Sunday, March 31, 2013

Conditions affecting Shoulder (Impingement syndrome)

Impingement syndrome
  • Painful condition of the rotator cuff due to impingement 
  • Repetitive compression or rubbing of tendons supraspinatus under coracoacromial arch
  • Passively, when the internally rotated shoulder is moved into forward flexion, the patient will experience discomfort (Neer impingement sign)
  • Thickening of ACJ, OA spurs, Swelling of cuff, bursa

  • Any prolonged repetitive overhead activity such as tennis, pitching, golf, or swimming may compromise the space between the humeral head and the coracoacromial arch that includes the acromion, coracoacromial ligament, and the coracoid process
  • Localised edema and swelling – tendinitis
  • Scarring, Fibrosis, Calcification
  • Incomplete and complete tear
  • Secondary Arthropathy – Milwaukee shoulder
Clinical Features
  • Depends upon the stage of disease
  • Tendinitis - less than 40 years of age, anterior shoulder pain after activity, tenderness anteriorly at supraspinatus 
  • Painful arc, Impingement sign,
  • Chronic tenditis : 40 – 50 yrs , repeated attacks of shoulder pain, pain more at night, cannot lie on affected side, stiffness
  • Tear: greater than 45 yrs, Partial/ complete, difficulty in abduction, local injection, atrophy
  • Diagnosis: History, Physical examination, Imaging  X-ray, arthrography, USG, MRI
  •         Conservative: Rest, avoiding painful activities, warm packs, physiotherapy, NSAIDs, Local steroids
  •         Surgical: Acromioplasty, Debridement, Rotator cuff repair

  • Frozen shoulder
  • Condition characterised by progressive pain and stiffness of shoulder which resolves spontaneously in 18 to 24 months.
  • Idiopathic, Fibroblastic proliferation, Association with DM, Dupuytrens disease, hyperthyroidism
  • Clinical features:40 – 60 yrs, h/o trauma +/-, progressively increasing pain in shoulder and arm, night pain, Gradual stiffness and decreasing pain, Gradual regain of motion
  •     Wasting of muscles, ROM- decreased in all direction

X-rays Normal, to exclude other diseases
  • Diagnosis: Not every stiff shoulder is frozen shoulder
  • Other causes of stiffness ruled out, painful restriction of movement with normal x rays and natural progression in three stages


  •      Conservative: NSAIDs, ROM exercises Pendulum exercises, Local steroid injection, Large volume injection and manipulation under anaesthesia,
  •     Surgical: No definitive role.

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