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Shoulder Impingement Syndrome

Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

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Page 1: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder Impingement Syndrome

Page 2: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder Impingement Syndrome

• Painful Arc Syndrome

• Supraspinatus Syndrome

• Swimmer's Shoulder

• Thrower's Shoulder

Page 3: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder 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.

Page 4: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder 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.

Page 5: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder
Page 6: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder Impingement Syndrome

• This can result in pain, weakness and loss of movement at the shoulder.

Page 7: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Causes

• The 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.

Page 8: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Causes - Bony Structures

• Subacromial spurs (bony projections from the acromion)

• Osteoarthritic spurs on the acromioclavicular joint

• Variations in the shape of the acromion.

Page 9: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder
Page 10: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder
Page 11: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Causes

• Thickening or calcification of the coracoacromial ligament

Page 12: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Causes

• • Loss of function of the

rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly

Page 13: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Causes

• Inflammation and subsequent thickening of the subacromial bursa may also cause impingement.

Page 14: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Shoulder 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.

Page 15: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• The most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder

Page 16: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• The pain is often worsened by shoulder overhead movement and may occur at night, especially if the patient is lying on the affected shoulder.

Page 17: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• The onset of the pain may be acute if it is due to an injury

• Insidious onset if it is due to a gradual process such as an osteoarthritic spur.

Page 18: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• Other symptoms can include a grinding or popping sensation during movement of the shoulder.

Page 19: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• The 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°.

Page 20: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Signs and Symptoms

• Passive 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.

Page 21: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Diagnosis

• Impingement syndrome can usually be diagnosed by history and physical exam.

Page 22: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Neer test

• Stabilizes the scapula while passively elevating the shoulder, in effect jamming the humeral head into the acromion.

Page 23: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Hawkins test

• Elevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff under the subacromial arch.

Page 24: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Diagnosis - Plain X-ray

• Joint pathology and variations in the bones,

• Acromioclavicular arthritis

• Variations in the acromion

• Calcifcation

Page 25: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Diagnosis - Arthrography

Page 26: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Diagnosis - Ultrasonography

Page 27: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Diagnosis

• MRI showing subacromial impingement with partial rupture of the supraspinatus tendon.

Page 28: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Treatment - 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.

Page 29: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

TREATMENT

• 1 - stop any activity that can/may aggravate symptoms• 2 - medicate with anti-inflammatory medicine• 3 - cold therapy or 'cryotherapy'• 4 - REST!!!!• 5 - gentle stretching exercises• 6 - exercises to STRENGTHEN the rotator cuff• 7 - 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

Page 30: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder
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RTC Exercises - one

• Start 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 hand

• Stop when your hand is level with your shoulder. Lower the hand slowly.

Page 34: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

RTC Exercises - Two• Lie 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.

Page 35: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Rotator 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.

Page 36: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Rotator 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.

Page 37: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Treatment

• Therapeutic 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.

Page 38: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Treatment - Surgery

• Done arthroscopically or as open surgery.

Page 39: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Treatment - Surgery

• The 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

Page 40: Shoulder Impingement Syndrome. Painful Arc Syndrome Supraspinatus Syndrome Swimmer's Shoulder Thrower's Shoulder

Treatment - Surgery

• Also damaged rotator cuff muscles can be surgically repaired.