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[Music] shoulder impingement is the Communists reason why people come to see me it's a condition that the scribes pain, but usually the pain is not felt in the shoulder itself but rather over the top of the upper arm and the reason for that it is a typical referred pattern of pain now most people with shoulder impingement will be in their middle years anything between thirty and sixty or perhaps even older in some cases and frequently will start after a period of unaccustomed activity, so a typical example would be someone who's decided to trim their hedges, and they spend a day using a heavy hedge trimmer at shoulder height and then later that evening they develop pain over the aspects of the upper arm that's unrelenting and persisting and doesn't settle despite taking rest and anti-inflammatory tablets that they've bought from the pharmacist and that would be a good reason to go and see your physiotherapists if that's you other common reasons are perhaps polishing your beautiful new car that would be a good way of doing it and quite a common reason other examples of people who come to me having played a lot of tennis perhaps they're already keen and regular tennis players but for some reason now they're getting this same pain they've often tried resting they talk to their tennis coach they've tried some anti-inflammatories but if the problem is just not settling then the right thing to do is go and talk to your GP and very frequently your GP will listen to your story and examine you and then perhaps prescribe a course of physiotherapy and that would be a good starting point but let's say you've tried all that, and you return to your physiotherapy therapists back to your GP with persistent pain and the GP then might choose to refer you to see a specialist a shoulder specialist someone like me who would then make an assessment of your shoulder a typical examination for someone with children in Japan would look like this we would just need you to be wearing a scrappy top for example this would be perfect, and then we'd start by looking at the shoulder and I have a careful look around the outside of the front and side and the back of the shoulder, and then I would start pressing, and I'd ask you if it hurts so call out if I hurt you any pain there any pain around here good so there didn't seem to be anywhere particularly tender was that fair good now I'd like to ask you to move your arm, and I'm going to be watching your face to see if it hurts as you move first can you lift both of your arms forwards and upwards as high as they'll possibly go and down you come does it hurt as you do that good, and now it's the side like a pair of wings again as high as you go, and I tell me if it hurt like it hurt then as you come down does it hurt yes I can see it's clearly painful through that middle arc of movement, and now we're going to examine how much twist you've got so bend your elbows keeping your elbows tucked to your side let your arms out, and they...
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