Sub Acromial Rotator Cuff Impingement

Three stages of SAIS:

Stage One

common with patients younger than 25

years
overuse injury (painters, athletes)
acute inflammation, edema, and
hemorrhage in the rotator cuff

Stage two
What is sub acromial rotator cuff
impingement?

Narrowing of sub acromial space where

the sub acromial bursae lies that allows
for smooth gliding of the rotator cuff
tendons
Compression of the supraspinatus
tendon against the acromion, the
coracoacromial ligament and
sometimes projecting bone spur from
the acromion causing an impingement
May come from intrinsic or extrinsic
causes or combination of both

Pain, weakness and loss of motion are

the major complaints

Pain is exacerbated by overhead

activities

Frequent complaint is night pain

Symptoms may be acute, after an injury,

or insidious, particularly in older
patients where no specific injury occurs

Stage three

40+ years
frequently involves a tendon rupture or
tear
acromioplasty and rotator cuff repair is
commonly required

Physical Examination
The shoulder examination should be done with
every patient

Intrinsic Causes: Overuse, tension overload

or trauma to tendons.
Extrinsic Causes: Compression of
structures external to tendons.

Common with patients 25-40 years

fibrosis and irreversible tendon change
commonly does not respond to
conservative treatment and requires
operative intervention

inspection, palpation, rom, strength

testing, neurological assessment and
special shoulder tests
a thorough assessment of the cervical
spine and the upper extremity
Special impingement tests for shoulder
instability
o apprehension test
o drawer test
o Jobe relocation test
o Neer test
o Hawkins/ Kennedy
Ultrasonography
MRI
Arthrography

Treatment

Pain and anti-inflammatory

medications
Physical therapy
injections to reduce inflammation
and control pain
operative treatment
o surgery to the acromion
Acromioplasty
decompressionwhich will increase
the volume to the sub
acromial space (open
or arthroscopy)
o surgery to the rotator cuff
partial or full
thickness tears

Rehab Phase

Interventions
Acute Phase

Eliminate overhead activities

Ice
relieve pain and reduce inflammation
prevent muscle atrophy without
exacerbation
reestablish ROM without pain
Patient education is particularly
important for the acute phase
regarding activity, pathology, and
avoiding overhead activity, reaching,
and lifting
Sling is NOT used due to the cause
of adhesive capsulitis

Once the acute phase resolves, a

strengthening program to the rotator
cuff is used to prevent future injuries
the motions of the rotator cuff that
are emphasized for strengthening
o internal rotation
o external rotation
o abduction
stronger rotator cuff
muscles result in
better glenohumeral
joint stabilization
can use theraband,
hand weights
Isometric stretches to increase ROM
Isokinetic
Sports specific movements
Massage
Ultrasound
e-stim