Sub-Acromial Shoulder Pain Flashcards

1
Q

What is subacromial impingement syndrome?

A
  • Inflammation and irritation of rotator cuff tendons as they pass through subacromial spoace
  • = pain, weakness and reduced ROM of shoulder
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2
Q

What does SAIS encompass?

A

Range of pathology eg:
* Rotator cuff tendinosis (swelling)
* Subacromial bursitis
* Calcific tendonitis

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3
Q

Typical patients with SAIS

A
  • Active individuals eg manual professions
  • Under 25
  • MOST COMMON PATHOLOGY OF SHOULDER
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4
Q

What is the subacromial space?

A
  • Below coracoacromial arch
  • Above humeral head and greater tuberosity of humerus
  • Arch consists of acromion (lateral), coracoacromial ligament and coracoid process (medial)
  • Rotator cuff tendons, long head biceps tendon and coracoacomial ligament run through
  • Subacromial bursa reduces friction
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5
Q

Two types pathologies that can lead to SAIS

A
  • Intrinsic - pathologies of rotator cuff tendons due to tension
  • Extrinsic - pathologies of rotator cuff tendons due to external compression
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6
Q

Intrinsic causes of SAIS

A
  • Muscular weakness of rotator cuffs - imbalances = humerus shifts proximally
  • Overuse - micrtrauma = inflammation and friction
  • Degenerative tendinopathy - tearing due to degen changes = migration of humeral head
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7
Q

Extrinsic causes of SAIS

A
  • Anatomical - variations of shape and gradient of acromion
  • Scapular muscles - reduced function serratus anterior and trapezius - as usually allows humerus to move past acromion in overhead extension, may reduce size of subacromial space
  • Glenohumeral instability - superior subluxation of humerus = increased contact
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8
Q

Video to see movement of shoulder and how scapula muscles effect

A

https://youtu.be/3VygGuBObVc

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9
Q

Clinical features of SAIS

A
  • Progressive pain
  • Exacerbated by shoulder abduction - 60 to 120 degrees painful arc
  • Relieved by rest
  • Associated with weakness and stiffness secondary to pain
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10
Q

Specific examination tests for SAIS

A
  • Neers impingement test
  • Hawkins test
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11
Q

Neers impingement test

A
  • Arm placed by patients side
  • Fully internally rotated
  • THEN passively flexed
  • If pain in anterolateral shoulder = positive
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12
Q

Hawkins test

A
  • Shoulder and elbow flexed to 90 degrees
  • Examiner stabilises humerus
  • Passively internally rotates shoulder
  • +ve if pain in anterolateral shoulder
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13
Q

Differentials for SAIS presentation

A
  • Muscular tear of rotator cuffs/biceps long head
  • Neurological pain eg brachial plexus injury - parasthesia also
  • Frozen shoulder - relieve pain = still stiff
  • Acromioclavicular pathology eg arthritis - general pain, weakness and stiffness from pain
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14
Q

Investigations for SAIS

A
  • Clinical
  • But can be confirmed with MRI
  • X-ray may show osteophyte formation and sclerosis/irregularity of bones, sometimes cystic changes
  • Can see bursitis on MRI
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15
Q

Conservative management SAIS

A
  • NSAIDs
  • Physiohterapy
  • Corticosteroid injections into subacromial space
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16
Q

Surgery - when in SAIS?

A

If 6 months of conservative management tried and not improved

17
Q

Surgery for SAIS

A

Commonly arthroscopic
Aim is to decompress and increase space within subacromial space
Options are:
* Muscle tear repairs
* Bursectomy - subacromial bursa
* Acromioplasty - removal of section of acromion

18
Q

Complications of SAIS

A
  • Rotator cuff degeneration and tear
  • Adhesive capsulitis
  • Complex regional pain syndrome
19
Q

Why does overhead activity worsen SAIS pain?

A
  • When arm moves above head rotator cuff tendons move through subacromial space
  • Space also narrows
  • Can then get caught/rub on acromion
  • = pain
20
Q

Recovery and rehab post SAIS surgery

A
  • 3-6 months to fully recover
  • Avoid lifting above head for 3 months
  • Avoid heavy lifting for 3 weeks
  • Easier to wash and dress after 3 weeks
21
Q
A