Shoulder Impingement Syndrome:

Hassan Shawky Elsaka

Rotator cuff tears and tendinopathy are a common presentation to the shouldersurgeon, impingement was initially considered to be a problem arising from the antero-lateral acromion causing extrinsic pressure on the superior surface of the supraspinatustendon.Recently it is a multifactorial condition that involves both extrinsic factors, such ascompression of the tendon, intrinsic factors such as hypoxia and collagen degenerationwith risk factors including some occupations and sporting activities.It is a common diagnosis from the late fourth decade onwards, the diagnosis inyounger patients should be undertaken with caution to rule out more common conditionssuch as subtle instabilityThe standard orthopedic practice of ‘look, feel, and move’ should be utilized inmaking the diagnosis. Diagnosis should be apparent from the history and examinationalone in the majority of patients using the specific tests. The use of injectiontherapy and specific radiology is used as adjuncts in the confirmation of the diagnosis.Treatment include analgesia and physiotherapy to improve muscle tone and proprioceptionmay be all that some patients require, however some may benefit from asingle or repeated injections.Many patients, however need surgical interference in the form of complete decompressionof the tendon over the entire depth and width of the acromion, excision ofthe bursa and division of the coracoacromial ligament. This can be carried out as anopen procedure but generally the arthroscopic technique has gained favour