Dr Rahul Aggarwal
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SUB ACROMIAL IMPINGEMENT

WHAT IS SUB ACROMIAL IMPINGEMENT

A condition caused by painful entrapment of structures occupying sub acromial space in shoulder.

WHAT IS SUBACROMIAL SPACE?

It is space between humeral head and acromian. It contains rotator cuff tendons, the long head of the biceps tendon, the bursa, and the coracoacromial ligament.

Symptoms

  1. PAIN. Patients usually complaint of pain on elevating the arm between 70o -120o (Painful arc).

s It develops slowly over a period of days to weeks.

s It is typically located at the anterolateral shoulder and may radiate to the lateral arm.

s Patients usually complain of pain at bedtime, exacerbated by lying on the affected shoulder, or sleeping with the arm overhead.

s Normal daily overhead activities become increasing painful.

  1. Patient may also complaint of weakness or stiffness of affected limb.

Diagnosis:

  1. Swelling, wasting, tenderness at shoulder region.

s Some positive special clinical tests :

  1. Neer’s sign and test, Hawkin’s test etc
  1. MRI: GOLD STANDARD. It provides information about both bony and soft tissue structures like rotator cuff, sub acromial bursa, abnormal acromion shape and slope, osteophytes, AC arthritis etc.

TREATMENT

•Conservative: In the absence of major structural issues, it is therapy of choice. The treatment may last for 3-6 months and addresses pain at first, then passive and active motion, and lastly strength and coordination.

  1. Rest to part. Immobilise by sling/ strapping.
  2. Apply Ice to affected shoulder. Preferably 3-4 times a day.
  3. NSAIDs to reduce inflammation and relieve pain.
  4. Intra articular and periarticular steroid injections- to reduce inflammation and pain
  5. Physiotherapy – USG therapy/ Laser therapy/ TENS etc.
  6. Gradual joint mobilisation once symptoms start improving.
  7. Intra lesional PRP (Platelet Rich Plasma) injections for chronic lesions.

 

•Surgery:  Indicated if symptoms fail to respond after three or more months of adequate conservative treatment.

SUB ACROMIAL DECOMPRESSION: aim to remove mechanical blocks and increase sub acromial space. Depending on the etiology, surgical procedures are varied.

  1. BURSECTOMY- removal of inflamed and thickened sub acromial bursa.
  2. ACROMIOPLASTY- removal of bursa, any bony spurs like osteophytes, shaving of acromial under surface and trimming of coraco-acromial ligament