shoulder impingement, rotator cuff tendonitis and subacromial bursitis Flashcards
what is it?
pain originating from the subacromial space
which patients does impingement mostly occur in?
<25 athletes or people in manual professions
why does impingement also occur in older patients?
degenerative change, acromioclavicular bony changes
what is the intrinsic pathophysiology?
tendon vascularity
watershed area
tender degeneration
cuff dysfunction
what is the extrinsic pathophysiology?
type of acromion
caoraco-acromial ligament
clavicular supr/osteophyte
what is the pathophysiology of shoulder impingement?
refers to inflammation and irritation of rotator cuff tendons as they pass through the subacromial space resulting in pain weakness and reduced ROM within the shoulder
what are the intrinsic mechanisms?
muscular weakness - weakness in rotator cuff lead to humerus shifting proximally towards the body
overuse of shoulder - repetitive microtrauma result in soft tissue inflammation of rotator cuff tendons and the subacromial bursa
degenerative tendinopathy - degenerative changes of the acromion can lead to tearing of rotator cuff, allows for proximal migration of humeral head
what are the extrinsic mechanisms?
anatomical factors - congenital or acquired variations in shape and gradient of acromion
scapular musculature - reduction in function of scapular muscles may result in reduction in size of subacromial space
glenohumeral instability - can lead to superior subluxation of humerus causing increased contact between the acromion and subacromial tissues
what is the pathophysiology of rotator cuff tendonitis?
repeated impingement results in inflammation or damage of the rotator cuff tendons
what is the pathophysiology of subacromial bursitis?
may be calcification of tendon - subacromial also becomes inflamed
can exaggerate problem as now inflamed tendons rub against acromium and clavicoacromial joint and ligament
what is Neer’s classification?
- inflammation, oedema and haemorrhage (<25 years)
- fibrosis and tendonitis bursa/cuff (25-40 years)
- partial/full thickness tears and degeneration of rotator cuff (>40 years)
what are the symptoms?
pain characteristically radiates to deltoid and upper arm
progressive pain in anterior superior shoulder
pain exacerbated by abduction and relieved by rest
what are the signs?
tenderness below the lateral edge of acromion
what tests are used?
Hawkins-Kennedy
Jobe’s
Painful arc
what investigations are used?
x-ray
USS
MRI
what are the management options?
rest, analgesia, NSAIDs, physio
subacromial decompression after 6 months of non-operative management
