Subacromial Impingement Syndrome

Syndrome is a collection of diagnoses that cause mechanical inflammation in the subacromial space

Causes of impingement syndrome can be related to

• Muscle strength imbalances

• Poor scapula control

• Rotator cuff tears

• Subacromial bursitis

• Bone spurs

Pain, instability, weakness, or loss of range of motion

Classically presents with one or more of the following:

• Pain with overhead activities

• Nocturnal pain with sleeping on the shoulder

• Pain on internal rotation (eg, putting on a jacket or bra)

Numbness and pain radiation below the elbow are usually due to cervical spine disease

Atrophy in the supraspinatus or infraspinatus fossa may be appreciable

Mild scapula winging or "dyskinesis" may be present

Patient often has a rolled-forward shoulder posture or head-forward posture

Tenderness over the anterolateral shoulder at the edge of the greater tuberosity may be present

Symptoms can be elicited with the Neer and Hawkins impingement signs (Table 41–1)

Four radiographic views should be ordered

• Anteroposterior scapula view can rule out glenohumeral joint arthritis

• Anteroposterior acromioclavicular view evaluates the acromioclavicular joint for inferior spurs.

• Scapula Y view evaluates the acromial shape

• Axillary lateral view visualizes the glenohumeral joint as well and for the presence of os acromiale

MRI of the shoulder may demonstrate full or partial thickness tears or tendinosis

Ultrasound evaluation may demonstrate thickening of the rotator cuff tendons and tendinosis

Most patients respond well to conservative treatment, including education, activity modification, and physical therapy exercises

Procedures include arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, or debridement or repair of rotator cuff tears

However, the value of acromioplasty alone for rotator cuff problems is not supported by evidence