3Shoulder Impingement Syndrome is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion.
4Shoulder Impingement Syndrome Occurs when one of the rotator cuff tendons (supraspinatus) or bursa (a flat, fluid-filled membrane that prevents the shoulder parts from rubbing together) is pinched between the ‘ball’ part of the upper bone (the humeral head) and the undersurface of the top of the shoulder blade (acromion).This happens because as we raise our arm, the narrow space between the top of our arm bone (the humeral head) and the top of the shoulder blade naturally compresses.It is the repetition of such movements that ultimately leads to the condition developing, causing swelling and an excess of fluid in the joint.
6Shoulder Impingement Syndrome This can result in pain, weakness and loss of movement at the shoulder.
7CausesThe rotator cuff muscle tendons pass through a narrow space between the acromion process of the scapula and the head of the humerus.Anything which causes further narrowing of this space can result in impingement syndrome.
8Causes - Bony Structures Subacromial spurs (bony projections from the acromion)Osteoarthritic spurs on the acromioclavicular jointVariations in the shape of the acromion.
11CausesThickening or calcification of the coracoacromial ligament
12CausesLoss of function of the rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly
13CausesInflammation and subsequent thickening of the subacromial bursa may also cause impingement.
14Shoulder Impingement Syndrome Result of painting, carpentry, construction work or any other jobs that involve overhead work.take many years before someone begins to notice the symptoms of the condition.
15Signs and SymptomsThe most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder
16Signs and SymptomsThe pain is often worsened by shoulder overhead movement and may occur at night, especially if the patient is lying on the affected shoulder.
17Signs and SymptomsThe onset of the pain may be acute if it is due to an injuryInsidious onset if it is due to a gradual process such as an osteoarthritic spur.
18Signs and SymptomsOther symptoms can include a grinding or popping sensation during movement of the shoulder.
19Signs and SymptomsThe range of motion at the shoulder may be limited by pain. A painful arc of movement may be present during forward elevation of the arm from 60° to 120°.
20Signs and SymptomsPassive movement at the shoulder will appear painful when a downwards force is applied at the acromion but the pain will ease once the downwards force is removed.
21DiagnosisImpingement syndrome can usually be diagnosed by history and physical exam.
22Neer testStabilizes the scapula while passively elevating the shoulder, in effect jamming the humeral head into the acromion.
23Hawkins testElevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff under the subacromial arch.
24Diagnosis - Plain X-ray Joint pathology and variations in the bones,Acromioclavicular arthritisVariations in the acromionCalcifcation
27DiagnosisMRI showing subacromial impingement with partial rupture of the supraspinatus tendon.
28Treatment - Conservative Rest,Cessation of painful activity,Physiotherapy focused at maintaining range of movement and avoid shoulder stiffness.NSAID's and ice packs may be used for pain relief.
29TREATMENT 1 - stop any activity that can/may aggravate symptoms 2 - medicate with anti-inflammatory medicine3 - cold therapy or 'cryotherapy'4 - REST!!!!5 - gentle stretching exercises6 - exercises to STRENGTHEN the rotator cuff7 - if all else fails after 6 to 12 months, arthroscopic or open surgery to repair damage and relieve the pressure on the tendons and bursae
33RTC Exercises - oneStart by lying on your stomach on a table or a bed.Put your left arm out at shoulder level with your elbow bent to 90° and your hand down.Keep your elbow bent and slowly raise your left handStop when your hand is level with your shoulder. Lower the hand slowly.
34RTC Exercises - TwoLie on your right side with a rolled-up towel under your right armpit.Stretch your right arm above your head.Keep your left arm at your side with your elbow bent to 90° and the forearm resting against your chest, palm down.Roll your left shoulder out, raising the left forearm until it's level with your shoulder.Lower the arm slowly.
35Rotator Cuff Exercises - Three Lie on your right side. Keep your left arm along the upper side of your body.Bend your right elbow to 90°.Keep the right forearm resting on the table.Now roll your right shoulder in, raising your right forearm up to your chest.Lower the forearm slowly.
36Rotator Cuff Exercise - Four In a standing position, start with your right arm halfway between the front and the side of your body, thumb down.Raise your right arm until almost level (about a 45° angle). (This is like emptying a can.) Don't lift beyond the point of pain.Slowly lower your arm.
37TreatmentTherapeutic injections of corticosteroid and local anesthetic may be used for persistent impingement syndrome.The total number of injections is generally limited to three due to possible side effects from the corticosteroid.
38Treatment - SurgeryDone arthroscopically or as open surgery.
39Treatment - SurgeryThe impinging structures may be removed in surgery, and the subacromial space may be widened by resection of the distal clavicle and excision of osteophytes on the under-surface of the acromioclavicular join
40Treatment - SurgeryAlso damaged rotator cuff muscles can be surgically repaired.