Injury of the Month
Shoulder Impingement Syndrome

 

Also known as

Trapped tendons, tendonitis, bursitis, painful arc syndrome, supraspinatus syndrome and thrower’s shoulder.

Overview

It is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become impinged leading to irritation and inflammation as they pass under the acromial space (the passage beneath the acromion) that can lead to degeneration and tearing of the rotator cuff tendon(s).  

Signs and symptoms

The most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder.The pain is often aggravated by overhead shoulder  movement and may occur at night (especially if lying on the affected shoulder). Onset of pain may be acute in the event of injury or it may be insidious if due to a gradual process such as formation of an osteoarthritic spur. Other symptoms can include a grinding or popping sensation during movement of the shoulder.

The 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° – shoulder impingement syndrome may become a serious problem for some people and disturb their sleep, normal daily activities and sporting activities. This is when treatment is needed.

 

Anatomy and biomechanics

The Rotator cuff is made up of four muscles (and their respective tendons) that functions to allow an individual to raise and lower their arm. Another important function of the rotator cuff is to depress and centralise the humeral head within the glenohumeral joint, especially when the arm is elevated allowing the humeral head to glide easily underneath the acromion.

The rotatar cuff lies under the roof of the shoulder (an extension of the shoulder blade know as the acromion). The space between the acromion and the rotator cuff tendons is occupied by the subacromion bursa. A bursa is a fluid filled sac that allows for smooth gliding of the rotator cuff tendons under the acromion with overhead movements of the shoulder.

Any abnormality affecting the function of the rotator cuff tendons can lead to dysfunction and loss of the depression and centralision effect at the humeral head when the arm is elevated. This causes the humeral head to ride upwards closer to the underneath surface of acromion causing shoulder impingement syndrome.

 
Causes:
  • Rotator cuff strain
  • Partial or full thickness tear
  • Calcific coracoacromial ligament
  • Labral tears
  • Glenohumeral instability
  • Variations in the shape of the acromion
  • Subacromial spurs
  • Abnormal muscle patterning
  • Acromioclavicular joint osteoarthritic spurs
  • Calcific tendonitis
  • Tendonopathy due to chronic overuse
  • Inflammation and thickening of the subacromial bursa
Diagnosis:
Shoulder impingement syndrome can be diagnosed by a thorough physiotherapy assessment. Within the physical examination the physiotherapist may perform specific musculoskeletal shoulder tests that provoke the shoulder to reproduce pain helping localise the pathology to the rotator cuff tendon(s).
 
Treatment

Shoulder impingement syndrome is treated conservatively with a personalised physiotherapy programme that includes:

  • Strapping.
  • Advice on appropriate levels of rest.
  • Ice application.
  • Modification of sporting activities or daily activities.
  • Electrotherapy (ultrasound).
  • Correction of abnormal muscle patterning and shoulder strengthening exercises.
  • Manual therapy (friction massage/mobilisations/manipulation/trigger point release/myofascial release).

Additional conservative measures may include:

  • Pain relief and anti-inflammatories.
  • Therapeutic injections (corticosteroid and local anaesthetic).
 

Surgery is occasionally required for persistant symptoms – the goal of any surgery is to reduce the effects of impingement, by increasing the amount of space between the acromion and the rotator cuff tendons. The operation performed is arthroscopic subacromial decompression (ASD) with damaged rotator cuff muscles/tendons frequently being repaired surgically at the same time.

 

 

Clinic Fees

clinic fees are £30

 

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Clinic Fees

clinic fees are £30

 

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