Shoulder.impingement SYNDROME

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Impingement Syndrome

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Transcript of Shoulder.impingement SYNDROME

  • Impingement Syndrome

  • Learning Objectives

    What is?Why people get?Who gets?How does manifest ?How do we investigate ?How do we treat? Definition / Anatomy Etiology / Mech of injury Incidence Hystory / Physical exam Investigation Treatment

  • What is ? Definition

    Impingent syndrome describes pain in the subacromial space when the humerus is elevated or internally rotated

    Impingent syndrome is thought to precipitate structural changes in the Rotator Cuff leading to Rotator Cuff tears

  • What is ? Anatomy

    Functionally Shoulder = 3 joints

    1. Scapulo thoracic joint

    2. Acromio-clavicular joint

    3. Gleno humeral joint

  • What is ? Anatomy

    The Gleno humeral joint , a ball-and-socket joint is stabilised by soft tissue

    AP view

    Lat view

  • What is ? Anatomy

    Bursa located between the acromion and the rotator cuff tendons prttecting from grinding against each other

  • Why people get ? Etiology Mech of injury

    Etiological theories

    Mechanical wear variations in shape of acromion Avascularity of supraspinatus tendonTrauma micro / macro

    Acromion variations

    Lat view

    AP view

    I

    II

    III

  • Who gets it ? Incidence

    Impingement occurs to some degree in everyones shoulder on day-to-day basis

    Age : 40 50

    Physical activity : Labour / Sport / Trauma

    Jobs: painter, carpenter, truckdrivers ( overhead activities )

    Sports: swimming, tenis, baseball

  • How does it manifest? History

    Pain is the main complaint

    Ask for:- onset

    - duration

    - location

    - timing

    - quality of pain

    Age > 40 Grey hair = Cuff tear

    Onset / Timiningtrauma / overuse / overhead / repetitive activities

    SleepPain at night / inability to sleep on affected side

    Weakness

    Catching & Crepitus

    Reaching the back pocket

  • How does it manifest ? Physical Exam

    Inspection - muscle atrophy / posture / position of scapula / deformities

    Palpation - systematic / orderly soft tissue & bony structures

    - tenderness greater tuberosity extension & internal rot

    Reaching the back pocket

    Range of movement

    painful arc = 60 120 degree

  • How does manifest ? Physical Exam

    Impingement Tests

    1. Neer test

    2. Hawkins Kennedy Test

  • How do we investigate ? Investigation

    Radiography - osteophytes of the acromion

    - two views mandatory (5-10 caudal tilt)

    shape of acromion

    Ultrasound - preferable requires experience

    Shoulder Arthrogram - mainly for Rotator Cuff tears

    MRI - v. sensitive , expensive

  • How do we treat? Treatment

    Non operative treatment

    Rest / Modification of activity

    NSAIDs acute phase

    Subacromial injection corticosteroid & local anasthetic

    Physiotherapy stretching / strenthening

  • How do we treat ? Treatment

    Surgical Treatment

    Open : Anterior acromioplasty & coracoacromial lig resection

    Arthroscopic : Acromioplasty


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