‫بنام خداوند جان وخرد‬
Injuries to the athletic shoulder
(impingement syndrom)
Dr.H.Saremi
Orthopaedic surgeon, Hand & Shoulder fellowship
Hamedan university of medical sciences
Hamedan,IRAN
www.shoulderclinic.ir
Sport injuries
• Sport specific injuries
• Regional Injuries
Injuries to the athletic shoulder
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Instability
Impingement and rotator cuff problems
Biceps labral complex injuries
Ac joint injuries
S.c joint injuries
Fractures
Neurovascular injuries
Impingement syndrom
The term impingement syndrome was fi rst used
byNeer in 1972 to describe a condition of shoulder
pain associated with chronic bursitis and partial
tearing of the rotator cuff. Impingement comes
froma Latin root impingo, which means “to strike
against.
Impingement and rotator cuff
problems
• Subacromial impingement is one of the most
common couse s of shoulder pain in athletes
Rotator cuff
Impingement
• Outlet impingement
• Non outlet impingement
• An unstable head that subluxes anteriorly due ro
capsular laxity may displace upward against the
acromion
• Stabilize the shoulder
• Secondary impingement is the most common
type of impingement in young athletes
Bigliani classification
Sign &symtoms
• Pain with overhead activities,and internal
rotation
• Partial cuff tear symptoms
Painful arc sign
Positive howkin’s sign and neer sign
Impingement syndrom
Cuff arthropathy
Impingement syndrom
• Non operative treatment
• Operative treatment(arthroscopic)
Non operative treatment
• Physio therapy
• NASAID
• Corticoid injection
Non operative Treatment
• STEP 1 :Avoid repeated injury
• Work
• Sport
Non operative treatment
• STEP 2: Restore normal flexibility
• Stretch out all the direction of tightnessspecially
posterior
• Most effective by the patient
• Gentle stretched five times a day by patient
• To the point of pull of tightness not to the point
of pain
• Each stretche for 1 min----30 min a day
• Obvious improvement---1 m may be 3 m full
Non operative treatment
• STEP 3: Restore normal strenth
• When near normal passive flexibility of the
shoulder is restored
• Internal and external strenthening
excersiseswith the arm at the side
• By the patient
Non operative treatment
• Deltoid strengthing is added when it can be
performed comfortably
• Scapular motors
Non operative treatment
• STEP 4:Perform aerobic exercise
• To get back in shape and improve the sense
of well being
• 5 days a week,sweaty ex 30 min
Non operative treatment
• STEP5: Modify work or sport
• Reviewe the technique of sport
• Modifiy the job
Operative treatment
• Sub acromial decompression
• Rotator cuff repair
Internal Glenoid impingement
Subcoracoid impingement
• ‫ریش ریش شدن و پارگی طولی درساب اسکاپوالریس به‬
‫دلیل گیر کردن به کوراکوئید‬
• longitudinal tear and fraying of subscapularis
tendon due to subcoracoid impingement