Subacromial impingement is the most common complaint concerning the shoulder joint. It is defined as an irritation of the tendons which compose the rotator cuff as they pass through the subacromial space.
CAUSES Factors involved in injuries to rotator cuff tendons are as follows:
Vascular factors: The tendons which make up the rotator cuff have sufficient vascularisation except the supraspinatus muscle tendon. Supraspinatus vascularisation relies on the contribution of the blood circulation vessels: the anterior circumflex humeral artery, the sub and suprascapular muscle artery and the tendinous ships resulting from the prior anastomosis of the anterior ones. The critical area is a small region located medially at 1cm from the insertion of the rotator cuff, a relatively avascular area. It is from this area that fluids flow through the tendon. This capacity diminishes with age.
Mechanical factors: Neer proved that in the shoulder adduction movement, the rotator cuff chafes against the lower section of the acromion. The mechanical aetiology is aggravated by the presence of an “aggressive” acromion due to its shape or an osteophyte (spur) on its lower side. According to Bigliari, there are three acromion shapes: type I, or flat, which is “benign,” type II (curved) and type III (pointed), which is aggressive.
Another cause of subacromial impingement is the presence of an unfused acromion (“Os Acromiale”), which is a variation on the normal situation whereby the acromion is not fused or in one single piece but is unfused or in two parts, probably because fusion did not occur during childhood. The “Abnormal” movement of this acromion also causes this chafing against the tendons of the rotator cuff.
Thickening of the subacromial bursa is also a factor causing chafing of the structure passing through subacromial space.
Degenerative factors: Degenerative changes to the rotator cuff occur in the over-50 age group, and friction against the acromion aggravates these changes.
SYMPTOMS of Subacromial Impingement
- Insidious and progressive onset of pain
- Gradual loss of shoulder strength –
- Dull, persistent shoulder pain with a sensation of tiredness, especially at night
- Exacerbation of pain with excessive movement
- Radiating pain to the elbow – Intensified pain when raising arms above the head or putting arms behind the back
Faqs For Subacromial Impingement
What are the common causes of subacromial impingement?
Subacromial impingement is commonly caused by irritation and compression of the rotator cuff tendons as they pass through the subacromial space. This can be due to factors such as vascular issues, mechanical factors, unfused acromion, and thickening of the subacromial bursa.
What are the typical symptoms of subacromial impingement?
Symptoms may include insidious and progressive onset of shoulder pain, gradual loss of shoulder strength, dull persistent pain and tiredness, exacerbation of pain with movement, and possible radiating pain to the elbow.
How is subacromial impingement diagnosed?
Diagnosis typically involves a thorough physical examination, imaging tests such as X-rays, MRI, or ultrasound, and possibly a diagnostic injection to confirm the diagnosis.
What treatment options are available for subacromial impingement?
Treatment may include rest, physical therapy, anti-inflammatory medications, corticosteroid injections, and in some cases, surgical intervention to address the underlying causes.
What are the possible complications of untreated subacromial impingement?
Untreated subacromial impingement may lead to worsening pain, loss of shoulder function, and potential damage to the rotator cuff tendons, ultimately requiring more extensive treatments.
Can subacromial impingement be prevented?
Prevention strategies include maintaining good shoulder mechanics, avoiding repetitive overhead activities, and addressing any shoulder pain or discomfort promptly.
What lifestyle changes can help alleviate the symptoms of subacromial impingement?
Avoiding activities that exacerbate shoulder pain, maintaining good posture, and incorporating shoulder-strengthening exercises into the routine can help alleviate symptoms.
Is physical therapy beneficial for subacromial impingement?
Physical therapy can be highly beneficial in strengthening shoulder muscles, improving range of motion, and reducing pain associated with subacromial impingement.
What are the surgical options for subacromial impingement, if needed?
Surgical options may include subacromial decompression, rotator cuff repair, or, in severe cases, joint replacement surgery.
How soon can one expect relief from symptoms with the recommended treatment plan?
Relief from symptoms varies depending on the severity of the condition and the chosen treatment plan. However, many individuals experience improvement with conservative treatments within a few weeks to months.