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Shoulder impingement syndrome is a syndrome involving tendonitis (inflammation of tendons) of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle . [ 1 ]
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle. [1]
As part of clinical decision-making, a simple, minimally invasive, in-office procedure, the rotator cuff impingement test, may be performed. A small amount of a local anesthetic and an injectable corticosteroid are injected into the subacromial space to block pain and provide anti-inflammatory relief. If pain disappears and shoulder function ...
If conservative measures are unsuccessful, surgery can be trialed. Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy. Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitis or rotator cuff tear, may be needed.
The Hawkins-Kennedy test [11] [12] has a sensitivity of approximately 80% to 90% for detecting impingement. The infraspinatus and supraspinatus [13] tests have a specificity of 80% to 90%. [10] A common cause of shoulder pain in rotator cuff impingement syndrome is tendinosis, which is an age-related and most often self-limiting condition. [14]
Neer test for subacromial impingement The Neer impingement test is a test designed to reproduce symptoms of rotator cuff impingement through flexing the shoulder and pressure application. Symptoms should be reproduced if there is a problem with the supraspinatus or biceps brachii. [ 1 ]
Diagram of normal bursae surrounding the shoulder joint: (1) subacromial-subdeltoid bursa, (2) subscapular recess, (3) subcoracoid bursa, (4) coracoclavicular bursa, (5) supra-acromial bursa and (6) medial extension of subacromial-subdeltoid bursa.
The coracoacromial ligament may impinge and compress rotator cuff muscle or tendon. [3] It may be damaged during a shoulder injury. [4]The attachment of the coracoacromial ligament may be moved from acromion to the end of the clavicle when reconstructing the acromioclavicular joint.