Shoulder impingement/Sub Acromial Impingement
Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears
The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery.
accounting for 44–65% of all complaints of shoulder pain during a physician's office visit.1 SAIS encompasses a spectrum of subacromial space pathologies including partial thickness rotator cuff tears, rotator cuff tendinosis, calcific tendinitis, and subacromial bursitis. The main consequences of SAIS are functional loss and disability
What causes Subacromial impingement
SAIS is an encroachment of the subacromial tissues as a result of narrowing of the subacromial space. Mechanisms of rotator cuff (RC) tendinopathy have been classically described as extrinsic, intrinsic or a combination of both
Anatomical factors that may excessively narrow the subacromial space and outlet to the RC tendons include variations in shape of the acromion, orientation of the slope/angle of the acromion or prominent osseous changes to the inferior aspect of the acromio-clavicular (AC) joint or coracoacromial ligament
shortening of the posterior-inferior glenohumeral joint capsule and decreased RC muscle performance
Aberrant scapular muscle activity has been identified in patients with SAIS and been directly linked to abnormal scapular kinematics
The supraspinatus along with the other rotator cuff muscles of teres minor, infraspinatus, and subscapularis serve to maintain the congruent contact between the humeral head and the glenoid fossa by producing a compressive force during glenohumeral movements.5 Weakness or dysfunctional rotator cuff musculature can lead to changes in glenohumeral and scapulothoracic kinematics. Excessive superior translation of the humeral head resulting from rotator cuff weakness can lead to a decrease in the subacromial space during elevation, and thus increased mechanical compression of the subacromial contents
What are the 3 stages of Frozen Shoulder?
Frozen shoulder commonly passes through three stages/Phases:
1. Painful/Freezing stage: During this stage Pain is the biggest problem that initially starts at night but then progresses to be painful at rest. There will be a slow increase of limiting movement and can last from 2-9 months
2. Frozen/ Adhesive stage: This period is characterized by progressive stiffness and reduced movement in all planes limiting normal function. Pain tends to reduce during this phase but stiffness is prevalent (lasts approximately 3-12 months
3. Thawing/Regression stage: Range of movement improves and daily activities should become easier. Stiffness and pain should ease but there is a high chance of reoccurrence and full movement may not have returned (lasts approximately 12-24 months).
What Treatments can I do?
Many treatments are available for impingement syndrome such as physical therapy, shock-wave therapy, medication, and surgery
For most patients with SAIS, nonsurgical treatment is successful. Surgical intervention is successful in patients who fail nonsurgical treatment. Surgeon experience and intraoperative assessment may guide the method of surgical treatment. Studies have shown that many surgical interventions, including debridement and open and arthroscopic acromioplasty, have been successful