Shoulder Impingement Syndrome

Walch et al first described the internal impingement as an intraarticular impingement of the rotator cuff in the abducted and externally rotated shoulder. With 90 degrees of both abduction and external rotation, the articular surface of the posterior superior rotator cuff becomes pinched between the labrum and the greater tuberosity.5 The authors separated the labral lesions from SLAP lesions which extended anteriorly to the biceps anchor at the supraglenoid tubercle, concluding that internal impingement may be responsible for a subset of patients with isolated posterior SLAP tears.5

Four muscles that are attached to the shoulder blade make up the rotator cuff. These muscles work together to ensure the shoulder moves and rotates properly. If the muscles become inflamed or torn, you will struggle

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Instability Impingement. This occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. Shoulder instability can be classified into two different types, dislocations and subluxations. Dislocations happen when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma although some people can have these without any injury at all. After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior - this means that the ball pops out the front of the socket. Subluxations are the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very "loose-jointed". Sometimes these happen in just one direction like out the front, "anterior", and other times they happen out multiple directions like the front and back,

DOI: 5/8/2016. Patient is a 48-year old male maintenance operator who sustained a strained shoulder when he was throwing waste metal into a bin.The patient was subsequently diagnosed with left shoulder impingement syndrome with massive tear of the supraspinatus and infraspinatus tendons. MRI report dated 5/28/16 revealed suboptimal examination; massive full-thickness rotator cuff tear involving the entire supraspinatus and infraspinatus tendons with severe medial retraction beyond the level of the glenoid measuring approximately 6.2 cm. Severe fatty atrophy and loss of muscle bulk in the supraspinatus and infraspinatus muscles; large glenohumeral joint effusion with fluid in the subacromial/subdeltoid bursa and subcoracoid bursa; mild to moderate degenerative changes of the glenohumeral joint; severe acromioclavicular joint arthritis with

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

Rotator cuff surgery affects the function of the shoulder. It is very painful injury and there is loss in strength. If the rotator cuff tendon becomes inflamed or is partially torn, it can be painful and will most limit shoulder movement. This injury occurs from a sudden impact, like falling on your arm which might accrue in motocross, snowboarding, playing football, and similar collision sport. Activities that might cause overload to the tendon have a possibility to tear the tendon. Other ways a rotator cuff can tears is from old age and over use over the years.

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

The purpose of this study was to discuss the disable throwing shoulder with a focus on the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. SICK stands for Scapular malposition, Inferior medial border prominence, coracoid pain and palposition, and dykinesis of scapular movement. Appearing on examination as if one shoulder is lower than the other, SICK is asymmetric malposition of the scapula in the dominant throwing shoulder. They are grouped into 3 clinically recognizable patterns of scapular dyskinesis. Type I which is inferior medial scapular border prominence and type II, medial scapular border prominence. While those are 2 most commonly associated with labral pathology, type III is towards impingement and rotator

The supraspinatus muscle is the initial muscle for this movement during the first 15 degrees of its arc and past 15 degrees, the deltoid muscle becomes increasingly more effective at abducting the arm. The supraspinatus muscle is one of the musculotendinous support structures called the rotator cuff that surrounds the shoulder. In addition, it also helps to stabilize the shoulder joint by keeping the head of humerus firmly pressed medially against the glenoid fossa of the scapula. The most common form of injury in the shoulder is rotator cuff tendonitis. It involves the tendon of the supraspinatus muscle, which attaches to the upper portion of the upper portion of the humerus at the shoulder joint. Less commonly, the tendon of the infraspinatus

The shoulder is the most complex joint in the body. It is capable of moving in more than 16,000 positions. Many of its ailments, including the most common ones, involve biomechanical mechanisms that are unique to the shoulder. The most common shoulder problem for which professional help is sought out for is shoulder impingement (Haig 1996). Shoulder impingement is primarily an overuse injury that involves a mechanical compression of the supraspinatus tendon, subacromial bursa, and the long head of the biceps tendon, all of which are located under the coracoacromial arch (Prentice 2001). Impingement has been described as a continuum during which repetitive compression eventually leads to irritation and inflammation that progresses to

Osteoarthritis of the acromioclaviular joint and lateral acromion down sloping with subacromial spur with contact f bursal surface of supraspinatus and infraspinatus with subacromial effusion. Please correlate for evidence of impingement.

Impingement syndrome have two types – external impingement and internal impingement (McKinnis, 2014). External impingement compresses the rotator cuff tendons in the supraspinatus outlet when the arm is elevated (McKinnis, 2014, p. 544). On the other hand, internal impingement is the compression of the posterior capsule and rotator cuff between the humeral head and glenoid when the arm is elevated and rotated (McKinnis, 2014, p. 544). The patient’s history and physical exam are diagnostic for impingement syndrome. To further define the corresponding soft tissue pathologies such as rotator cuff tears, labral tears, and tendinitis, a magnetic resonance imaging (MRI) is utilized (McKinnis, 2014). Hence, MRI is the best radiological

The cause is unknown but it is believed that thickening and contraction of the glenohumeral joint capsule and the consequent formation of adhesions cause pain and loss of movement. It can occur spontaneously or following an injury to the shoulder (rotator cuff injury) or a period of immobilisation. Diagnosis is made upon history and examination, and the main diagnostic test is the patient’s inability to externally rotate the shoulder, other movements such as abduction and internal