shoulder impingment syndrome , also called subacromial implications, painful pain syndrome , supraspinatus syndrome , bt shoulders , and shoulders thrower, is a clinical syndrome that occurs when the rotator cuff muscle tendons become irritated and inflamed as they pass through the subacromial space, the underside of the acromion. This can cause pain, weakness and loss of movement in the shoulder.
Video Impingement syndrome
Signs and symptoms
The most common symptoms in impingement syndrome are pain, weakness and loss of movement in the affected shoulder. The pain is often exacerbated by shoulder movement and should occur at night, especially if the patient is lying on the affected shoulder. The onset of pain can be acute if it is due to injury or it may be harmful if it is due to a gradual process such as spurring osteoarthritic. Pain has been described as boring rather than sharp, and lingers for long periods of time, making it difficult to fall asleep at night. Other symptoms may be a sensation of grinding or appearing during a shoulder movement.
The range of motion on the shoulder may be limited by pain. A painful bow movement may exist during advanced arm elevation from 60 ° to 120 °. Passive movement on the shoulder will look painful when downward force is applied to the acromion but the pain will decrease after the down force is removed.
Maps Impingement syndrome
Cause
When the arm is raised, the subacromial space (the gap between the anterior edge of the acromion and the humeral head) narrows, where the supraspinatus muscle tendons pass through it. Anything that causes further narrowing has a tendency to puncture the tendon and cause an inflammatory response, resulting in an upset syndrome. This can be caused by bony structures such as subakromial spurs (bony projections of acromion), osteoarthritic spurs in acromioclavicular joints, and variations in the form of acromion. Thickening or liming of the korakoacromial ligament may also cause collisions. Loss of rotator cuff muscle function, due to injury or loss of strength, can cause the humerus to move superiorly, resulting in impingement. Subsequent inflammation and subacromial burial burials can also cause collisions. Heavy weight training in which the arm is raised above the shoulder but in an internally rotated position such as the vertical line has been suggested as the cause of the subakromial collision.
Mechanism
The scapula plays an important role in shoulder slump syndrome. It is a wide flat bone located in the posterior thoracic wall that provides attachment to three different muscle groups. The intrinsic muscles of the scapula include rotator cuff-subscapularis muscle, infraspinatus, teres minor and supraspinatus. These muscles attach to the surface of the scapula and are responsible for internal and external rotation of the glenohumeral joint, along with the abduction of the humeral. Extrinsic muscles include the biceps, triceps, and deltoid muscles and attach to coracoid processes and supraglenoid tubules of the scapula, the infraglenoid tubule of the scapula, and the spine of the scapula. These muscles are responsible for some action of the glenohumeral joint. The third group, which is primarily responsible for the stabilization and rotation of the scapula, comprises the trapezius, the anterior serratus, the levator scapula, and the rhomboid muscle and attaches to the medial, superior, and inferior border of the scapula. Each of these muscles has their own role in proper shoulder function and must be balanced with each other to avoid shoulder pathology. Abnormal skapular function is called scapular dyskinesis. One action the scapula performs during throwing or service is enhancement of the acromion process to avoid the impact of rotator cuff tendon. If the scapula fails to raise the acromion properly, impingement may occur during the locking and acceleration phases of overhead activity. The two muscles most often inhibited during the first part of the above movement are the serratus anterior and the lower trapezius. Both of these muscles act as a force pair in the glenohumeral joint to improve the acromion process, and if there is a muscle imbalance, there can be a shoulder collision.
Diagnosis
An outlet syndrome can usually be diagnosed with a history and a physical examination. On physical examination, the doctor can rotate or lift the patient's arm to test reproducible pain (Neer sign and Hawkins-Kennedy test). These tests help to locate pathology to the rotator cuff; However, they are not specific for impingement. The more abnormal signs can also be seen with subacromial bursitis.
The doctor may inject lidocaine (usually combined with steroids) to the bursa, and if there is an increased range of motion and decreased pain, this is considered a positive "Impingement Test". It not only supports the diagnosis for impingement syndrome, but also therapeutic.
Plain X-rays on the shoulder can be used to detect pathology and variation of joints, including acromioclavicular arthritis, acromion variation, and calcification. However, x-rays do not allow visualization of soft tissue and thus have a low diagnostic value. Ultrasonography, arthrography and MRI can be used to detect rotator cuff muscle pathology. MRI is the best imaging test before arthroscopic surgery. Due to a lack of understanding of pathoaetiology, and the lack of diagnostic accuracy in the assessment process by many physicians, some opinions are recommended prior to the intervention.
Treatment
The impingement syndrome is usually treated conservatively, but is sometimes treated with arthroscopic surgery or open surgery. Conservative treatments include rest, stopping painful activity, and physical therapy. Physical therapy treatments will usually focus on maintaining various movements, increasing posture, strengthening shoulder muscles, and relieving pain. Physical therapists may use the following treatment techniques to improve pain and function: joint mobilization, interferential therapy, acupuncture, soft tissue therapy, therapeutic recordings, rotator cuff strengthening, and education on the cause and mechanism of conditions. NSAIDs and ice packs can be used to relieve pain.
Therapeutic injections of corticosteroids and local anesthetics can be used for persistent impulsment syndrome. The amount of injections is generally limited to three because of possible side effects of corticosteroids. A recent systematic review of the level of evidence suggests that corticoestroid injections only provide small and temporary relief of pain.
A number of surgical interventions are available, depending on the nature and location of the pathology. Surgery can be performed by arthroscopy or as an open surgery. The overriding structure can be removed in surgery, and subacromial space may be dilated by distal clavicle resection and osteophyte excision on the underlying surface of the acromioclavicular joint. Damaged rotator cuff muscles can be repaired surgically.
History
An outlet syndrome was reported in 1852. The previous shoulder adhesion was thought to be triggered by shoulder abduction and surgical intervention focused on lateral or total acromionectomy. In 1972, Charles Neer proposed that the impingement was caused by an anterior third of the acromion and the korakoacromial ligaments and suggested surgery should be focused on this area. The role of the anteriorinferior aspect of acromion in the syndrome of impingement and excision of parts of the anteriorinferior acromion has been an important part of the surgical treatment of the syndrome.
Criticism
Subacromial suppression is not free from criticism. First, identification of acromion types shows poor intra and inter-observer reliability. Second, a computerized three-dimensional study fails to support impingement by any part of the acromion on the rotator cuff tendon at different shoulder positions. Thirdly, most tear-thickness tears do not occur on the bursal surface fibers, where a mechanical abrasion of the acromion does occur. Fourth, it has been suggested that the candied tear bursal may be responsible for subakromial spurs and not vice versa. And finally, there is growing evidence that routine acromioplasty may not be necessary for successful rotator cuff repair, which would be an unexpected finding if the acromial form has a major role in producing tendon lesions. In short, despite being a popular theory, much of the evidence suggests that subakromial bulkers may not play a dominant role in many cases of rotator cuff disease.
See also
- Milwaukee's shoulder syndrome
References
Source of the article : Wikipedia
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