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160: SUBACROMIAL IMPINGEMENT SYNDROME

W. Justin Jones, DPT, PT, OCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Impingement syndrome shoulder

  • Shoulder impingement

  • Subacromial compression

ICD-9-CM CODE1

  • 726.19 Other specified disorders of bursae and tendons in shoulder region

ICD-10-CM CODE2

  • M75.80 Other shoulder lesions, unspecified shoulder

PREFERRED PRACTICE PATTERN3

  • Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

A 43-year-old male presents to the OP PT clinic with complaints of right shoulder pain. The patient states it has been bothering him for about 4 weeks. He describes the pain as more of a discomfort. He denies any cervical pain and any radicular symptoms in the arms. He thinks it began when he was throwing a Nerf football with his 10-year-old son. The football does not weigh very much and he says he has to throw the ball hard when passing. If he does not use the arm overhead the shoulder does not bother him much. The patient has good strength throughout the shoulder and is negative for an empty can test and acromioclavicular (AC) compression test.

KEY FEATURES

Description

  • Shoulder pain and dysfunction due to compression and abrasion of one or more of the rotator cuff tendons, the long head of the bicep tendon, and/or the subacromial bursa beneath the coracoacromial arch due to an abnormal mechanical relationship.

  • The coracoacromial arch consists of the undersurface of the acromion, coracoacromial ligament as well as the undersurface of the AC joint.

  • Impingement is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms, which can impact both treatment and prognosis.

FIGURE 160-1

Evaluating for impingement of the supraspinatus tendon with the “empty can” test. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 160-2

A and B. Palpation and location of the subdeltoid portion of the bursa. (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Multifactorial and thought to be related to intrinsic and/or extrinsic mechanisms

    • Extrinsic mechanisms (extratendinous, cause decreased subacromial space and subsequent microtrauma with repetitive movements)

      • Mechanical wear under the coracoacromial arch

      • Aberrant movement patterns due to rotator cuff and or periscapular muscular dysfunction

      • Capsular abnormalities

        • Capsular tightness (particularly posterior capsule)

        • Capsular laxity (poor humeral head dynamic control)

      • Suboptimal posture

        • Muscle imbalances

      • Overuse/repetitive motions occurring above 90 degrees of elevation

    • Intrinsic factors (directly associated with the narrowing of the subacromial space)

      • Vascular supply/changes to the cuff tendons

      • Acromial morphology ...

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