By Chris Pullen

Shoulder Impingement

Clinical Features

• Pain– nocturnal ++– overhead activities– unable to sleep on involved side

• Painful arc (70-120°)• Impingement signs

– Neer– Hawkins

Investigations 1

• Plain XR– AP, Lateral & Outlet view

• USS• MRI• Arthrogram• CT scan

Investigations 2

Investigations 3

Investigations 4

Management

• Non - operative– NSAID– Physiotherapy– Sub-acromial injection

• Operative– Open– Arthroscopic

Non – Operative Treatment

• 3 month rehabilitation programme• Physiotherapy

– scapular muscle strengthening – posterior capsular stretching– US

• Success 33-92%

Arthroscopic Treatment 2

Advantages• less surgical morbidity• decreased hospitalization time• quicker rehab• direct visualization of GH joint • smaller scar

Arthroscopic Treatment 3

Arthroscopic Treatment 4

Arthroscopic Treatment 5

Conclusion

• Common condition• Diagnosis usually made on examination

findings & XR ( not USS) • 3/12 of non-operative treatment may be

helpful• Arthroscopic techniques have significant

benefits when surgery is required

THE END