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Subacromial Impingement and Rotator Cuff Disease
The human shoulder has a unique design, depending on the enveloping soft tissues
for motion and stability. The tendons of the rotator cuff pass inferior to the
relatively rigid coracoacromial arch, composed of the acromion,
acromioclavicular joint, and the coracoacromial ligament. Normally, the
subacromial bursae promotes smooth gliding between the two surfaces. Disruption
of this mechanism, in the form of bursitis (inflammation of the bursa),
tendonosis, or a rotator cuff tendon tear, is extremely common and can lead to
shoulder pain and disability. The estimated incidence of rotator cuff tear is
greater than 56% in the population.Once subacromial impingement and/or rotator cuff disease has been identified,
treatment goals for the patient are to improve range of motion and decrease
pain. A treatment regimen includes:
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Anti-inflammatory medications
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Physical
therapy
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A
corticosteroid injection in the subacromial bursa—for those patients who do not
respond to anti-inflammatories and/or physical therapy
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Surgery--indicated only when all of the above conservative measures have failed,
or if there is a history consistent with an acute rotator cuff tear.
For more information, please see
the following articles:
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