Painful arc syndrome

1. PAINFULL ARCSYNDROME

2. • 1867 FIRSTJARJA
V
A
Y’S
DESCRIBED AS
SUBACROMIAL
BURSITIS
• 1931 CODMAN NOTED
THAT PATIENTS WITH
INABILITY TO ABDUCT
THE ARM HAD
INCOMPLETE OR
COMPLETE RUPTURES
OF THE
SUPRASPINATUS
TENDON

3. • LATER NEER
INTRODUCED
IMPINGEMENT
SYNDROME
THE SUPRASPINITUS
INSERTION INTO
GREATER TUBIROSITY
THAT PASSS BENEATH THE
CORACOACROMIAL ARCH
DURING FORWARD
FLEXION OF SHOULDER
IS SUSCEPTIBLE TO
IMPINGEMENT.

4. • NEER IMPINGEMENT SIGN
WITH THE PATIENT SEATED,
THE EXAMINER RAISES
THE AFFECTED ARM IN
FORCED FORWARD
ELEVATION WHILE
STABILIZING THE
SCAPULA, CAUSING THE
GREATER TUBEROSITY TO
IMPINGE AGAINST THE
ACROMION.
• NEER IMPINGEMENT TEST
SUBACROMIAL INJECTION
OF 10 ML OF 1%
XYLOCAINE. PAIN CAUSED
BY IMPINGEMENT USUALLY
IS SIGNIFICANTLY
REDUCED OR ELIMINATED,
BUT PAIN CAUSED BY
OTHER CONDITIONS (WITH
THE EXCEPTION PERHAPS
OF CALCIFIC TENDINITIS)
IS NOT RELIEVED

6. • Acromial morphology has been implicated as
contributing to impingement.

8. THERE ARE THREE TYPES
• PRIMARY IMPINGEMENT
• SECONDARY
IMPINGEMENT
• SUBCOROCHOID
IMPINGEMENT

9. • PRIMARY
IT IS CLASSIC VERSION AND OCCURS WITHOUT
ANY OTHER CONTRIBUTING PATHOLOGY
DIVIDED
INTO
INTRINSIC
EXTRINSIC

10. • INTRINSIC
STRUCTURES PASSING BENEATH THE
CORACOACROMIAL ARCH BECOME ENLARGED
RESULTING IN ABUTMENT AGAINST THE ARCH
THICKINING OF ROTATOR CUFF
CALCIUMDEPOSITSWITHInROTATOR
CUFF
THICKENING OF SUBACROMIAL
BURSA

11. • EXTRINSIC
WHEN THE SPACE AVAILABLE FOR THE ROTATOR CUFF IS
DIMINISHED SUBACROMIAL SPURRING
ACROMIAL FRACTURE
OSTEOPHYTESOfACROMIOCLAVICULAR
JOINT
EXOSTOSES OF GREATER TUBEROSITY

12. • SECONDARY
IT OCCURS WEN THERE IS INSTABILITY OF THE
GLENOHUMERAL JOINT ALLOWING TRANSLATION OF
HUMERAL HEAD TYPICALLY ANTERIORLY RESULTING IN
CONTACT OF ROTATORY CUFF AGAINST
CORACOACROMIAL ARCH

13. SUBCORACOID IMPINGEMENT
PAIN CAUSED BY
CONTACT BETWEEN
THE ROTATOR CUFF
AND THE CORACOID
PROCESS
MAINLY DUE TO
PROMINENT
CORACOID
WHICH MAY BE
IDIOPATHIC (MOST
COMMON)

14. DIFFERENTIAL DIAGNOSIS
• ACROMIOCLAVICULAR ARTHRITIS
• GLENOHUMERAL ARTHRITIS
• SHOULDER INSTABILITY IN THROWING
ATHLETES
• ADHESIVE CAPSULITIS
• FIBROMYALGIA
• CERVICAL SPONDYLOSIS
• SUPRASCAPULAR NERVE INJURY

15. TREATMENT
•NON OPERATIVE REGIMEN
ANTIINFLAMMATORY
MEDICATION
½ SUBACROMIAL
CORTISONE INJECTION
PHYSIOTHERAPY ON
STRENGTHNING THE
ROTATORY CUFF & FULL
RANGE OF MOVEMENTS

16. • OPERATIVE
ARTHROSCOPIC OR
ANTERIOR
ACROMIOPLASTY

17. • COMPLICATIONS AFTER ACROMIOPLASTY INCLUDE, BUT
ARE NOT LIMITED TO, INFECTION, SEROMA FORMATION,
HEMATOMA, SYNOVIAL FISTULA, BICEPS RUPTURE,
PULMONARY EMBOLUS, ACROMIAL FRACTURE, AND
COMPLEX REGIONAL PAIN SYNDROME. POOR PATIENT
MOTIVATION, POOR REHABILITATION COMPLIANCE, OR A
POORLY DESIGNED REHABILITATION PROGRAM ALSO
CAN LEAD TO FAILURE BECAUSE OF CONTINUED PAIN
AND STIFFNESS.
• WITHOUT QUESTION, THE WORST COMMON
COMPLICATION IS LOSS OF ANTERIOR DELTOID
FUNCTION, WHICH IS CAUSED BY EITHER AXILLARY
NERVE INJURY OR DETACHMENT OF THE DELTOID FROM
THE ACROMION

18. THANK YOU