Subacromial impingement steroid injection

Hey Mike. I was hoping that you could clear something up for me. I am still trying to visualize the arthrokinematics that you discuss when you state "the humeral head slides anterior slightly causing the undersurface of the cuff to impingement on the inside against the posterior glenoid rim and labrum". If the humeral head is gliding anteriorly, isnt it moving AWAY from the posterior glenoid rim and labrum? How would this ant glide cause an impingement on the posterior aspect? Is it more of a superior humeral head migration that would impinge the post/sup aspect of the labrum and/or the post/sup undersurface of the cuff?? What do you think? Thx.

Subacromial impingement is a condition that causes pain in the shoulder and upper arm. It happens when the tendons of the shoulder joint are strained or injured, or when a spur of bone develops under a flat bone found at the top of your shoulder blade, called the acromion. Either of these conditions can result in the inflammation, pinching or rubbing of any of four tendons (known as the rotator cuff) against the acromion. When this happens it is known as impingement.

1. KATCHINGWE AF, PHILLIPS B, SLETTEN E, PLUNKETT SW., Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. The Journal of Manual fckLRManipulative Therapy 2008;16(4): p238-¬‐247
Level of evidence: 2A
2. TATE ., MCCLURE ., YOUNG ., SALVATOR R., MICHENER ., Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. The Journal of orthopaedic and sports physical therapy 2010; 40(8): p474-93
Level of evidence: 4
3. BIRRER ., O’CONNOR ., Sports medicine for the primary care physician. 3rd edition, Boca Raton: RCR PRESS, 2004: p507- 10
4. DE BIE ., BASTIANENEN . Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial. BMC Musculoskeletal Disorders. 2010 Jun 9; 11:114
Level of evicence: 1B
5. MICHENER ., WALSWORTH ., DOUKAS ., MURPHY . Reliability and Diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subacromial Impingement. Archives of Physical Medicine and Rehabilitation. 2009 Nov; 90(11): 1898-903
Level of evicence: 1C
6. DORRESTIJN O., STEVENS M., WINTERS ., VAN DER MEER C.,DIERCKS . Conservative or surgical treatment for subacromial impingement syndrome? A systematic of shoulder and elbow surgery board of Jul-Aug;18(4):652-60
Level of evidence: 1A
7. YELDAN I., CETIN E., OZDINCLER . The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disability and rehabilitation. 2009; 31(11): 935–940
Level of evidence: 1C
8. Bang MD, Deyle GD. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients with Shoulder Impingement Syndrome. Journal of Orthopaedic and Sports Physical Therapy. 2000;30(3):126-137
Level of evidence: 1B
9. Kuhn JE. Exercise in the treatment of rotator cuff impingement: A systematic review and synthesized evidence-based rehabilitation protocol. Journal fo Shoulder and Elbow Surgery. 2009;18:138-160
Level of evidence: 1A
10. Smith M, Sparkes V, Busse M, Enright S. Upper and Lower trapezius muscle activity in subjects with subacromial impingement symptoms: Is there imbalance and can taping change it? Physical Therapy in Sport. 2009:10, 45-50
Level of evidence 3A
11. ( http:///?article=48&section=9&tile=2 )

Subacromial impingement steroid injection

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