Subacromial Impingement

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What is subacromial impingement?

Subacromial impingement - also known as subacromial impingement syndrome (SAIS) - is a condition which involves the irritation and inflammation of the rotator cuff tendons where they go through the subacromial space. This leads to pain and a limited range of motion in the shoulder.

The condition can be related to a range of other conditions, including subacromial bursitis, rotator cuff tendinosis and calcific tendinitis, which can all cause wear between the subacromial bursa or supraspinatus tendon and coracoacromial arch.

Subacromial impingement is uncommon in patients under the age of 30. It typically affects those in manual occupations or with active lifestyles.

What causes subacromial impingement?

The main causes of subacromial impingement are; vascular factors, such as when the supraspinatus muscle tendon doesn't have an adequate blood supply; mechanical factors, such as the chafing of the rotator cuff against the acromion's under surface; degenerative factors which affect the rotator cuff with older age; and the thickening of the subacromial bursa.

Symptoms of subacromial impingement

Subacromial impingement is a condition which develops gradually, and as such symptoms arise slowly, too. A slight pain can progress to acute pain and a lack of power in the shoulder. At night, a dull pain can typically be felt, as well as a feeling of tiredness in the shoulder.

The inflammation resulting from subacromial impingement can lead to pain, and so can excessive movement. It is normal for the pain from subacromial impingement to intensify when performing movements which require you to put your hands behind your back or above your head. Subacromial impingement can spread down the arm towards the elbow.

Treatment options for subacromial impingement

As part of the diagnostic process, your doctor is likely to review your medical history and ask you about your exercise habits. They may perform a physical examination, which can involve testing your shoulder for any unusual signs especially when moving your shoulder. Imaging tests, x-rays, ultrasound or a MRI scan may be used in order to rule out other conditions, as well as check for the presence of bone abnormalities.

Conservative treatments for subacromial impingement can include; home care, such as rest and ice treatment to reduce pain and swelling; physiotherapy, including exercises to improve range of motion and strengthen the rotator cuff muscles; modifying activities at work or for sports, in order to put less pressure on the rotator cuff; and medications, including nonsteroidal anti-inflammatory drugs (NSAID).

Surgical treatments can be advised for cases in which the above options have proven ineffective. Surgery is typically focused on opening up the space around the rotator cuff. This can make it less likely to rub or catch. Arthroscopic surgery, which is minimally invasive, can be used, but for more severe cases, open surgery may be required. In cases where the rotator cuff has torn - which are uncommon - surgery which focuses on repairing the rotator cuff as well as opening up the space around the rotator cuff may be required.

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