بنام خداوند جان وخرد

Injuries to the athletic shoulder(impingement syndrom)Dr.H.SaremiOrthopaedic surgeon, Hand & Shoulder fellowshipHamedan university of medical sciencesHamedan,IRANwww.shoulderclinic.ir

Sport injuriesSport specific injuriesRegional Injuries

Injuries to the athletic shoulderInstabilityImpingement and rotator cuff problemsBiceps labral complex injuriesAc joint injuriesS.c joint injuriesFracturesNeurovascular injuries

Impingement syndromThe term impingement syndrome was fi rst used byNeer in 1972 to describe a condition of shoulderpain associated with chronic bursitis and partialtearing of the rotator cuff. Impingement comes froma Latin root impingo, which means to strikeagainst.

Impingement and rotator cuff problemsSubacromial impingement is one of the most common couse s of shoulder pain in athletes

Rotator cuff

ImpingementOutlet impingementNon outlet impingementAn unstable head that subluxes anteriorly due ro capsular laxity may displace upward against the acromionStabilize the shoulder

Secondary impingement is the most common type of impingement in young athletes

Bigliani classification

Sign &symtomsPain with overhead activities,and internal rotationPartial cuff tear symptoms

Painful arc signPositive howkins sign and neer sign

Impingement syndrom

Cuff arthropathy

Impingement syndromNon operative treatment Operative treatment(arthroscopic)

Non operative treatmentPhysio therapyNASAIDCorticoid injection

Non operative TreatmentSTEP 1 :Avoid repeated injuryWorkSport

Non operative treatmentSTEP 2: Restore normal flexibilityStretch out all the direction of tightnessspecially posterior Most effective by the patientGentle stretched five times a day by patient

To the point of pull of tightness not to the point of painEach stretche for 1 min----30 min a dayObvious improvement---1 m may be 3 m full recovery

Non operative treatmentSTEP 3: Restore normal strenthWhen near normal passive flexibility of the shoulder is restoredInternal and external strenthening excersiseswith the arm at the sideBy the patient

Non operative treatmentDeltoid strengthing is added when it can be performed comfortably

Scapular motors

Non operative treatmentSTEP 4:Perform aerobic exerciseTo get back in shape and improve the sense of well being5 days a week,sweaty ex 30 min

Non operative treatmentSTEP5: Modify work or sportReviewe the technique of sportModifiy the job

Operative treatmentSub acromial decompressionRotator cuff repair

Internal Glenoid impingement

Subcoracoid impingement

longitudinal tear and fraying of subscapularis tendon due to subcoracoid impingement

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