Shoulder Impingement

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