Epidemiology Subacromial impingement syndrome

Epidemiology Subacromial impingement syndrome

Subacromial impingement syndrome  
Incidence The incidence of shoulder complaints in Dutch general practice is about 24 episodes per 1000 patient-years.8,9
Prevalence The prevalence approximately 35 patients per 1000 patients per year. 8,9
Sex The annual prevalence of shoulder pain is estimated at 31%. Of this group, approximately 60% are women.8,9
Age The incidence is in the age group older than 20 years is greater for women than for men. The incidence increases with age until the age category of 50-59 years and then gradually decreases. 8,9

An abnormality in the subacromial space is by far the most common cause of shoulder pain (80%). The most common shoulder disorders in the age to 35 years are traumatic lesions of the rotator cuff and dislocations or subluxations of the glenohumeral or acromioclavicular joint. Between the ages of 35 to 75 years mainly non-traumatic rotator cuff damage and aseptic inflammation of subacromial structures occur. The risk of non-traumatic partial or total rupture increases significantly with age.7

Deviations of the subacromial space In the subacromial space we find the subacromial bursa, the tendon of the supraspinatus (part of the rotator cuff), and the long tendon of the biceps. Shoulder complaints which are assumed to be caused by disorders of subacromial structures are in literature described under the names subacromial syndrome, impingement syndrome, painful arc syndrome and periarthritis humeroscapularis (PHS). Shoulder complaints in general practice, are in 80% of cases to abnormalities in the subacromial space, called the subacromial impingement syndrome.2,3,4
Pain location Shoulder joint
1st stadium The first stage of a primary subacromial impingement syndrome is characterized by aseptic inflammation of the tendon tissue, it is a major source of complaints in young adults under 35.4
2nd and 3rd stadium The second and third stages of the syndrome are characterized respectively by partial and complete ruptures of the rotator cuff due to calcification and degeneration, and are the main causes of shoulder pain in patients aged over 35 years.2,3,4
Pain sensation / Symptoms Subacromial impingement normally does not lead to limitations of passive movement, but is often associated with pain (part of) in the active abduction range.1 Pain during the execution of tasks above shoulder height (work or sport) is an indicator for subacromial impingement, as well as problems in the range between 60 ° and 120 ° abduction / elevation.4 Lesions of the rotator cuff may be associated with aseptic inflammation of the subacromial bursa.5 In a study (N = 37), in which patients with a partial cuff rupture (non-perforated cuff) and a bursitis subacromial compared to patients with a complete cuff rupture (perforated cuff) shows that the pain is significantly more severe in patients with a non-perforated cuff.5 In a comparative study (N = 1097) the relationship between self-reported shoulder pain, impairment, disability and findings in MRI, no link was found between pain or limitations and the size or location of complete tears of the rotator cuff, but between the pain or limitations and partial injury of the supraspinatus tendon or subacromial bursitis.6
Literature
  1. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ 2005;331:1124-8.
  2. Browning DG, Desai MM. Rotator cuff injuries and treatment. Prim Care 2004;31:807-29.
  3. Arcuni SE. Rotator cuff pathology and subacromiale impingement. Nurse Pract 2000;25:58, 61, 65-6.
  4. Stevenson JH, Trojian T. Evaluation of shoulder pain. J Fam Pract 2002;51:605-11.
  5. Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromiale bursa and shoulder pain in rotator cuff diseases. J Orthop Res 1998;16:618-21.
  6. Krief OP, Huguet D. Shoulder pain and disability: comparison with MR findings. AJR Am J Roentgenol 2006;186:1234-9.
  7. Winters JC, Van der Windt DAWM, Spinnewijn WEM, De Jongh AC, Van der Heijden GJMG, Buis PAJ, Boeke AJP, Feleus A, Geraets JJXR. Huisarts. Wet 2008:51(11):555-65.
  8. Bot SD, Van der Waal JM, Terwee CB, Van der Windt DA, Schellevis FG, Bouter LM, et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 2005a;64:118-23.
  9. Van der Linden MW, Westert GP, De Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: Klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/ Bilthoven: NIVEL/RIVM, 2004.

 

 Physical Examination

Tests:

Rent Test (rotator cuff tear)

Supine Impingement Test (rotator cuff tear)

Lift-Off Test (subscapularis tear)

Internal Rotation Lag Sign (subscapularis tear)

External Rotation Lag Sign (Supraspinatus/Infraspinatus Tear)

Drop Sign (Infraspinatus, Irreparable Fatty Degeneration of Infraspinatus)

Drop Arm Test (Supraspinatus Tear, Subacromial impingement)

Empty Can Test/Supraspinatus Test (Rotator Cuff Tear)

– All stages of impingement syndrome from bursitis through a Rotator Cuff Tear

Full Can / Supraspinatus Test (Supraspinatus Tear)

Neer test

Hawkins-Kennedy test

Painful arc test

Neer test

Hawkins-Kennedy test

Painful arc test

Empty Can Test and Full Can Test /Supraspinatus Test (Rotator Cuff Tear)

Rent test

Drop arm test

External lag sign

Internal lag sign

Drop Arm Test (Supraspinatus Tear, Subacromial impingement)

Supine Impingement Test (rotator cuff tear)

Lift-Off Test (subscapularis tear)

Physical examination

Shoulder pain with passive movement restriction. This refers to a limitation of motion in externalrotation(exorotation) and / or abduction in passive tests. It is assumed that a limitation of external rotation is associated with an aseptic inflammation of the glenohumeral joint capsule or a degenerative abnormality of the glenohumeral joint.A limitation of the abduction could be related to an aseptic inflammation or degenerative abnormality of a structure in the subacromial space.

Shoulder problems without passive movement restrictions but with a painful motion in the abduction. Here the patient experiences pain during a part of or at the end of the active and / or passive abduction, without restriction of passive range of motion. It is assumed here that one or more structures in the subacromial space are affected.

 

 Evidence Based Practice

Rent Test (Rotator Cuff Tear) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Wolf & Agrawal54 96 97 9
Lyons & Tomlinson33 91 75 6
Supine Impingement Test(Rotator Cuff Tear) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Litaker et al.30 97 9 11
Comment: This study was designed well but retrospectively. The supine test does not appear diagnostic but may have value as a screen since a negative finding may rule out a rotator cuff tear. Further research needs to be performed.
Lift-Off Test (Subscapularis Tear) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Gerber & Krushell11 92 NT 9
Hertel et al.16 62 100 8
Ostor et al.44 NT NT NA
Internal Rotation Lag Sign (Subscapularis Tear) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Hertel et al.16 97 96 8
External Roration Lag Sign (Supraspinatus/Infraspinatus Tear) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Hertel et al.16 70 100 8
Walch et al52 100 100 6
Drop Sign (Infraspinatus, Irreparable Fatty Degeneration of Infraspinatus) Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Hertel et al.16 20 100 8
Walch et al52 100 100 6
Drop Arm Test (Supraspinatus Tear, Subacromiale impingement) Utility 3
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Calis et al.3
Supraspinatus tear 15 100 8
Impingement 8 97 8
Murrell & Walton40 Rotator Cuff Tear 10 98 5
Park et al.46 Impingement or Rotator Cuff Disease 27 88 10
Empty Can Test/Supraspinatus Test (Rotator Cuff Tear,

All stages of Impingement Syndrome from

Bursitis Through a Rotator Cuff Tear

Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Itoi et al.19 (supraspin.) 89 50 9
Park et al.46 Impingement or Rotator Cuff Disease 44 90 10
Ostor et al.44 (suprasp.) NT NT NA
Full Can/ Supraspinatus Test (Supraspinatus Tear) Utility 3
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Itoi et al.19 86 57 9
Test1,2 Sensitivity (show) Specificity (exclude)
Neer test 79% 53%
Hawkins Kennedy test 79% 59%
Painful arc 71% 47%
Empty can test
Stage I impingement 25% 67%
Stage I-III impingement 44% 90%
 Literature
  1. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. E J Hegedus, A Goode, S Campbell, A Morin, M Tamaddoni, C T Moorman, III and C Cook. Br. J. Sports Med. 2008;42;80-92;
  2. Park HB, Yokota A, Gill HS, et al. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005;87:1446-55.
  3. Calis M, Akgun K, Birtane M, Karacan I, Calis H, Tuzun F. Diagnostic values of cinical diagnostic tests in subacromiale impingement syndrome. Ann Rheum Dis. 2000;59:44-47
  4. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389-394
  5. Hertel R, Ballmer FT, Lombert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg. 1996;5:307-313
  6. Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the “full can test” or the “empty can test,” in detecting the torn supraspinatus tendon? Am J Sports Med. 1999;27:65-68
  7. Lyons AR, Tomlinson JE. Clinical diagnosis of tears of the rotator cuff. J Bone Joint Surg Br. 1992;74:414-415
  8. Murrel GA, Walton JR. Diagnosis of rotator cuff tears. Lancet. 2001;357:769-770
  9. Ostor AJ, Richards CA, Prevost AT, Hazleman BL, Speed CA. Interrater reproducibility of clinical tests for rotator cuff lesions. Ann Rheum Dis. 2004;63:1288-1292
  10. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromiale impingement syndrome. J Bone Joint Surg Am. 2005;87:1446-1455.
  11. Walch G, Boulahia A, Calderone S, Robinson AH. The “dropping” and “hornblower’s” signs in evaluation of rotator cuff tears. J Bone Joint Surg Br. 1998;80:624-628.
  12. Wolf EM, Agrawal V. Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears. J Shoulder Elboe Surg. 2001;10:470-473

 

Treatment for Subacromial impingement syndrome

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