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
Mainstay = nonoperative
– activity modification
– stretching exercises
– strengthening exercises
– 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
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