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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 TreatmentWhat 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 / macroAcromion 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