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بنام خداوند جان وخرد PowerPoint PPT Presentation

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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 Sport injuries. Sport specific injuries Regional Injuries.

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بنام خداوند جان وخرد

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Injuries to the athletic shoulder

Injuries to the athletic shoulder

(impingement syndrom)


Orthopaedic surgeon, Hand & Shoulder fellowship

Hamedan university of medical sciences


Sport injuries

Sport injuries

  • Sport specific injuries

  • Regional Injuries

Injuries to the athletic shoulder1

Injuries to the athletic shoulder

  • Instability

  • Impingement and rotator cuff problems

  • Biceps labral complex injuries

  • Ac joint injuries

  • S.c joint injuries

  • Fractures

  • Neurovascular injuries

Impingement syndrom

Impingement syndrom

The term impingement syndrome was fi rst used byNeerin 1972 to describe a condition of shoulder

pain associated with chronic bursitis and partial

tearing of the rotator cuff. Impingement comes fromaLatin root impingo, which means to strike


Impingement and rotator cuff problems

Impingement and rotator cuff problems

Subacromial impingement is one of the most common couse s of shoulder pain in athletes

Rotator cuff

Rotator cuff



  • 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

Bigliani classification

Sign symtoms

Sign &symtoms

Pain with overhead activities,and internal rotation

Partial cuff tear symptoms

Painful arc sign positive howkin s sign and neer sign

Painful arc signPositive howkins sign and neer sign

Impingement syndrom1

Impingement syndrom

Cuff arthropathy

Cuff arthropathy

Impingement syndrom2

Impingement syndrom

  • Non operative treatment

  • Operative treatment(arthroscopic)

Non operative treatment

Non operative treatment

  • Physio therapy


  • Corticoid injection

Non operative treatment1

Non operative Treatment

  • STEP 1 :Avoid repeated injury

  • Work

  • Sport

Non operative treatment2

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 recovery

Non operative treatment3

Non operative treatment

  • STEP 3: Restore normal strenth

  • When near normal passive flexibility of the shoulder is restored

  • Internal and external strentheningexcersiseswith the arm at the side

  • By the patient

Non operative treatment4

Non operative treatment

  • Deltoid strengthing is added when it can be performed comfortably


  • Scapular motors

Non operative treatment5

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 treatment6

Non operative treatment

  • STEP5: Modify work or sport

  • Reviewe the technique of sport

  • Modifiy the job

Operative treatment

Operative treatment

  • Sub acromial decompression

  • Rotator cuff repair

Internal glenoid impingement

Internal Glenoid impingement

Subcoracoid impingement

Subcoracoid impingement


longitudinal tear and fraying of subscapularis tendon due to subcoracoid impingement

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