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    (ADULT) 30 Desember 2021 Subacromial Impingement

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    1) Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain caused by narrowing of the subacromial space and encroachment of tissues between the humeral head and acromion. 2) It can be caused by extrinsic compression from structures like the acromion or coracoacromial ligament, or intrinsic degeneration of the rotator cuff tendons. 3) Diagnosis involves physical exams like the Neer impingement test and imaging like x-rays and MRI to evaluate the rotator cuff. Treatment ranges from non-operative options like physical therapy to surgery like subacromial decompression.

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    (ADULT) 30 Desember 2021 Subacromial Impingement

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    37 views42 pages
    1) Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain caused by narrowing of the subacromial space and encroachment of tissues between the humeral head and acromion. 2) It can be caused by extrinsic compression from structures like the acromion or coracoacromial ligament, or intrinsic degeneration of the rotator cuff tendons. 3) Diagnosis involves physical exams like the Neer impingement test and imaging like x-rays and MRI to evaluate the rotator cuff. Treatment ranges from non-operative options like physical therapy to surgery like subacromial decompression.

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    1) Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain caused by narrowing of the subacromial space and encroachment of tissues between the humeral head and acromion. 2) It can be caused by extrinsic compression from structures like the acromion or coracoacromial ligament, or intrinsic degeneration of the rotator cuff tendons. 3) Diagnosis involves physical exams like the Neer impingement test and imaging like x-rays and MRI to evaluate the rotator cuff. Treatment ranges from non-operative options like physical therapy to surgery like subacromial decompression.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    37 views42 pages

    (ADULT) 30 Desember 2021 Subacromial Impingement

    Uploaded by

    public newbie
    1) Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain caused by narrowing of the subacromial space and encroachment of tissues between the humeral head and acromion. 2) It can be caused by extrinsic compression from structures like the acromion or coracoacromial ligament, or intrinsic degeneration of the rotator cuff tendons. 3) Diagnosis involves physical exams like the Neer impingement test and imaging like x-rays and MRI to evaluate the rotator cuff. Treatment ranges from non-operative options like physical therapy to surgery like subacromial decompression.

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    You are on page 1of 42

    December, 30th 2021

    SUBACROMIAL
    IMPINGEMENT
    Supervisor:
    Dr. dr. Muhammad Sakti, Sp.OT (K)

    Team:
    ADULT RECONSTRUCTION DIVISION (FM/RW)

    Orthopaedic & Traumatology Department


    Hasanuddin University, Makassar, Sulawesi Selatan
    INTRODUCTION
    • SAIS is an encroachment of the
    subacromial tissues as a result of
    narrowing of the subacromial space
    • the most common disorder of shoulder
    • ± 44-65% of all complaints of shoulder
    pain

    Orthopedic Reviews 2012; volume 4:e18


    https://www.youtube.com/watch?v=o3bIGZijKzY&t=42s
    INTRODUCTION
    • Subacromial space is defined by:
    • the humeral head inferiorly,
    • the anterior edge and under surface of
    the anterior third of the acromion,
    coracoacromial ligament and the
    acromioclavicular joint superiorly.
    • The height of space between acromion
    and humeral head ranges from 1.0 to
    1.5 centimeters as seen on radiographs.

    Orthopedic Reviews 2012; volume 4:e18


    https://www.duncansportspt.com/2015/03/rotator-cuff/
    PATOPHYSIOLOGY
    • subacromial impingement is thought to be a combination of
    • Extrinsic compression
    • of the rotator cuff between the humeral head and
    • anterior acromion
    • coracoacromial ligaments
    • acromioclavicular joint

    • Intrinsic degeneration
    • supraspinatus
    • attrition of the supraspinatus leads to inability to balance the humeral head on
    the glenoid causing superior migration and narrowing of the subacromial
    space

    • inflammatory process
    • inflammation of the subacromial bursa due to abutement between
    the humerus and rotator cuff, and acromion and associated
    ligaments
    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Extrinsic Compression
    • Lateral acromion vs cuff in midarc of abduction
    (Watson – Jones)
    • Rotator cuff and humeral head vs undersurface
    of anterior acromion and CAL (Neer)

    https://www.orthobullets.com/shoulder-and-elbow/3054/internal-impingement
    Harrison AK, Flatow EL. Subacromial Impingement Syndrome. J Am Acad Orthop Surg 2011; 19: 701 – 708
    Intrinsic Degeneration
    • Diminished vascular supply, aging, tensile forces 
    rotator cuff failure
    • Lohr & Uhthoff  zone of hypovascularity in
    supraspinatus  degenerative tendinopathy + tear
    • Weakening of supraspinatus  humeral head
    migrates superior  abutting tuberosity & cuff vs
    acromion  Osteophytes + tuberosity erosion

    Harrison AK, Flatow EL. Subacromial Impingement Syndrome. J Am Acad Orthop Surg 2011; 19: 701 – 708
    NEER (three stages of impingement lesions)

    https://link.springer.com/chapter/10.1007/978-1-4471-6572-9_33
    https://journals.lww.com/clinorthop/citation/1983/03000/impingement_lesions.10.aspx
    ASSOCIATED CONDITION
    • hook-shaped acromion
    • os acromiale
    • posterior capsular contracture
    • scapular dyskinesia BIGLIANI Classification
    • tuberosity fracture malunion
    • instability

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    DIAGNOSIS
    • SYMPTOMS : PAIN
    • PHYSICAL EXAMINATION

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    DIAGNOSIS: Physical Examination
    • Neer impingement sign
    • Neer impingement test
    • Hawkins test
    • Jobe test
    • Painful Arc Test
    • Yocum Test
    • Internal Impingement test

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Neer Sign
    Hawkin’s Test
    Jobe Test
    Painful Arc
    Yocum Test
    IMAGING
    • Conventional X-Ray
    • true AP of the shoulder
    • 30° caudal tilt view
    • supraspinatus outlet view
    • axillary lateral

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    IMAGING
    • Conventional X-Ray
    • true AP of the shoulder
    • 30° caudal tilt view
    • supraspinatus outlet view

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    IMAGING
    • MRI
    • degree of rotator cuff pathology
    • subacromial and subdeltoid bursisits
    • CT arthography
    • can also accurately image the rotator
    cuff tendons and muscle bellies
    • Ultrasound
    • can also accurately image the rotator
    cuff tendons and muscle bellies

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Presentation
    Pain in the right shoulder with difficulties in raising the arm

    https://radiopaedia.org/cases/subacromial-impingement-1
    MANAGEMENT
    • Non-operative
    • physical therapy,
    • oral anti-inflammatory
    medication,
    • subacromial injections (CS, PRP)
    • Operative
    • subacromial decompression /
    acromioplasty

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Arthroscopic Surgery
    Open anterior acromioplasty

    Campbell’s, 2021
    COMPLICATIONS
    • Deltoid dysfunction
    • resulting from a failed deltoid repair following an open
    acromioplasty or an excessive acromionectomy during an
    arthroscopic procedure
    • secondary to direct excision of an os acromiale
    • Anterosuperior escape
    • avoid acromioplasty and CA ligament release to preserve the
    coracoacromial arch in patients with massive, irreparable
    rotator cuff tears

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    QUIZ
    #1

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Preferred response: 4
    (Will likely have no effect on pain, function or range of motion at one year, compared to therapy alone)

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    #2

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Preferred response: 2 (Metalloproteases)

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    #3

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    Preferred response: 3 (Meso os acromiale)

    https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement
    THANK YOU
    https://youtu.be/-DT4VMkDETI
    https://www.orthobullets.com/shoulder-and-elbow/3054/internal-impingement
    A brief review in anatomy…

    Netter’s Concise Orthopaedic Anatomy, 2nd Ed.


    Rockwood Matsen
    • 816
    Rockwood Matsen
    •?
    Rockwood Matsen
    1159
    https://www.physio-pedia.com/index.php?title=Classification_of_Shoulder_Pain&veaction=edit&section=11
    https://www.physio-pedia.com/index.php?title=Classification_of_Shoulder_Pain&veaction=edit&section=11
    https://somepomed.org/articulos/contents/mobipreview.htm?24/19/24882

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