Subacromial impingement steroid injection

Regarding diagnosis:

  • Does individual have any risk factors or predisposing conditions such as work or sports that stress the shoulder, bone spurs, osteoarthritis, shoulder injuries, or degenerative disease?
  • Did the shoulder pain appear suddenly (suggests another diagnosis) or was the onset gradual and progressive (suggests impingement)?
  • Was there pain following an injury?
  • What symptoms does individual have?
  • What were the findings on physical exam?
  • Has individual undergone shoulder x-rays, MRI, ultrasound, or arthrography to establish the diagnosis?
  • Have conditions with similar symptoms been ruled out?
Regarding treatment:
  • Has individual responded favorably to conservative treatment?
  • Did individual undergo shoulder manipulation under anesthesia for complicating adhesive capsulitis? Was surgery performed? What type? Were there complications from surgery?
Regarding prognosis:
  • Is recovery prolonged due to surgery?
  • Is individual active in physical therapy? In a home exercise program?
  • Is individual's employer able to accommodate the necessary restrictions?
  • Does individual have osteoarthritis, rheumatoid arthritis, shoulder injuries, shoulder instability, or shoulder degeneration?
  • Does individual have complications such as rotator cuff tear, biceps tendinitis, bursitis, or frozen shoulder?
  • Is the affected shoulder on the individual’s dominant or nondominant side?
Source: Medical Disability Advisor

SIS is one of the most common causes of shoulder pain. However, it has to be differentiated from other conditions affecting the shoulder; SIS is likely to be multifactorial and may involve both extrinsic compression and intrinsic degeneration factors. Conservative treatment is successful in most of the patients. Surgical treatment is used when conservative treatment fails. We recommend arthroscopic subacromial decompression as it has less surgical morbidities and it allows direct evaluation of the glenohumeral joint and the integrity of the rotator cuff.

As I am sure the majority of you are aware, motion of the glenohumeral joint involves spin and translation. For the purposes of discussing the “Diablo Effect” we are most concerned with the translation. During the first 30 degrees of elevation (. both flexion and abduction) the humeral head translates superiorly to the superior glenoid rim (Sizer et al 2003). Then upon further elevation the humeral head then translates inferiorly. During flexion this is combined with a posterior translation and during abduction its combined with an anterior translation. This inferior translation of the humeral head allows preservation of the subacromial space during elevation activities.

The bone above the rotator cuff (the point of the shoulder) is called the acromion. Many people with bursitis of the shoulder have a bone spur that forms on the undersurface of the acromion. Depending on the bone of the acromion, a burr may be used to remove the spur to create more space for the rotator cuff tendons. The benefit of removing the bone spur is a subject of debate among orthopedic surgeons. Some surgeons believe the spur is a major cause of inflammation by taking up space around the rotator cuff tendons, while others contend that removing the bone spur has never been shown to improve the results of patients who have this surgery.

Subacromial impingement steroid injection

subacromial impingement steroid injection

The bone above the rotator cuff (the point of the shoulder) is called the acromion. Many people with bursitis of the shoulder have a bone spur that forms on the undersurface of the acromion. Depending on the bone of the acromion, a burr may be used to remove the spur to create more space for the rotator cuff tendons. The benefit of removing the bone spur is a subject of debate among orthopedic surgeons. Some surgeons believe the spur is a major cause of inflammation by taking up space around the rotator cuff tendons, while others contend that removing the bone spur has never been shown to improve the results of patients who have this surgery.

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