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PAINFULL ARCSYNDROME
• 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
• 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.
• 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
• Acromial morphology has been implicated as
contributing to impingement.
THERE ARE THREE TYPES
• PRIMARY IMPINGEMENT
• SECONDARY
IMPINGEMENT
• SUBCOROCHOID
IMPINGEMENT
• PRIMARY
IT IS CLASSIC VERSION AND OCCURS WITHOUT
ANY OTHER CONTRIBUTING PATHOLOGY
DIVIDED
INTO
INTRINSIC
EXTRINSIC
• 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
• EXTRINSIC
WHEN THE SPACE AVAILABLE FOR THE ROTATOR CUFF IS
DIMINISHED SUBACROMIAL SPURRING
ACROMIAL FRACTURE
OSTEOPHYTESOfACROMIOCLAVICULAR
JOINT
EXOSTOSES OF GREATER TUBEROSITY
• 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
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)
DIFFERENTIAL DIAGNOSIS
• ACROMIOCLAVICULAR ARTHRITIS
• GLENOHUMERAL ARTHRITIS
• SHOULDER INSTABILITY IN THROWING
ATHLETES
• ADHESIVE CAPSULITIS
• FIBROMYALGIA
• CERVICAL SPONDYLOSIS
• SUPRASCAPULAR NERVE INJURY
TREATMENT
•NON OPERATIVE REGIMEN
ANTIINFLAMMATORY
MEDICATION
½ SUBACROMIAL
CORTISONE INJECTION
PHYSIOTHERAPY ON
STRENGTHNING THE
ROTATORY CUFF & FULL
RANGE OF MOVEMENTS
• OPERATIVE
ARTHROSCOPIC OR
ANTERIOR
ACROMIOPLASTY
• 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
THANK YOU

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Painful arc syndrome

  • 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
  • 5.
  • 6. • Acromial morphology has been implicated as contributing to impingement.
  • 7.
  • 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
  • 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