Shoulder Impingement
SHOULDER IMPINGEMENT
There are 2 main causes of impingement in shoulder :
- Subacromial impingement
- Subcoracoid Impingement
- Shape of the acromion
- osacromiale
- contracture of posterior capsule
- scapular dyskinesia
- malunited tuberosity fractures
- Type I – Flat
- Type II – Curved
- Type III – Hooked, Type III is most commonly associated with Subacromial impingement.
- Positive Neer’s impingement sign
- Neer’s impingement test:
- Hawkin-Kennedy test
- Radiographs
- True AP view of the shoulder (Grashey view): it is very useful in accessing the acromiohumeral interval. Normally it is between 7-14 mm. anything less than this predisposes to impingement.
- 30° caudal tilt view: this is a useful view in determining subacromial spurring.
- supraspinatus outlet view: very useful in accessing acromial morphology
- MRI
- CT arthography
- Ultrasound
- Nonoperative
- It is always used as first line and mainstay of treatment of isolated subacromial impingement. When it is associated with rotator cuff tear subacromial steroid injection is not indicated.
- Physiotherapy includes rotator cuff strengthening exercises and periscapular muscle strengthening and stabilization protocol.
- Operative
- surgery is performed under general anesthesia
- lateral or beech chair position is used
- first anterior acromionectomy is performed
- the anterior deltoid origin determines the extent of the acromionectomy and it must remain intact.
- Is outdated and not being used now a days.
- Radiographs: shows reduced coracohumeral distance.
- CT scan:
- This is done with arms crossed over chest
- coracohumeral distance of less than 6 mm is abnormal finding
- normally coracohumeral distance is around 8.5 mm with arm adducted and 6.5 mm with arm in flexion.
- MRI:
- This is used to access soft tissue pathology
- it shows increased signal at subscapularis muscle, sometimes may show complete tear with subluxation of biceps tendon.
- axial view can be used measure coracohumeral distance.
- Nonoperative
- It is always used as first line and mainstay of treatment of isolated subcorocoid impingement. When it is associated with rotator cuff tear subacromial steroid injection is not indicated.
- Physiotherapy includes stretching exercises and periscapular muscle strengthening and stabilization protocol.
- Operative
- surgery is performed under general anesthesia
- lateral or beech chair position is used
- Resection of posterolateral part of coracoid to create a 7 mm of coracohumeral distance.
- If there is significant subscapularis tendon tear then it has to be repaired.
- Is outdated and not being used now a days because of advancement in arthroscopic procedures.
- Resection of lateral aspect of coracoid process and the conjoined tendon is reattached to the remaining coracoid.
Our Result
After suffering from ACL injury, I have always been in lot of pain and instability. I was going to give up on playing football but since I got my treatment done by Dr Nagendra Prasad I am back on the field with full confidence.
rakesh kumar
Dr Prasad is the best surgeon I have ever met. Seriously, the guy is genius and has hands of gold. I can’t thank him enough for how he helped me when I was at my worst time after sustaining ligament injury.
Minakshi Tomar
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