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Shoulder Impingement

Shoulder Impingement Syndrome


Presentation

  • A summary of the intervention highlights is presented in Table 2. Table 2.[ncbi.nlm.nih.gov]
  • A painful arc of movement may be present during forward elevation of the arm from 60 to 120 . [4] Passive movement at the shoulder will appear painful when a downward force is applied at the acromion but the pain will ease once the force is removed. [[en.wikipedia.org]
Physician
  • On physical exam, the physician may twist or elevate the patient's arm to test for reproducible pain (the Neer sign and Hawkins-Kennedy test ).[en.wikipedia.org]
  • The injection itself should cause very little pain if performed by an experienced physician.[shouldersurgeon.com]
  • Rotator cuff problems account for one-third of physician visits for shoulder pain complaints especially for those individuals who are involved in repetitive use of the shoulder 2 ).[ncbi.nlm.nih.gov]
Inflammation
  • An MRI can be used to identify inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff will be identified.[shouldersurgeon.com]
  • Shoulder impingement syndrome is a syndrome involving tendonitis ( inflammation of tendons ) of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion.[en.wikipedia.org]
  • Decreasing pain, reducing joint and tissue swelling, inflammation and restriction must be achieved especially during the initial stages of the condition. Initial therapy should assist rather than retard soft tissue healing 3 ).[ncbi.nlm.nih.gov]
Swelling
  • Impingement may cause local swelling and tenderness in the front of the shoulder. Athletes participating in overhead sports may have pain when throwing, swimming, serving a tennis ball, volleyball, etc.[shouldersurgeon.com]
  • Stage 1 consists of tendon swelling and hemorrhage and widening of the subacromial-deltoid bursa.[ncbi.nlm.nih.gov]
Disability
  • Pain and disability are severe in Stage 3. Neer developed the anterior acromioplasty to eliminate the source of the impingement; a technique that has been widely used with favorable results 19 ).[ncbi.nlm.nih.gov]
Enthesopathy
  • Acromial enthesopathy and rotator cuff tear. A radiologic and histologic postmortem investigation of the coracoacromial arch. Clin Orthop Relat Res 1990; 254:39-48. Thompson WO, Debski RE, Boardman ND, et al.[en.wikipedia.org]
Suggestibility
  • Inflammation and subsequent thickening of the subacromial bursa may also cause impingement. [2] Weight training exercises where the arms are elevated above shoulder height but in an internally rotated position such as the upright row have been suggested[en.wikipedia.org]
  • The doctor may suggest that you rest and avoid overhead activities. He or she might prescribe a course of oral non-steroidal anti-inflammatory medication, such as ibuprofen, naprosyn, Aleve, Advil, etc.[shouldersurgeon.com]
  • Several treatment interventions have been suggested for successful management of shoulder impingement syndromes.[ncbi.nlm.nih.gov]

Workup

  • […] syndrome can be diagnosed by a targeted medical history and physical examination, [11] [12] but it has also been argued that at least medical imaging [13] (generally X-ray initially) and/or response to local anesthetic injection [14] is necessary for workup[en.wikipedia.org]

Treatment

  • Surgical Treatment If shoulder pain is not alleviated within a reasonable time by conservative treatment, the doctor may recommend surgery. The goal of surgery is to address the source of impingement.[shouldersurgeon.com]
  • In the 1970's and the 1980's, treatments were devised and refined based on this concept 5 ).[ncbi.nlm.nih.gov]
  • Physical therapy treatments would typically focus at maintaining range of movement, improving posture, strengthening shoulder muscles, and reduction of pain.[en.wikipedia.org]
  • Research in this area seeks to improve the treatment of disorders and the prevention of accidents, especially in the work environment.[sutterhealth.org]

Prognosis

  • Clinicians need to identify and select tests and measures that will allow them to differentially diagnose the condition and then to determine the appropriate prognosis (including plan of care) and intervention.[ncbi.nlm.nih.gov]

Etiology

  • Etiology Impingement is common in both young athletes and middle-aged people. Bursitis is probably the most common cause of impingement. When the bursa becomes inflamed, the conditon is known as bursitis.[shouldersurgeon.com]

Pathophysiology

  • Jobe coined the term “silent subluxators” to describe the pathophysiology of shoulder pain in the overhead athlete 17 ).[ncbi.nlm.nih.gov]

Prevention

  • The humerus must also rotate laterally before 90 degrees to prevent the greater tuberosity from impinging on the inferior portion of the acromion process 16 ).[ncbi.nlm.nih.gov]
  • Research in this area seeks to improve the treatment of disorders and the prevention of accidents, especially in the work environment.[sutterhealth.org]
  • "The Upright Row: Implications for Preventing Subacromial Impingement". Strength and Conditioning Journal. 33 (5): 25–28. doi : 10.1519/SSC.0b013e31822ec3e3. a b Kibler, BW. (1998). The role of the scapula in athletic shoulder function.[en.wikipedia.org]

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