SHOULDER SYNDROMES
ROTATOR CUFF IMPINGEMENT:
→Rotator cuff tendons are impinged as they pass though the subacromial space (which is formed between
the acromion, coracoacromial arch and the AC joint and GH joint below).
It causes mechanical irritation resulting in:
◦ Swelling
◦ Damage to the tendons / cuff.
Can be divided into:
→ External = further divided into Primary and Secondary).
→ Internal
PRIMARY EXTERNAL IMPINGEMENT:
→Abnormalities from the superior bony / ligamentous structures may lead
to encroachment into the subacromial space from above.
→The under surface of the acromion may be abnormally shaped.
→In older patients –thickening of the coracoacromial arch or osteophyte
formation on the inferior surface of the AC joint.
SECONDARY EXTERNAL IMPINGEMENT
→Encroachment into the subacromial space in younger people may occur due to excessive angulation of
the acromion due to inadequate muscular stabilization of the scapula.
→Serratus anterior weakness/decruitment results in poor control/excessive protraction and (downwards)
rotation of the scapula during GH movement. This results in the acromion not moving away (upwards
rotation) during overhead activities = impingement.
→Excessive humeral head elevation.
→Imbalance between humeral head elevators (Deltoid) and humeral head stabilizers (rotator cuff
muscles).
→This narrows the space under acromion through which RC runs.
, INTERNAL IMPINGEMENT:
→ Mainly in overhead athletes during late ‘cocking’ stage of throwing.
→ Impingement of the under surface of Rotator Cuff occurs against superior posterior surface of Glenoid
→ Rotator Cuff tendinopathy is a condition whereby Rotator Cuff tendons become swollen and
hypercellular, the collagen matrix is disorganized and the tendon is weaker.
IMPINGEMENT SIGNS AND SYMPTOMS:
✓ Pain with overhead activity.
✓ Associated history of instability (recurrent subluxations, episodes of ‘dead arm’)
✓ Palpable tenderness just proximal to supraspinatus insertion
✓ Active painful arc (70°-120°) but has full passive ROM.
✓ Internal rotation (HBB) may be reduced.
ROTATOR CUFF IMPINGEMENT:
→Rotator cuff tendons are impinged as they pass though the subacromial space (which is formed between
the acromion, coracoacromial arch and the AC joint and GH joint below).
It causes mechanical irritation resulting in:
◦ Swelling
◦ Damage to the tendons / cuff.
Can be divided into:
→ External = further divided into Primary and Secondary).
→ Internal
PRIMARY EXTERNAL IMPINGEMENT:
→Abnormalities from the superior bony / ligamentous structures may lead
to encroachment into the subacromial space from above.
→The under surface of the acromion may be abnormally shaped.
→In older patients –thickening of the coracoacromial arch or osteophyte
formation on the inferior surface of the AC joint.
SECONDARY EXTERNAL IMPINGEMENT
→Encroachment into the subacromial space in younger people may occur due to excessive angulation of
the acromion due to inadequate muscular stabilization of the scapula.
→Serratus anterior weakness/decruitment results in poor control/excessive protraction and (downwards)
rotation of the scapula during GH movement. This results in the acromion not moving away (upwards
rotation) during overhead activities = impingement.
→Excessive humeral head elevation.
→Imbalance between humeral head elevators (Deltoid) and humeral head stabilizers (rotator cuff
muscles).
→This narrows the space under acromion through which RC runs.
, INTERNAL IMPINGEMENT:
→ Mainly in overhead athletes during late ‘cocking’ stage of throwing.
→ Impingement of the under surface of Rotator Cuff occurs against superior posterior surface of Glenoid
→ Rotator Cuff tendinopathy is a condition whereby Rotator Cuff tendons become swollen and
hypercellular, the collagen matrix is disorganized and the tendon is weaker.
IMPINGEMENT SIGNS AND SYMPTOMS:
✓ Pain with overhead activity.
✓ Associated history of instability (recurrent subluxations, episodes of ‘dead arm’)
✓ Palpable tenderness just proximal to supraspinatus insertion
✓ Active painful arc (70°-120°) but has full passive ROM.
✓ Internal rotation (HBB) may be reduced.
