Case Manager's Corner

Mechanism of Injury:

Rotator cuff compression between the humeral head and the coracoacromial arch during repetitive overhead activities initially leading to bursitis within the subacromial space. May be posttraumatic and related to rotator cuff tendonitis or tearing.

Subjective Symptoms:

Painful forward elevation of the arm above the shoulder level. The pain is usually anterior or lateral over the deltoid. Often associated with difficulty sleeping on the affected side. May be associated with weakness and motion loss.

Objective Signs:

Painful arc of motion between 70-120 degrees of forward elevation, positive impingement findings with reproduction of pain with the arm passively elevated above the shoulder level (Neer's and Hawkin's signs). Positive impingement test (pain relief after a Lidocaine injection into the subacromial space). May be associated with rotator cuff weakness and motion loss. XR may show congenital or acquired spur formation of the acromion or distal clavicle.

Natural History:

Untreated without interruption of the precipitating cause, impingement syndrome can progress through 3 stages, ranging from simple and reversible inflammation to irreversible rotator cuff tendonitis and tearing.

Nonsurgical:

Temporary elimination of the precipitating cause, NSAIDs, physical therapy emphasizing glenohumeral and scapulothoracic strengthening and posterior capsular stretching, possibly a cortisone injection directly into the subacromial space.

Surgical:

Shoulder arthroscopy and subacromial decompression followed by short-term physical therapy.

Nonsurgical:

Approximately 6-8 weeks

Limit overhead activities

Surgical:

Approximately 8-12 weeks

Light duty 1-2 weeks postoperativety
Limit overhead activities