Sub acromial Impingement
Sub acromial Impingement
Shoulder pain is a commonly affects middle aged and elderly and could be due to many causes. Shoulder pain should be differentiated from neck pain radiating to shoulder and referred pain from other parts of body like gall bladder or heart.
The typical shoulder pain is felt only upto elbow (does not cross to forearm) and is typically worse on lying on the same shoulder and with overhead activities.
Sub acromial Impingement
The Shoulder is a ball and socket joint, covered by capsule and ligaments that provide stability. The ball is surrounded by a group of 4 muscle- tendons, collectively called the Rotator cuff. The cuff stabilizes the shoulder, rotates the arm and raises the arm. The cuff tendons lie under a bone called acromion, separated by lubricating sac – bursa
Shoulder pain arises, when these tendons are torn, abnormally rub against the bone ( impingement) or if the lubricating bursa is inflamed (bursitis). The capsule itself can get inflamed and contracted producing a stiff & painful condition called frozen shoulder. The moving surfaces of the joints get eroded with age or injury resulting in arthritis. The collar bone joint (AC joint) can result in pain when its become worn out. Pain could also come from calcific depositis in the tendon, irritation of the biceps tendon among other causes.
Impingement
Impingement refers to abnormal rubbing of the tendons against the shoulder blade end ( acromion). This can occur due to weak cuff muscles (age) that are unable to keep the ball contained or due to bony prominences of acromion irritating the tendon.
Symptoms : Pain with overhead activity ( painful arc), reaching back and pain on sleeping on the same side.
Treatment : Initial conservative – physio and sub acromial injections.
Resistant cases : Arthroscopy, debridement, sub acromial bursectomy ( removal of the inflamed bursa) and
acromioplasty (smoothening of the undersurface of the acromion bone to reduce the
irritation on the tendon.