MANUAL MINORS
Impingement syndrome, also known as subacromial impingement syndrome, occurs when the rotator cuff tendons or the subacromial bursa are compressed against the coracoacromial arch during shoulder movements, particularly during elevation.
This compression leads to irritation, inflammation, and can eventually result in more severe injuries such as tendinitis, bursitis, or tendon tears. It is common in individuals who perform repetitive overhead movements, such as athletes and manual labourers.
Diagnosis
Diagnosis is based on a clinical history of pain in the anterior or lateral shoulder, particularly when lifting the arm above shoulder height. The pain typically worsens at night or after repetitive activities. Physical examination includes tests such as Neer’s and Hawkins’ tests, which reproduce pain by compressing the rotator cuff tendons. Confirmation can be made through ultrasound or magnetic resonance imaging (MRI), which can reveal inflammation, tendon thickening, or bursitis.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Rotator cuff tear | Sharp pain with significant weakness when lifting the arm, more severe than impingement |
Subacromial bursitis | Localised pain at the top of the shoulder, often coexistent with impingement |
Bicipital tendinitis | Pain in the front of the shoulder, especially with flexion and supination of the arm |
Adhesive capsulitis (frozen shoulder) | Severe stiffness and shoulder pain with movement limitation in all directions |
Shoulder osteoarthritis | Chronic pain and stiffness, with progressive limitation of range of motion |
Emergency Management
Emergency management of impingement syndrome focuses on pain relief and reducing inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are administered, and ice can be applied to reduce inflammation. In more severe cases, a corticosteroid injection into the subacromial space can provide rapid relief.
It is important to avoid activities that exacerbate the symptoms, such as repetitive overhead movements. If the pain is severe, temporary immobilisation of the arm with a sling may be used.
Definitive Treatment
Definitive treatment is conservative in most cases. It includes physiotherapy to strengthen the rotator cuff muscles and improve shoulder mechanics. Stretching and mobility exercises are essential to prevent stiffness and symptom recurrence.
For cases that do not improve with conservative treatment, arthroscopic surgery may be required to decompress the subacromial space, remove osteophytes, or repair the affected tendon. Postoperative rehabilitation is crucial to restore function and prevent recurrence of the syndrome.
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