Shoulder impingement

Question 1

What is shoulder impingement?

Answer 1

The tendons of the rotator cuff muscles are compressed in the subacromial space on movement.

Question 2

Presentation of shoulder impingement?

Answer 2

Painful arc (60-120 degrees is sore)- occurs due to inflamed area of supraspinatous tendon passing through subacromial space. 
Pain characteristically radiates to the deltoid and upper arm. 
Tenderness may be felt on the lateral border of the acromion.

Question 3

Tests for shoulder impingement

Answer 3

Hawkins Kennedy test- flexing the shoulder and internally rotating it recreates the pain.

Question 4

Causes of shoulder impingement

Answer 4

Tendonitis subacromial bursitis
Acromioclavicular osteoarthritis with inferior osteophytes.
A hooked acromion rotator cuff tear.

Question 5

Predisposing factors for shoulder impingment

Answer 5

The shape of your acromion can pre-dispose you to having issues with it. Type 1 Bigliani is flat and straight, Type 2 is curved and type 3 is hooked.
A hooked or curved acromion are more at risk.

Question 6

Treatment of shoulder impingement

Answer 6

Generally conservative- NSAIDs, analgesics, steroid injections into the subacromial space.

Question 7

What do you do if the patient doesnt respond to conservative treatment?

Answer 7

Could do subacromial decompression surgery (creates more space for the tendon to pass through)