle (collar bone).

The head of the humerus is shaped like a ball fits in the cup or the glenoid fossa of the scapula.

At the top of the scapula is a boney hook called the acromion and it is here where the clavicle joins the scapula to assist in the stabilisation of the joint.

If you put your fingers on the top of your shoulder you can often feel the little step where the clavicle joins the acromion.

If you have ever injured or dislocated the acromioclavicular joint (the joint between the collar bone and the shoulder blade), it is likely there will be a bigger step than on the opposite shoulder.

The shoulder is the most mobile joint in the body as it has the widest range of movements of any joint.

The fact that the shoulder has so much mobility is what makes it vulnerable to dislocation.

The movements of the shoulder are complex biomechanically, however with an impingement syndrome the most affected movement is that of abduction.

This is when the arm is taken from the side of the body outwards sideways and up to the top when the arm should touch the ear!

If you do this, at just about half way up at about 90 degrees of abduction you will naturally turn your palm up from being faced downwards to facing upwards.

This is because of the presence of a boney lump called the greater tubercle of the outside of the humerus.

Turning the palm up rotates the humerus and allows the greater tubercle to miss the acromion.

The greater tubercle is one of the sites for muscle attachment around the shoulder.

The rotator cuff muscles as they are known are essential to good shoulder function.

The most commonly involved muscle is the supraspinatus which is responsible for the initial abduction of the arm.

Also the subacromial bursa can become pinched if inflamed under the acromion.

One of the most common causes of impingement however, is due to boney remodelling of the shoulder due to degenerative changes.

This week's case study is a great example of this, but it also demonstrates that despite degeneration, or arthritis, good results can be achieved when treated.

Case Study Mr Q is a retired gentleman who is 73 years old. He has always been active and since retiring, has enjoyed many activities such as tennis and gardening.

However, gradually over the last two years his left shoulder had become restricted and painful.

He could only raise his arm by approximately 35 degrees. Following visits to his GP an X-ray revealed "osteoarthritis of the acromioclavicular joint with osteophytes (boney projections) inferiorly and reduction of the sub-acromial space with osteophyte formation at the lateral acromion and superolateral humeral head consistant with impingement and rotator cuff attrition."

This was quite a depressing prospect to Mr. Q as it was all bone remodelling due to osteoarthritis.

He felt sure that nothing could be done that didn't involve surgery.

A trial period of treatment was agreed after a discussion. The treatment to Mr. Q's shoulder consisted of ultrasound, acupuncture and mobilisation of the glenohumeral joint and the acromioclavicular joint.

After two treatments Mr. Q reported a marked reduction in pain at the top of his shoulder.

Following four treatments, Mr. Q. obtained 100 degrees of abduction and greatly reduced pain falling from 8/10 at presentation, to 3/10.

After six treatments, his range of motion is continuing to improve with exercises given to perform at home.

He hopes that shortly he is going to return to some gentle tennis, something his GP had stated he would never be able to consider.

This case gives a clear indication that the process of joint degeneration is rarely a case of 'just having to live with it'.

If you have a suggestion for a future column or have a question to ask please contact me at Ilkley Chiropractic Clinic on 605060 or email on ilkleychiro@tiscali.com.