Professional articlesThe Aetiology of Subacromial Impingement Syndrome
Introduction
Subacromial impingement syndrome (SIS) is a general term used to describe a variety of conditions that may act independently or in combination, and manifest as anterior or anterior-lateral-superior shoulder pain. SIS occurs as a result of pathology of one or more of the structures located within the subacromial space. The pain is associated with a loss of shoulder function, especially during overhead activities, occurring during vocational, sporting or the normal activities associated with daily living.
The subacromial space has also been termed the acromio-humeral joint or the bursal joint (Wiles, 1955), the supraspinatus outlet (Neer and Poppen, 1987), and the suprahumeral space (Calliet, 1991). These names reflect the borders and contents of this region. The superior border is the coracoacromial arch, comprising the inferior surface of the acromion, the coracoacromial ligament and the coracoid process. The inferior border comprises the greater tuberosity and superior aspect of the head of the humerus. Petersson and Redlund-Johnell (1984) in a series of 175 radio-graphs reported that the mean distance between the inferior border of the acromion and the superior border of the humerus in an anteroposterior projection was between 9 to 10 millimetres (mm).
Located within the subacromial space are the tendons of the rotator cuff and the long head of biceps, the subacromial/subdeltoid bursa and the superior capsule of the glenohumeral joint. During elevation of the arm the greater tuberosity moves closer to the acromion, narrowing the space. SIS results from pathology of any of these structures. The inferior aspect of the acromioclavicular joint has also been implicated in the aetiology and pathogenesis of SIS (Petersson and Gentz, 1983).
Section snippets
Historical Background
Numerous early references to sub-acromial pathology have appeared in the literature (Adams, 1852; Bosworth, 1940; Codman, 1934; Diamond, 1964; McLaughlin and Asherman, 1951; Meyer, 1931). Neer (1972) argued that the anterior one-third of the acromion, the coracoacromial ligament and, at times, the acromioclavicular joint impinged upon the rotator cuff, primarily in the region of the insertion of the supraspinatus into the greater tuberosity. He stated that this impingement occurred mainly when
Primary Mechanical Impingement
SIS as described by Neer, et al., 1972, Neer, et al., 1983 has been termed primary mechanical impingement. Neer (1983) argued that the reason rotator cuff tears and SIS develop in some people and not in others is best explained by the shape of the acromion. In support, Bigliani et al (1986) examined the shape of the acromion of 140 shoulders in 71 cadavers and concluded that there were three distinct shapes, type 1 flat, 2 curved and 3 hooked, arguing that these differences were due to
Summary
Subacromial impingement syndrome is one of the most common causes of shoulder pathology (Jobe and Jobe, 1983; Kessel and Watson, 1977) with reference to the condition appearing in the literature approximately 150 years ago (Adams, 1852). The pain and dysfunction associated with SIS are generally considered to occur when the shoulder is placed in positions of elevation, an activity commonplace during many sporting and vocational pursuits, as well as during the activities involved in daily living.
Acknowledgements
The authors would like to thank Katie Money-Kyrle who contributed the diagrams for this paper.
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2023, Musculoskeletal Science and PracticeClinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?
2017, Musculoskeletal Science and PracticeCitation Excerpt :Multiple types of subacromial shoulder impingement (SSI), (intrinsic, extrinsic and internal), each with different underlying pathomechanical causes, have been proposed (Braman et al., 2013; Lewis et al., 2001; Michener et al., 2003). Anterolateral catching or aching shoulder pain, without a history of trauma, emanating from the rotator cuff tendons, subacromial bursa, biceps tendon and shoulder capsule or a combination of these structures is characteristic of SSI (Lewis et al., 2001; Michener et al., 2003). Forty to 60 years of age is reported as the peak age for SSI (Ostor et al., 2005; van der Windt et al., 1995) with an increased prevalence of these symptoms reported in occupations and athletes who perform frequent overhead activities (Ludewig and Cook, 2000).
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2017, Musculoskeletal Science and PracticeCitation Excerpt :a painful arc elicited with pain easing on lowering the arm (N. Hanchard et al., 2004) pain localized to the anterior or antero-lateral-superior shoulder (J. S. Lewis et al., 2001) insidious onset of symptoms with a possible history of gradual progression over time but without history of trauma (Bigliani and Levine, 1997)
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- 1
Jeremy S Lewis MSc MAPA MCSP MMPAA MMACP is a PhD candidate at Coventry University and research co-ordinator in the department of physiotherapy, Chelsea and Westminster Hospital
- 2
Ann Green MSc MCSP is principal lecturer, School of Health and Social Sciences, Coventry University.
- 3
Shmuel Dekel PhD MD is professor and head of the Department of Orthopaedic Surgery, Sourasky Medical Centre, Tel Aviv, Israel.