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Subacromial Impingment / Impingment Syndrome

This is also called swimmer's shoulder ot tennis shoulder

In this condition there is impingement of the rotator cuff tendons on the undersurface of the acromion bone causing pain, weakness and difficulty in raising arm overhead. This is due to the activities persay or be associated with a bent-type acromion bone called curved/hooked acromion. If it continues, the Rotator cuff muscles get torn finally.

This happens in certain positions of the shoulder as in swimming, sports with overhead activities like tennis/shuttle/badminton etc.. this is more possible in the presence of a predisposing hooked type of acromion bone which narrows the space for the muscles to freely glide about.

Patients complaint of pain with activities, pain in provoking position (called impingement position), pain at rest, weakness of the arm and difficulty in overhead abduction movement.

The first line of treatment includes Rest, arm sling (if needed), Ice application/contrast bath and avoiding sports. The second line of treatment includes one to three episodes of cocktail injection of Intraarticular steroid injections admixed with a long- and short-acting local anaesthetic. Surgery is the last line of management.

Injections are the bridging treatment between conservative and surgical management. The purpose is to reduce inflammation and provide pain relief.

Open/arthroscopic subacromial decompression is performed to lavage the joint, excise the subacromial bursa and also flatten the undersurface of the acromion and remove the bony spur causing impingement. If cuff tears are identified, they are repaired concomitantly.