The Painful Shoulder: Shoulder Impingement Syndrome
Yousaf Khan*, Mathias Thomas Nagy, Joby Malal, Mohammad Waseem
Identifiers and Pagination:Year: 2013
Issue: Suppl 3
First Page: 347
Last Page: 351
Publisher Id: TOORTHJ-7-347
Article History:Received Date: 19/1/2013
Revision Received Date: 2/2/2013
Acceptance Date: 23/2/2013
Electronic publication date: 6/9/2013
Collection year: 2013
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.
Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care.
The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition.
Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases.
A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible.