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
2
Q
What does SAIS encompass?
A
Range of pathology eg:
* Rotator cuff tendinosis (swelling)
* Subacromial bursitis
* Calcific tendonitis
3
Q
Typical patients with SAIS
A
- Active individuals eg manual professions
- Under 25
- MOST COMMON PATHOLOGY OF SHOULDER
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 coacoid process (medial)
- Rotator cuff tendons, long head biceps tendon and coracoacomial ligament run through
- Subacromial bursa reduces friction
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
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
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
8
Q
Video to see movement of shoulder and how scapula muscles effect
A
https://youtu.be/3VygGuBObVc
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
10
Q
Specific examination tests for SAIS
A
- Neers impingement test
- Hawkins test
11
Q
Neers impingement test
A
- Arm placed by patients side
- Fully internally rotated
- THEN passively flexed
- If pain in anterolateral shoulder = positive
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
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
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
15
Q
Conservative management SAIS
A
- NSAIDs
- Physiohterapy
- Corticosteroid injections into subacromial space
