There are four muscles that raise and lower the arm. The tendons of these four muscles are collectively known as the rotator cuff. This group of tissues fits neatly under the roof of the shoulder--an extension of the shoulder blade known as the acromion. However, if the cuff becomes inflamed, some bone deformity exists in the acromion, or acromio-clavicular joint the rotator cuff and acromion can rub against one another, causing a painful condition known as impingement. Each time the arm is raised there is a bit of rubbing on the tendons and the bursa (small fluid-filled sacs located in the shoulder to lubricate the joint and reduce friction) between the tendons and the acromion, which may cause pain and inflammation. Almost everyone will experience some degree of impingement due to the day-to-day activities that we perform with the arm above shoulder level. Impingement may become a serious problem for those who continuously work with their arms raised overhead (painters, carpenters) or those who repeatedly engage in throwing activities (pitchers). The impingement process may get worse if any condition decreases the amount of space between the acromion and the rotator cuff tendons or if bone spurs are present.
Detailed Description
Symptoms · General ache in the shoulder · Pain when raising the arm out from the side or in front of the body · Painon external rotation and abduction as when you cock your arm to throw a ball. . Pain when sleeping on the affected shoulder · Sharp pain when reaching into a back pocket · Stiffness · Catching sensation when the arm is lowered. asd
Causes and Risk Factors
Causes · Overuse · Wear and tear due to aging ·Overhead sports like pitchers in baseball, cricketers, improper technique in swimming. · Weak rotator cuff muscles Risk Factors · Continuously working with the arm above shoulder level · Repeated throwing activities · Excessive participation in activities like painting, pitching, and swimming
Diagnosis
Although impingement is common, other causes of shoulder pain should be ruled out. These include gall stones, cervical spondylosis, diaphragmatic irritation. A clinical exam will make the diagnosis. There is pain on lifting the arm forward in the plane of the shoulder blade. A catching pain is also noticed when the arm comes down from the top. The impingement test is positive and consists of pain on abduction and internal rotation. Injection of a local anaesthetic agent into the subacromial bursa leads to abolition of the pain. Special X ray views are required to see if there is any bony prominence from the acromion. An MRI scan may be needed to detect a rotator cuff tear. Shoulder arthroscopy is both diagnostic and therapeutic as an arthroscopic subacromial decompression can be done prior to repairing any rotator cuff tear.
Treatment
Immediate Action · If necessary take Paracetamol and an NSAID’s to manage pain. · Avoid activity that involves raising your arm above your head (this may involve altering your job to reduce overhead activity). · With any recent injury use the RICE method: Rest, Ice, Compression and Elevation See your orthopedic surgeon If · Pain continues and cannot be managed with medications. · I may administer upto two steroid injections into the subacromial space to diminish pain. .When the pain has reduced, I put my patients on a rehabilitation regime to strengthen the scapular muscles and the muscles acting on the gleno humeral joint except the offending muscle. Swelling and pain become chronic(persisting later than six months of conservative tratment then surgery may be necessary. The goal of any surgery will be to increase the amount of space between the acromion and the rotator cuff tendons, which will then allow for easier movement and less pain and inflammation. Shoulder arthroscopy will visualize and quantify the degree of impingment .The status of the rotator cuff is documented. A wedge of bone is removed from the front of the acromion. In addtion there may be osteoarthritis in the acromioclavicular (AC) joint. In this case it may be necessary to remove the end of the clavicle, this is called a resection arthroplasty. These procedures may be performed arthroscopically or through an open incision(arthroscopic or open subacromial decompression)
Prevention
Avoid excessive overhead activities. Strengthen your shoulders and do not try to play or work through the pain. |
