Subacromial impingement syndrome Flashcards
What is it?
It refers to the inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space, resulting in pain, weakness and reduced range of motion within the shoulder
What range of pathology does SAIS encompass?
Rotator cuff tendonitis
Subacromial bursitis
Calcific tendinitis
Who does it most commonly occur in?
Under 25
Typically active or manual professions
Is it the most common pathology of the shoulder?
Yes
What lies within the subacromial space?
Rotator cuff tendons
Long head of biceps tendon
Coraco-acromial ligament
Subacromial bursa
What can cause it?
Intrinsic mechanisms:
- muscular weakness resulting in humerus shifting proximally
- overuse of the shoulder causing repetitive microtrauma and soft tissue inflammation
- degenerative changes at acromion can lead to tearing of rotator cuff allowing for proximal migration of humeral head
Extrinsic mechanisms:
- Anatomical variations in shape and gradient of acromion
- reduction in function of scapular muscles
- glenohumeral instability
What are the associated symptoms?
Progressive pain in the anterior superior shoulder
Exacerbated by abduction
Relieved by rest
May be associated with weakness and stiffness secondary to the pain
What examination signs can be elicited?
Neers impingement test
Hawkins test
How is it diagnosed?
CLinically although often confirmed via imaging - MRI mainstay
What can be seen on MRI
Subacromial osteophytes and sclerosis
Subacromial bursitis
Humeral cystic changes
Narrowing of subacromial space
How is it managed?
Conservative = mainstay
Sufficient analgesia (NSAIDS)
Regular physio
Corticosteroid injections can be trialled
If persists beyond 6 months surgery recommended
What surgical interventions can be done?
Repair of muscle tears
Removal of subacromial burs
Removal of section of acromion
