Rotator Cuff Impingement Syndrome
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- Compression of rotator cuff tendons and subacromial bursa between the humeral head and the structures comprising the coracoacromial arch and proximal humerus
- Most common cause of atraumatic shoulder pain in patients >25 years of age
- Primary symptom is pain that is most severe when the arm is abducted between 60 and 120 degrees (the “painful arc”).
- Classically divided into three stages:
- Stage I: acute inflammation, edema, or hemorrhage of the underlying tendons due to overuse (typically in those age <25 years)
- Stage II: progressive tendinosis that leads to partial rotator cuff tear along with underlying thickening or fibrosis of surrounding structures (commonly, ages 25 to 40 years)
- Stage III: full-thickness tear (typically in patients age >40 years)
- Shoulder pain accounts for 1% of all primary care visits.
- Peak incidence of 25/1,000 patients per year occurs in patients aged 42 to 46 years.
- Impingement responsible for 18–74% of shoulder pain diagnoses
Prevalence of shoulder pain in general population ranges from ~7% to 30%.
- Repetitive overhead motions (throwing, swimming)
- Glenohumeral joint instability or muscle imbalance
- Acromioclavicular arthritis or osteophytes
- Thickened coracoacromial ligament
- Shoulder trauma
- Increasing age
- Proper throwing and lifting techniques
- Proper strengthening to balance rotator cuff and scapula stabilizer muscles