OrthoNet

Impingement
Subacromial Impingement Syndrome

Mechanical impingement of bursal surface of rotator cuff on coracoacromial arch.

Classification: Neer (1983) based on degree of involvement of rotator cuff
Stage I - inflammation & edema of rotator cuff
Stage II - fibrosis & tendonitis
Stage III - partial or full-thickness rotator cuff tear

Careful history & physical to r/o instability, rotator cuff tears, bicipital tendonitis.

Imaging: plain xrays - 3 views
MRI +/- gadolinium, U/S, contrast arthrography

Treatment:
Mainstay = nonoperative
- activity modification
- NSAIDS
- stretching exercises
- strengthening exercises
Surgical treatment:
- goals = pain relief & restoration of function
- Stage I or II à arthroscopic subacromial bursectomy & acromioplasty; shoulder arthroscopy
- Stage III à rotator cuff repair in young patients with subacromial bursectomy & acromioplasty
debridement in older paitents if cuff unrepairable