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A - MSRA MSK [11] > [19] Subacromial Impingement Syndrome > Flashcards

[19] Subacromial Impingement Syndrome Flashcards

1
Q

What does subacromial impingement syndrome (SAIS) refer to?

A

Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space

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2
Q

What does inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space result in?

A

Pain, weakness, and reduced range of motion within the shoulder

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3
Q

What does SAIS encompass?

A

A range of pathologies, including rotator cuff tendinosis, subacromial bursitis, and calcific tendonitis

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4
Q

What do the pathologies leading to SAID all result in?

A

Attrition between the coracoacromial arch and the supraspinatus tendon or subacromial bursa

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5
Q

Who does SAIS most commonly occur in?

A

Patients under 25 years old, typically in active individuals or manual professions

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6
Q

What % of shoulder pain presentations are SAIS?

A

Around 60%

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7
Q

Where does the subacromial space lie?

A

Below the coracoacromial arch, and above the humeral head and greater tuberosity of the humerus

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8
Q

What does the coracoacromial arch consist of?

A

Acromion
Coracoacromial ligament (anterior to the acromioclavicular joint)
The coracoid process

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9
Q

What runs within the subacromial space?

A

The rotator cuff tendons
The long head of the biceps tendon
The coraco-acromial ligament

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10
Q

What are the structures running within the subacromial space all surrounded by?

A

The subacromial bursa

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11
Q

What is the function of the subacromial bursa?

A

It helps reduce friction between these structures

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12
Q

What can the underlying cause of SAIS be divided into?

A

Intrinsic and extrinsic mechanisms

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13
Q

What do the intrinsic mechanisms of SAIS involve?

A

Pathologies of the rotator cuff tendons due to tension

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14
Q

What are the intrinsic mechanisms of SAIS?

A

Muscular weakness
Overuse of the shoulder
Degenerative tendinopathy

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15
Q

How can muscular weakness cause SAIS?

A

Weakness in the rotator cuff muscles can lead to muscular imbalances, resulting in the humerus shifting proximally towards the body

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16
Q

How can overuse of the shoulder cause SAIS?

A

Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa, leading to friction between the tendons and coracoacromial arch

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17
Q

How can degenerative tendinopathy cause SAIS?

A

Degenerative changes of the acromion can lead to tearing of the rotator cuff, which allows for proximal migration of the humeral head

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18
Q

What do the extrinsic mechanisms of SAIS involve?

A

Pathologies of the rotator cuff tendons due to external compression

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19
Q

What are the extrinsic mechanisms of SAIS?

A

Anatomical factors
Scapular musculature
Glenohumeral instability

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20
Q

What anatomical factors can cause SAIS?

A

Congential or acquired anatomical variations in the shape and gradient of the acromion

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21
Q

How can the scapular musculature cause SAIS?

A

A reduction in function of the scapular muscles may result in reduction in size of subacromial space

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22
Q

Which scapular muscles in particular can a reduction in function of be important in the development of SAIS?

A

Serratus anterior and trapezius

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23
Q

What do the serratus anterior and trapezius normally do?

A

Allow the humerus to move past the acromion on overhead extension

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24
Q

How can glenohumeral instability cause SAIS?

A

Any abnormality of the glenohumeral joint or weakness in the rotator cuff muscles can lead to superior sublaxation of the humerus, causing increased contact between the acromion and subacromial tissues

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25
Q

What is the most common symptom of SAIS?

A

Progressive pain in the anterior superior shoulder

26
Q

What are the features of the pain in SAIS?

A

It is classically exacerbated by abduction in the affected shoulder, and relieved by rest
It may be associated with weakness and stiffness secondary to the pain

27
Q

What specific examination tests can be done in SAIS?

A

Neers Impingement Test

Hawkins test

28
Q

How is a Nerve Impingement Test performed?

A

The arm is placed by the patient’s side, fully internally rotated and then passively flexed

29
Q

What is a positive Nerve Impingement Test?

A

If there is pain in the anterolateral aspect of the shoulder

30
Q

How is Hawkins test performed?

A

The shoulder and elbow are flexed to 90 degrees, with the examiner then stabilising the humerus and passively internally rotating the arm

31
Q

What is a positive Hawkins test?

A

If pain is elicited in the anterolateral part of the shoulder

32
Q

What are the differential diagnoses for SAIS?

A

Muscular tear
Neurological pain
Frozen shoulder syndrome
Acromioclavicular pathology

33
Q

Give two examples of muscular tears that could be differentials for SAIS

A

Rotator cuff tear

Long head of biceps tear

34
Q

How can a muscular tear be differentiated from SAIS?

A

In a muscular tear, the weakness will persist despite the shoulder pain being relieved

35
Q

Give 3 examples of neurological pain that could be differentials for SAIS

A

Thoracic outlet syndrome
Cervical radiculopathy
Brachial plexus injury

36
Q

How can neurological pain be differentiated from SAIS?

A

In neurological pain, any weakness will likely be associated with paresthesia and/or pain, yet the weakness will persist despite the shoulder pain being relieved

37
Q

How can frozen shoulder syndrome be differentiated from SAIS?

A

In frozen shoulder syndrome, stiffness will persist even if the pain is relieved

38
Q

What acromioclavicular pathology may be a differential for SAIS?

A

Acromioclavicular arthritis

Glenohumeral arthritis

39
Q

How can acromioclavicular pathology be differentiated from SAIS?

A

Acromioclavicular pathology presents with a more generalised pain

40
Q

How is a diagnosis of SAIS made?

A

It is a clinical diagnosis, however is often confirmed via additional imaging

41
Q

What is often the mainstay of imaging for SAIS?

A

MRI imaging of the affected shoulder

42
Q

What features can be seen on MRI imaging in SAIS?

A

Formation of subacromial osteophytes and sclerosis
Subacromial bursitis
Humeral cystic changes
Narrowing of the subacromial space

43
Q

What is the mainstay of treatment in most cases of SAIS?

A

Conservative management

44
Q

What is involved in the conservative management of SAIS?

A

Sufficient analgesia

Regular physiotherapy

45
Q

What analgesia is given in SAIS?

A

Typically NSAIDs

46
Q

What should physiotherapy include in SAIS?

A

Postural, stability, mobility, and stretching exercises

47
Q

What can be trialled for those who require further intervention following conservative management for SAIS?

A

Corticosteroid injections into the subacromial space

48
Q

What should patients with SAIS be educated regarding?

A

Adequate warm up techniques

Monitoring for early signs of worsening impingement

49
Q

When is surgical intervention recommended in SAIS?

A

If it persists beyond 6 months without response to conservative management

50
Q

Which patients with SAIS is conservative management particularly useful in?

A

Patients with a reduced range of movement

51
Q

What kind of surgery is most commonly used in SAIS?

A

Arthroscopic

52
Q

What techniques can be used in SAIS surgery?

A

Surgical repair of muscular tears
Surgical removal of subacromial bursa
Surgical removal of a section of the acromion

53
Q

What muscular tears are most commonly repaired in SAIS surgery?

A

Supraspinatus and long head of biceps tendon

54
Q

What results from surgical repair of muscular tears in SAIS?

A

Improvement in range of motion

55
Q

What results from surgical removal of the subacromial bursa in SAIS?

A

Increases subacromial space and reduces pain

56
Q

What is the surgical removal of a section of the acromion known as?

A

An acromioplasty

57
Q

What results from an acromioplasty?

A

Increases the subacromial space and reduces pain

58
Q

What is the benefit of surgical decompressed over arthroscopy alonr?

A

Recent evidence shows it provides no extra benefit, and the benefits that are seen from surgical intervention might only be placebo effect or increased post-operative physiotherapy

59
Q

What are the complications of SAIS?

A

Rotator cuff degeneration and tear
Cuff tear arthropathy
Complex regional pain syndrome

60
Q

How effective is conservative management in SAIS?

A

If diagnosed and assessed early, SAIS resolves with conservative management in 60-90% of patients

A - MSRA MSK [11] (38 decks)

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