Shoulder impingement syndrome

An analysis of the results of 53 patients treated by an open Neer decompression for chronic impingement of the shoulder is presented. Patients were evaluated pre- and post-operatively on the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength and patient satisfaction. After an average period of 27.3 months, good or excellent results were found in 81.1%. Satisfactory results (according to Neer) were found in 94.3%. Differential diagnosis of acromioclavicular pathology and cervical syndromes is important.     

Shoulder impingement presenting as neck pain

BACKGROUND: Chronic neck pain can be a difficult problem to evaluate and treat, as it can have several different causes. We studied a series of patients with neck pain near the superomedial aspect of the scapula that was referred pain from inflammation of the shoulder secondary to chronic impingement. We postulate that some patients with specific clinical findings and neck pain can benefit from treatment of shoulder impingement. METHODS: We conducted a retrospective review of the charts of thirty-four patients with neck pain who met three criteria for the diagnosis of shoulder impingement syndrome: (1) a positive impingement sign with pain referred to the neck, (2) radiographic abnormalities, and (3) relief of neck pain after injection of lidocaine and cortisone into the subacromial space. Subjective pain scores were determined before and after the injection. RESULTS: Thirty of the thirty-four patients obtained immediate relief of the neck pain following injection into the subacromial space, and the remaining four had substantial pain relief when they were evaluated three weeks following the injection. Avoidance of the shoulder impingement position (forward elevation of the arm above 90 degrees ) subsequently minimized recurrences. CONCLUSIONS: In selected patients, chronic neck pain may be caused by shoulder impingement, which can be easily diagnosed with standard techniques. The difficulty in making this diagnosis is that the patient presents with neck pain rather than with the typical shoulder pain. The differential diagnosis of chronic lower neck pain should include shoulder impingement syndrome, which can be identified by classic physical and radiographic signs and can be treated with injection into the subacromial space and avoidance of the shoulder impingement position.     

Shoulder impingement syndrome. A critical review

Impingement syndrome is an ill-defined term for a variety of disorders of the shoulder that manifest as anterior shoulder pain, especially during overhead activities. These disorders each have a common pathologic course that includes rotator cuff tendinitis (RCT), and, if untreated, may proceed to cuff rupture. RCT has at least two distinct etiologies. Primary impingement of the supraspinatus tendon on the coracoacromial arch is responsible in the majority of nonathletic cases. Overhead movements in sports are prone to developing secondary mechanical impingement because of an instability pattern that is common in this population. Information from this review and clinical practice permits differentiation of the two distinct etiologies of RCT which is important in treatment planning. Much work still needs to be done in defining the microscopic pathology of RCT.     

Shoulder impingement syndrome in athletes treated by an anterior acromioplasty

Shoulder pain caused by a impingement syndrome commonly affects an athlete's performance. Thirty-five shoulders in 33 athletes had an impingement syndrome treated by an anterior acromioplasty after failure of conservative treatment. Thirty-one of 35 shoulders (89%) were subjectively judged improved by the patients from their preoperative status. The moderate and severe pain was reduced from 97% of the shoulders preoperation to 20% postoperation. The pain at rest and with activities of daily living was reduced from 71% of the shoulders preoperation to 9% postoperation. However, only 15 of 35 operated shoulders (43%) allowed return to the same preinjury level of competitive athletics, and only four of 18 athletes involved in pitching and throwing returned to their former preinjury status. This operation is satisfactory for pain relief but does not allow an athlete to return to his former competitive status. A prolonged rehabilitation program may improve the results.     

Shoulder rhythm in patients with impingement and in controls: Dynamic RSA during active and passive abduction

Background and purpose Impingement syndrome is probably the most common cause of shoulder pain. Abnormal abduction and proximal humeral translation are associated with this condition. We evaluated whether the relative distribution between glenohumeral and scapular-trunk motions (the scapulohumeral rhythm) and the speed of motion of the arm differed between patients with impingement and a control group without shoulder symptoms.Patients and methods 30 patients with shoulder impingement (Neer stage 2) and 11 controls were studied during active abduction and 21 patients and 9 controls were studied during passive abduction. Dynamic RSA at a speed of 2 simultaneous exposures per second was used to record the shoulder motions for 5–6 seconds.Results Within the interval statistically evaluated (observations between 20–55° of relative active abduction in the glenohumeral joint), the patient group showed more scapular and trunk motions (p = 0.04), especially at up to 40°. The pattern of motion at passive abduction was somewhat similar to that in the controls.Both controls and patients showed an increasing absolute (i.e. global) proximal displacement of the center of the humeral head with increasing active and passive abduction of the glenohumeral joint and humerus, without any certain difference between the groups. The mean maximum absolute proximal displacement in the patient and control groups amounted to about 30 mm and 20 mm, respectively. The corresponding relative displacement (with fixed scapula) was only 2.0 and 0.5 mm.Active abduction was initiated with angular velocity of about 50 and 80 degrees per second, respectively, in the patients and the controls. In both groups it decreased with progressing abduction down to about 20 degrees per second (controls) after 3 seconds without there being any statistically significant difference. The angular velocities at passive abduction showed a similar pattern, still without any difference.In both groups, the speed of proximal translation during active abduction peaked 0.5–1 second later than the speed of rotation and remained relatively even for about 1 second, followed by a deceleration.Interpretation We found that the glenohumeral-thoracoscapular ratio during abduction of the arm in our study, measured as the distribution of motion between the glenohumeral joint and the trunk in both controls and patients with impingement, was less than or equal to 1:1. This finding differs from earlier results, probably due to the use of a method with high resolution and small influence of motions out of the frontal plane. The reason for reduced glenohumeral motions in the early phase of active abduction in the patient group is uncertain, but pain or avoidance of pain elicited by the motion was probably of importance.     

Ischiofemoral impingement

Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised impingement-type condition around the hip - ischiofemoral impingement. This is caused by abnormal contact between the lesser trochanter of the femur and the ischium, and presents as atypical groin and/or posterior buttock pain. The symptoms are gradual in onset and may be similar to those of iliopsoas tendonitis, hamstring injury or bursitis. The presence of ischiofemoral impingement may be indicated by pain caused by a combination of hip extension, adduction and external rotation. Magnetic resonance imaging demonstrates inflammation and oedema in the ischiofemoral space and quadratus femoris, and is distinct from an acute tear. To date this has only appeared in the specialist orthopaedic literature as a problem that has developed after total hip replacement, not in the unreplaced joint.     

股骨髋臼撞击综合征

骨关节炎是一个多病因引起的疾病,常累及髋关节。老年性髋关节骨关节炎患者的发病机制是在长期轴向负荷作用下关节软骨发生退行性的改变。临床上也可见到部分成年人及经常运动的年轻人表现出髋关节炎症状,用传统的发病机制不能得到满意的解释。Ganzetal提出股骨髋臼撞击综合征（femoro—acetabularimpingement,FAI）可能是导致原发性髋关节炎的重要原因。     

股骨髓臼撞击综合征

近年来学者们注意到一些中年人及喜爱运动的年轻人表现出来的髋关节疼痛无法用传统的发病机制解释.直到2003年Ganz等[1]首先提出了由于存在髋臼以及股骨近端的形态结构异常,在髋关节运动终末期发生股骨头颈和髋臼的异常碰撞,导致髋臼、盂唇及软骨损伤,从而引发髋关节疼痛症状,且持续发展并导致髋关节的退变,即股骨髋臼撞击综合征(femoroacetabular impinge-ment,FAI).     

Femoroacetabular impingement

Evidence is emerging that subtle morphologic abnormalities around the hip, resulting in femoroacetabular impingement, may be a contributing factor in some instances to osteoarthritis in the young patient. The morphologic abnormalities result in abnormal contact between the femoral neck/head and the acetabular margin, causing tearing of the labrum and avulsion of the underlying cartilage region, continued deterioration, and eventual onset of arthritis. Nonsurgical treatment typically fails to control symptoms. Surgical management involves dislocation of the hip (while preserving the blood supply to the femoral head) and femoroacetabular osteoplasty. Encouraging results have been reported following femoroacetabular osteoplasty and arthroscopic treatment of femoroacetabular impingement.     

Shoulder rotator strength in patients with stage I-II subacromial impingement: relationship to pain, disability, and quality of life

The purpose of this study was two-fold: to determine the shoulder rotator strength in patients with stage I and II subacromial impingement syndrome and to explore its relationship with pain, disability, and quality of life. Thirteen patients with at least 2 positive tests (Neer, Hawkins, painful arc) on the dominant side and 25 unaffected control subjects were included. All individuals had an intact rotator cuff bilaterally, as evaluated by sonography. Isokinetic testing of the shoulder internal and external rotators was performed using Biodex System 3 during concentric/concentric shoulder rotations at a velocity of 60 degrees /s in the scapular plane. The Shoulder Pain and Disability Index, Simple Shoulder Test, and Nottingham Health Profile were self-reported by all subjects. Peak torque values of patients were found to be indifferent from those of controls'. External and internal rotation strength were negatively correlated with pain (r = .63, r = .66, P < .05). In spite of shoulder pain and disability, general health in stage I and II impingement patients did not show any deterioration.     

Costo-iliac impingement syndrome

A syndrome of back and loin pain produced by impingement of the lowest rib against the iliac crest is described in six patients. All had noticed a significant loss of height and five had osteoporosis of the vertebral column. It is suggested that mechanical irritation of the lowest rib against the iliac crest was the cause of the pain and that subperiosteal resection of the outer two-thirds of the rib would stop this irritation and relieve the symptoms. The six patients who underwent resection of the twelfth rib all obtained relief of symptoms; in one patient the eleventh rib also was resected. At latest review 5 to 34 months postoperatively there has been no recurrence of symptoms.     

The subcoracoid impingement

Researchers must gather all anatomic and clinical information and evaluate the results of various imaging techniques and operative procedures if more is to be learned about anteromedial subcoracoid or coracohumeral impingement. Although the impingement syndrome constitutes an anatomic and clinical entity, more must be learned about the pathogenesis to arrive at well-founded surgical solutions.     

Meniscal impingement syndrome

The meniscal impingement syndrome consists of three elements: impaction on the anterior medial femoral condyle by the leading edge of the medial meniscus, articular cartilage damage of at least Outerbridge grade 3, and knee hyperextension of at least 5°. This report reviews this condition in a series of seven knees with an average follow-up of 39 months. The time from the onset of symptoms until surgery averaged 45 months. Treatment consisted of a thorough arthroscopic knee evaluation and debridement of the articular cartilage fragmentation and any impinging synovitis. Postoperative rehabilitation includes extension block bracing, hamstring strengthening, and closed-chain exercise. With this regimen, there was improvement in the Tegner scores and a reduction in postoperative knee hyperextension. Identification of this uncommon condition requires a complete evaluation of the medial femoral condyle in patients with knee hyperextension.     

Ulnar impingement syndrome

We report the ulnar impingement syndrome, which is caused by a shortened ulna impinging on the distal radius and causing a painful, disabling pseudarthrosis. Of the 11 cases reported, 10 were due to excision of the distal ulna after injury to the wrist; the other was a result of a growth arrest after a fracture of the distal ulna in a child. The symptoms are a painful, clicking wrist and a weak grip; clinical examination reveals a narrow wrist with pain on compression of the radius and ulna and on forced supination. Radiographs in the majority of cases show scalloping of the distal radius corresponding to the site of impingement. The mechanism by which ulnar impingement occurs after radio-ulnar convergence is illustrated. The plan of management for the young patient with traumatic dysfunction of the distal radio-ulnar joint is discussed; excision of the lower end of the ulna is not advised in such patients.