Shoulder Impingement Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes shoulder impingement syndrome. Shoulder impingement can have many symptoms and there are many shoulder impingement tests and exercises that can be done. Shoulder impingement treatment and shoulder impingement surgery is explained .bankart lesion is shown .shoulder examination and rehab is shown .shoulder animation is also shown.
This is a common source of pain in the shoulder; you’ll find it in about 50% of the patients who come to the doctor with a complaint of shoulder problem.
Sometimes we call it cuff tendonitis, or shoulder bursitis, the patient is more familiar with shoulder bursitis, so we use that term.
It’s really an irritation of the rotator cuff and it can lead to break down and tear of the tendon.
It could be an overuse syndrome.
Shoulder anatomy:
- Scapula
- Glenoid
- The head of the humerus
- The rotator cuff muscles inserted into the greater tuberosity
- Above it is the bursa
- Above that is the acromion
You can see the shoulder joint different than the area where the bursa is, and in this dynamic view, as you lift the arm up, the tendons can be easily irritated, because there is bone above these tendons, and bone below these tendons, and as these tendons squeeze and irritate, it cause pain.
You diagnose this case by starting with the history:
Pain in the shoulder that increase by overhead activity.
If the patient has mild pain, probably non-operative treatment will not work, it’s probably a cuff tear.
Examination:
- Warn the patient before moving the arm.
- These are called impingement tests.
- The whole idea with this test the head of the humerus will rise up and squeeze the tendons, and the patient will have pain and will stop lifting the arm up, and keep in mind; these tendons can progress to a full thickness cuff tear with the continuation of the irritation.
- Neer impingement sign: is when you get the impingement.
- Neer impingement test: when the pain is relieved after injecting numbing medication.
- Hawkin’s sign: bring the greater tuberosity under the acromion will lead to impingement.
Imaging:
- X-rays can show the bone spur of the acromion which is a prominence on the under surface of the acromion.
- This spur digs into the cuff.
- We get the true anteroposterior view x-ray.
- Get the scapular Y view lateral.
- The supraspinatus outlet view.
- MRI: is helpful as well.
Treatment:
• Non-operative treatment:
- NSAIDS
- Physiotherapy
- Subacromial injection: numbing medicine and cortisone
• Surgery: when do we do surgery?
- We do the surgery when you fail conservatively for about 4-6 months
- The surgery outcome is not as good usually with worker’s compensation claims.
- So we’ll shave the under surface of the acromion to make more room, we call that: subacromial decompression.
- If there is pain from the AC joint associated with the impingement, then you probably need to excise the outer part of the clavicle.
- You got the biceps next to the impingement, is connected to the rotator cuff associated tendonitis, then you may want to work on the biceps like biceptinotomy or biceps tenodesis.
The result of surgery is usually very good if you have:
- The proper patient.
- The proper clinical situation.
- Proper diagnosis.
- Positive injection test.
After surgery you give the patient a sling for few days, patient will return to normal daily activity in a day or two, in two weeks the patient will be able to lift the arm above the head.
At two months, the patient will have a near normal condition.
Complications of surgery:
- Usually it involve the deltoid, deltoid disruption, either the doctor will do acromionectomy, or excise an OS and that will lead to deltoid dysfunction.
- In the OS excision, you may Want that to heal first then later on you do the acromioplasty, axidently you will see that OS in an axillary view.
- Another complication is if you excise the CA ligament, in a patient with a massive cuff tear, in these type of patients, try to avoid the acromioplasty and the coracoacromial ligament release to preserve the coracoacromial arch.
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