Impingement Syndrome: Diagnosis and Management


Chapter 7

Impingement Syndrome


Diagnosis and Management



Chunyan Jiang, and Fenglong Li

Introduction


Shoulder impingement syndromes are caused by external or internal impingement. External impingement includes subacromial and subcoracoid impingement, and is caused by the abnormalities of the anterolateral acromion and coracoacromial arch, leading to disorders of the outlet structures. Internal impingement is caused by pinching of the posterosuperior labrum on the glenoid rim and the undersurface of the rotator cuff with the arm in abduction and external rotation. This nonoutlet impingement usually occurs in overhead athletes.

Procedure


Subacromial or subcoracoid decompression can be used to treat the outlet impingement syndromes. Debridement or repair of the rotator cuff tear and posterosuperior labral lesion may be needed for symptomatic nonoutlet (internal) impingement.

Patient History



Patient Examination



Imaging



Treatment Options: Nonoperative and Operative



Surgical Anatomy



Surgical Indications





  1. • Outlet impingement.
  2. • Patients with persistent pain affecting the activities of daily living and symptoms irresponsive to conservative treatment (including subacromial cortisone injection and physiotherapy) for 3 to 6 months.
  3. • Acromioplasty is indicated for patients with hooked acromion or huge acromial spur with a healthy cuff or reparable rotator cuff tear.
  4. • Coracoplasty is indicated for the patients with both clinical and radiologic evidences of coracoid impingement (coracoid spur or close contact between coracoid and subscapularis).
  5. • Internal impingement.
  6. • Failure to respond to conservative treatment for 3 to 6 months (including intraarticular cortisone injection and physiotherapy).
  7. • Inability to return to sports despite at least 3 months of structured rehabilitation.

  8. image
    FIG. 7.5 Viewing from the lateral portal, inside the subacromial space are (A) the coracoacromial ligament (CAL), conjoined tendon (CT), (B) long head of biceps tendon (LHBT), bursal side of the supraspinatus tendon (Ssp), and upper portion of subscapularis (Ssc).



  10. image
    FIG. 7.6 Viewing from the posterior portal, inside the glenohumeral joint are the posterosuperior labrum (A) and the articular side of the rotator cuff tendon (B).

    Related posts:

    Patient Positioning and Anesthesia for Rotator Cuff Surgery Arthroscopic Trillat Procedure for Recurrent Anterior Shoulder Instability With Associated Irreparable Rotator Cuff Tear Nonoperative Care of Rotator Cuff Disorders: Physical Therapy, Modalities, and Injectables What Type of Rotator Cuff Tear Is This? Tear Pattern Recognition and Soft-Tissue Releases Subscapularis Tendon Tears: Arthroscopic Management Shoulder Stiffness (Adhesive Capsulitis) With A Rotator Cuff Tear: How to Manage

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Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Impingement Syndrome: Diagnosis and Management

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