Impingement syndrome

Background

• Refers to subacromial bursitis, rotator cuff tendinitis, supraspinatus tendinitis, and painful arc syndrome
  • All are due to repetitive subacromial impingement due to overhead use of the arm
• Shoulder range of motion should be intact

Stages

• Stage 1
  • Classically seen in young athletes <25yr
  • Reversible edema and hemorrhage about the rotator cuff
  • Dull ache over anterolateral shoulder aggravated by activity and improved by rest
• Stage 2
  • Seen in pts 25-40yr
  • Occurs if pts continue the aggravating activity without treatment
  • Edema and hemorrhage advance to rotator cuff tendinitis
  • Prolonged pain (weeks to months) or recurrence of symptoms
  • Chronic aching pain w/ daily activities and night pain
• Stage 3
  • Rotator cuff tear
  • Often requires surgical decompression of the subacromial space

Clinical Features

• Pain
  • Develops insidiously over period of weeks-months
  • Located over anterolateral acromion; radiates to lateral mid-humerus
  • Exacerbated by activities that require overhead arm use
  • Night pain

Diagnosis

• See Shoulder (Tests)

Treatment

1. Relative rest and activity modification
   1. Avoid the aggravating activity and minimize all overhead activities
2. NSAIDs and opioids as needed for pain
3. Cryotherapy
   1. Apply ice to affected shoulder for 10-15min TID-QID
4. Range of motion exercises
   1. Pendulum swings
      1. Pt bends slightly at waist w/ arm hanging freely in front of body
      2. Arms should be swung in gentle arcs of motion both clockwise and counter-clockwise
      3. Swing to level of pain tolerance x 5-10min TID-QID
   2. Walk fingers up wall
      1. Stand sideways an arm's length from wall and walk fingers up wall to level of pain tolerance TID-QID

Disposition

• Refer to PMD within 2 weeks

Source

• Tintinalli