IMPINGEMENT SYNDROME OF THE SHOULDER

Question 1

Shoulder impingement syndrome (SIS) refers to what

Answer 1

a combination of shoulder symptoms,
examination findings, and radiologic signs attributable to the compression of structures
around the glenohumeral joint that occur with shoulder elevation.

Question 2

(Impingement Syndrome of the Shoulder)

Common structures impinged in the subacromion space:

Answer 2

(1) Subacromial bursa
(2) Tendon of the supraspinatus
(3) Tendon of the infraspinatus
(4) Long head of the biceps tendon

Question 3

Types of acromion morphology vary in different individuals:

Answer 3

(1) Flat
(2) Curved
(3) Hooked

Question 4

What type of acromion morphology has the highest association of impingement

Answer 4

Hooked

Question 5

Symptoms of a patient with Impingement Syndrome of the Shoulder.

Answer 5

(1) Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
(2) Night pain and difficulty sleeping on affected side

Question 6

Physical Exam of a patient with Impingement Syndrome of the Shoulder

Answer 6

(1) Palpation
(a) Tenderness over greater or lesser tuberosity
(b) Tenderness over bicipital groove
(c) Systematically palpate shoulder structures and note tenderness
(2) ROM
(a) Typically full AROM but possibly limited due to pain
(b) Pain worse between 90 degree and 120 degree of abduction and when
lowering arm
(3) Muscle Test
(a) Flexion and abduction limited by pain
(4) Neurovascular
(a) Typically unremarkable
(5) Special tests: Neers and Hawkins

Question 7

Diagnostic Tests of a patient with Impingement Syndrome of the Shoulder

Answer 7

(1) AP and axillary radio graphs are usually normal
(2) Narrowing of sub acromial space suggests long standing rotator cuff tear
(3) MRI with gadolinium is helpful in establishing exact soft tissue pathology

Question 8

Treatment of a patient with Impingement Syndrome of the Shoulder

Answer 8

(1) NSAIDS
(2) Ice
(3) Light duty to avoid offending activities
(4) Home Exercise Program: Shoulder stretches and strengthening
(5) Physical therapy consult if failed local management

Question 9

Referral decision of a patient with Impingement Syndrome of the Shoulder

Answer 9

Orthopedic consult if failed conservative management after 2-3 months or other
pathology is suspected