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PAINFUL ARC SYNDROME
Prashant Badiger
PAINFUL ARC SYNDROME
• Shoulder Impingement Syndrome
• Supraspinatus Syndrome
• Swimmer's Shoulder
• Thrower's Shoulder
PAINFUL ARC SYNDROME
• It is a clinical syndrome which occurs when the tendons of the rotator cuff muscles
become irritated and inflamed as they pass through the subacromial space.
PAINFUL ARC SYNDROME
• Occurs when one of the rotator cuff tendons (supraspinatus) or bursa is pinched
between the humeral head and the undersurface of the acromion.
• This happens because as we raise our arm, the narrow space between the humeral
head and the acromion naturally compresses.
• It is the repetition of such movements that leads to the condition developing,
causing swelling and an excess of fluid in the joint.
Painful Arc Syndrome.pptx
PAINFUL ARC SYNDROME
• Result of painting, carpentry,
construction work or any other jobs
that involve overhead work.
• Take many years before someone
begins to notice the symptoms of the
condition.
CAUSES - BONY STRUCTURES
• Subacromial spurs (bony projections from the acromion)
• Osteoarthritic spurs on the acromioclavicular joint
• Variations in the shape of the acromion.
Painful Arc Syndrome.pptx
Painful Arc Syndrome.pptx
CAUSES
• Thickening or calcification of the
coracoacromial ligament
CAUSES
• Loss of function of the rotator cuff
muscles, due to injury or loss of
strength, may cause the humerus to
move superiorly.
CAUSES
• Inflammation and subsequent
thickening of the subacromial bursa
may also cause impingement.
SIGNS AND SYMPTOMS
• The most common symptoms are:
1. pain
2. weakness
3. loss of movement at the affected
shoulder
SIGNS AND SYMPTOMS
• The pain is often worsened by shoulder
overhead movement and may occur at
night, especially if the patient is lying
on the affected shoulder.
SIGNS AND SYMPTOMS
• The onset of the pain maybe:
1. Acute, due to an injury.
2. Insidious onset, due to a gradual
process like an osteoarthritic spur.
SIGNS AND SYMPTOMS
• Other symptoms:
• Grinding or popping sensation during
movement of the shoulder.
SIGNS AND SYMPTOMS
• The range of motion at the shoulder
may be limited by pain. A painful arc of
movement may be present during
forward elevation of the arm from 60°
to 120°.
SIGNS AND SYMPTOMS
• Passive movement at the shoulder will
appear painful when a downwards
force is applied at the acromion but the
pain will ease once the downwards
force is removed.
DIAGNOSIS
• By history and physical examination
• Neer Test
• Hawkins-Kennedy Test
• X-ray
• Arthrography
• Ultrasonography
• MRI
NEER TEST
• 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.
• Pain Positive test
Painful Arc Syndrome.pptx
HAWKINS-KENNEDY TEST
• Elevate the arm to 90 degrees, bend the
elbow and force the shoulder into
internal rotation, grinding the greater
tuberosity under the coraco-acromial
arch impinging supraspinatus tendon.
• Pain Positive test
Painful Arc Syndrome.pptx
DIAGNOSIS - PLAIN X-RAY
• Joint pathology and variations in the bones,
• Acromioclavicular arthritis
• Variations in the acromion
• Calcification
DIAGNOSIS-MRI
• MRI showing subacromial impingement
with partial rupture of the
supraspinatus tendon.
TREATMENT
1. Stop any activity that can/may aggravate symptoms
2. Medicate with anti-inflammatory medicine
3. REST
4. Gentle stretching exercises
5. Exercises to STRENGTHEN the rotator cuff
6. If all else fails after 6 to 12 months, arthroscopic or open surgery to repair damage
and relieve the pressure on the tendons and bursae
TREATMENT - CONSERVATIVE
• Rest.
• Cessation of painful activity.
• Physiotherapy focused at maintaining range of movement and avoid shoulder
stiffness.
• NSAID's and ice packs may be used for pain relief.
TREATMENT - CONSERVATIVE
• Therapeutic injections of corticosteroid and local anesthetic may be used for
persistent painful arc syndrome.
• The total number of injections is limited to three due to possible side effects from
the corticosteroid like tendon damage.
TREATMENT - SURGERY
• Done arthroscopically or as open surgery.
TREATMENT - SURGERY
• The impinging structures may be removed in surgery.
• The subacromial space may be widened by resection of the distal clavicle and
excision of osteophytes on the under-surface of the acromioclavicular joint.
• Also, damaged rotator cuff muscles can be surgically repaired.
THANK YOU

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Painful Arc Syndrome.pptx

  • 2. PAINFUL ARC SYNDROME • Shoulder Impingement Syndrome • Supraspinatus Syndrome • Swimmer's Shoulder • Thrower's Shoulder
  • 3. PAINFUL ARC SYNDROME • It is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space.
  • 4. PAINFUL ARC SYNDROME • Occurs when one of the rotator cuff tendons (supraspinatus) or bursa is pinched between the humeral head and the undersurface of the acromion. • This happens because as we raise our arm, the narrow space between the humeral head and the acromion naturally compresses. • It is the repetition of such movements that leads to the condition developing, causing swelling and an excess of fluid in the joint.
  • 6. PAINFUL ARC SYNDROME • Result of painting, carpentry, construction work or any other jobs that involve overhead work. • Take many years before someone begins to notice the symptoms of the condition.
  • 7. CAUSES - BONY STRUCTURES • Subacromial spurs (bony projections from the acromion) • Osteoarthritic spurs on the acromioclavicular joint • Variations in the shape of the acromion.
  • 10. CAUSES • Thickening or calcification of the coracoacromial ligament
  • 11. CAUSES • Loss of function of the rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly.
  • 12. CAUSES • Inflammation and subsequent thickening of the subacromial bursa may also cause impingement.
  • 13. SIGNS AND SYMPTOMS • The most common symptoms are: 1. pain 2. weakness 3. loss of movement at the affected shoulder
  • 14. SIGNS AND SYMPTOMS • The pain is often worsened by shoulder overhead movement and may occur at night, especially if the patient is lying on the affected shoulder.
  • 15. SIGNS AND SYMPTOMS • The onset of the pain maybe: 1. Acute, due to an injury. 2. Insidious onset, due to a gradual process like an osteoarthritic spur.
  • 16. SIGNS AND SYMPTOMS • Other symptoms: • Grinding or popping sensation during movement of the shoulder.
  • 17. SIGNS AND SYMPTOMS • The range of motion at the shoulder may be limited by pain. A painful arc of movement may be present during forward elevation of the arm from 60° to 120°.
  • 18. SIGNS AND SYMPTOMS • Passive movement at the shoulder will appear painful when a downwards force is applied at the acromion but the pain will ease once the downwards force is removed.
  • 19. DIAGNOSIS • By history and physical examination • Neer Test • Hawkins-Kennedy Test • X-ray • Arthrography • Ultrasonography • MRI
  • 20. NEER TEST • 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. • Pain Positive test
  • 22. HAWKINS-KENNEDY TEST • Elevate the arm to 90 degrees, bend the elbow and force the shoulder into internal rotation, grinding the greater tuberosity under the coraco-acromial arch impinging supraspinatus tendon. • Pain Positive test
  • 24. DIAGNOSIS - PLAIN X-RAY • Joint pathology and variations in the bones, • Acromioclavicular arthritis • Variations in the acromion • Calcification
  • 25. DIAGNOSIS-MRI • MRI showing subacromial impingement with partial rupture of the supraspinatus tendon.
  • 26. TREATMENT 1. Stop any activity that can/may aggravate symptoms 2. Medicate with anti-inflammatory medicine 3. REST 4. Gentle stretching exercises 5. Exercises to STRENGTHEN the rotator cuff 6. If all else fails after 6 to 12 months, arthroscopic or open surgery to repair damage and relieve the pressure on the tendons and bursae
  • 27. TREATMENT - CONSERVATIVE • Rest. • Cessation of painful activity. • Physiotherapy focused at maintaining range of movement and avoid shoulder stiffness. • NSAID's and ice packs may be used for pain relief.
  • 28. TREATMENT - CONSERVATIVE • Therapeutic injections of corticosteroid and local anesthetic may be used for persistent painful arc syndrome. • The total number of injections is limited to three due to possible side effects from the corticosteroid like tendon damage.
  • 29. TREATMENT - SURGERY • Done arthroscopically or as open surgery.
  • 30. TREATMENT - SURGERY • The impinging structures may be removed in surgery. • The subacromial space may be widened by resection of the distal clavicle and excision of osteophytes on the under-surface of the acromioclavicular joint. • Also, damaged rotator cuff muscles can be surgically repaired.

Notas do Editor

  1. bursa (a flat, fluid-filled membrane that prevents the shoulder parts from rubbing together)
  2. The pain is often worsened by shoulder overhead movement and may occur at night, especially if the patient is lying on the affected shoulder.
  3. Acute, if it is due to an injury Insidious onset if it is due to a gradual process such as an osteoarthritic spur.
  4. Passive movement at the shoulder will appear painful when a downwards force is applied at the acromion but the pain will ease once the downwards force is removed.
  5. Stabilise pt. scapula, then pronate, passively forced forward elevation. this pinches rotator cuff muscles under coraco-acromial arch.
  6. Forward elevation to 90 degrees, bend elbow, internal rotation of humerus This drives greater tuberosity under coraco-acromial arch impinging supraspinatus tendon.
  7. Physiotherapy focused at maintaining range of movement and avoid shoulder stiffness. The main types of NSAIDs include: ibuprofen. naproxen. diclofenac. celecoxib. mefenamic acid. etoricoxib. indomethacin. high-dose aspirin (low-dose aspirin is not normally considered to be an NSAID)
  8. 2. Due to possible side effects from the corticosteroid like tendon damage.