Subacromial impingement syndrome

Question 1

What is subacromial impingement syndrome?

Answer 1

Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space = pain, weakness + reduced range of movement

Question 2

Who is most commonly affected by subacromial impingement syndrome?

Answer 2

Patients under 25
Active
In manual professions

Question 3

What anatomical structures run through the subacromial space?

Answer 3

Rotator cuff tendons
Long head of biceps tendon
Coraco-acromial ligament
Subacromial bursa

Question 4

What can cause subacromial impingement syndrome?

Answer 4

Intrinsic causes

• muscular weakness of rotator cuff muscles
• overuse of the shoulder - repetitive microtrauma
• degenerative tedinopathy

Extrinsic causes -

• anatomical factors
• scapular musculature weakness
• glenohumeral instability - subluxation of the humerus

Question 5

How does subacromial impingement syndrome present?

Answer 5

Progressive pain in the anterior superior shoulder
- exacerbated by abduction + relieved by rest
Weakness and stiffness of joint

Special tests can also be used to test for this

Question 6

What special tests can be done to show subacromial impingement syndrome?

Answer 6

Neers impingement test - place arm by patients side, fully internally rotated. Then passively flex. If positive there is pain in anterolateral shoulder.

Hawkins test - shoulder + elbow are flexed to 90 degrees. Stabilise the humerus and passively internally rotate the arm. If positive there is pain in anterolateral shoulder. (look at photos / vids)

Question 7

How is subacromial impingement syndrome managed?

Answer 7

Mainly conservatively

• analgesia + topical NSAIDs
• physiotherapy
• corticosteroid joint injections can be trialled

Surgery - if >6 months with no response to the above

• repair of tears - most commonly supraspinatous of long head of biceps
• removal of bursa (bursectomy)
• removal of a section of the acromion