Shoulder impingement syndrome

Question 1

What is shoulder impingement syndrome?

Answer 1

Impingement syndrome is a syndrome characterised by pain originating from the sub-acromial space

This is most commonly transient and has both intrinsic and extrinsic causes

Question 2

What are some causes of shoulder impingement syndrome?

Answer 2

• Poor tendon vascularity
• Watershed area
• Tendon degeneration
• Cuff dynfunction

Question 3

What is the most common cause of shoulder impingement in those under 30?

Answer 3

Rotator cuff tendonitis
Sub-acromial bursitis

Question 4

What is the most common cause of shoulder impingement in those aged 30-40?

Answer 4

Calcific tendonitis

Question 5

What is the most common cause of shoulder impingement in those aged 40-50?

Answer 5

Tendinosis
Partial rotator cuff tears

Question 6

What is the most common cause of shoulder impingement in those aged 50-60?

Answer 6

Cuff tears

Question 7

What is the most common cause of shoulder impingement in those over 70?

Answer 7

Cuff arthropathy

Question 8

What are the 3 stages of shoulder impingement (Neer’s classification)?

Answer 8

Stage 1 - Inflammation, oedema and haemorrhage

Stage 2 - Fibrosis and tendonitis of bursa and cuff

Stage 3 - Partial or full thickness tears and degeneration of the rotator cuff

Question 9

How will shoulder impingement usually present?

Answer 9

Patients will often present with pain in the neck and shoulder and problems with reach and stretching of the arm

Question 10

What are some clinical signs of shoulder impingement?

Answer 10

Tender bursa and acromioclavicular joint
Painful arc
Recued rotator cuff strength
Pain on Hawkin’s and Jobe’s test

Question 11

What investigations are required in shoulder impingement syndrome?

Answer 11

X-ray
USS or MRI

Question 12

How are most cases of impingement syndrome managed?

Answer 12

Rest
Activity modification
NSAIDs
Physiotherapy
Corticosteroid injection

Question 13

When is surgery indicated in shoulder impingement syndrome?

Answer 13

In cases of minimum 6 months of non-operative treatment which is still symptomatic

Question 14

What is the main surgical procedure of shoulder impingement syndrome?

Answer 14

Arthropscopic/open subacromial decompression is the main surgical operation used in whicj the subacromial bursa are removed, the acromion is shaved, the CA ligament is released and the infraclavicular spur is excised to relieve pressure