Subacromial Pain Syndrome: Difference between revisions
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Original Editor - | Original Editor - [http://www.physio-pedia.com/index.php5?title=User:David_Drinkard David Drinkard] | ||
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
Subacromial Impingement is defined as the compression of the subacromial structures (rotator cuff tendons, long head of the biceps, glenohumeral joint capsule, and subacromial bursa) during elevation of the arm. These structures are compressed against the coracoacromial arch<ref name="Kachingwe et al">Kachingwe AF, Phillips B, Sletten E, Plunkett SW. Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. The Journal of Manual &amp;amp;amp;amp;amp; Manipulative Therapy 2008;16(4):238-247.</ref>, creating sensations of pain. The margin between the superior portion of the humeral head and the inferior | Subacromial Impingement is defined as the compression of the subacromial structures (rotator cuff tendons, long head of the biceps, glenohumeral joint capsule, and subacromial bursa) during elevation of the arm. These structures are compressed against the coracoacromial arch<ref name="Kachingwe et al">Kachingwe AF, Phillips B, Sletten E, Plunkett SW. Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. The Journal of Manual &amp;amp;amp;amp;amp;amp;amp; Manipulative Therapy 2008;16(4):238-247.</ref>, creating sensations of pain. The margin between the superior portion of the humeral head and the inferior | ||
[[Image:Subacromial structures.jpg|thumb|right|Subacromial Structures]] | [[Image:Subacromial structures.jpg|thumb|right|Subacromial Structures]] | ||
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== Clinical Presentation == | == Clinical Presentation == | ||
Individuals with subacromial impingement will usually complain of pain with active elevation of the shoulder. Activities performed with the involved arm below shoulder level are often not painful because the subacromial structure are not impinged when the shoulder is in anatomic position. | Individuals with subacromial impingement will usually complain of pain with active elevation of the shoulder. Activities performed with the involved arm below shoulder level are often not painful because the subacromial structure are not impinged when the shoulder is in anatomic position. | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
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[http://www.physio-pedia.com/index.php5?title=Subacromial_Impingement_Cluster Also see Impingement Cluster page] | [http://www.physio-pedia.com/index.php5?title=Subacromial_Impingement_Cluster Also see Impingement Cluster page] | ||
A number of tests can be used to test for Subacromial Impingement Syndrome: | A number of tests can be used to test for Subacromial Impingement Syndrome: | ||
== Outcome Measures == | == Outcome Measures == | ||
Revision as of 19:41, 22 March 2010
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Clinically Relevant Anatomy
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Subacromial Impingement is defined as the compression of the subacromial structures (rotator cuff tendons, long head of the biceps, glenohumeral joint capsule, and subacromial bursa) during elevation of the arm. These structures are compressed against the coracoacromial arch[1], creating sensations of pain. The margin between the superior portion of the humeral head and the inferior
surface of the acromion is known as the subacromial space. This margin holds the supraspinatus muscle belly and tendon, long head of the biceps brachii, and subacromial bursa. Subacromial structures can be pinched either due to pathologic factors (muscle imbalance, overuse) or anatomic factors. The shape of the acromion can play a role. There are three types of acromial shapes:
- Type I Acromion: Flat shape (Least likely to contribute to impingement)
- Type II Acromion: Curved shape
- Type III Acromion: Hooked shape (Most likely to contribute to impingement)
Bony spurs on the underside of the acromion process can also cause irritation of the subacromial structures.
Mechanism of Injury / Pathological Process
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Impingement is often a condition than can have a variety of causes acting together to create symptoms. Subacromial impingement occurs when the arm is elevated, narrowing the subacromial space and compressing the structures that reside in that margin. With repeated elevation, these structures sustain microtrauma that can cause them to become inflammed. Subacromial impingement can be caused by a variety of factors:
- Rotator cuff weakness, causing the humeral head to drift superiorally
- Chronic rotator cuff irritation due to overuse
- Posterior GH capsule tightness
- Anatomical variations such as narrow SA space, Type II or III Acromion, or bony spurs
- Poor posture (forward shoulder posture can cause functional narrowing of subacromial space)
Clinical Presentation[edit | edit source]
Individuals with subacromial impingement will usually complain of pain with active elevation of the shoulder. Activities performed with the involved arm below shoulder level are often not painful because the subacromial structure are not impinged when the shoulder is in anatomic position.
Diagnostic Procedures[edit | edit source]
Also see Impingement Cluster page
A number of tests can be used to test for Subacromial Impingement Syndrome:
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
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Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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References[edit | edit source]
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- ↑ Kachingwe AF, Phillips B, Sletten E, Plunkett SW. Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. The Journal of Manual &amp;amp;amp;amp;amp;amp; Manipulative Therapy 2008;16(4):238-247.
