Differential Diagnosis of Shoulder Impingement. Charlie Cotterill Junior Physiotherapist Feb 2006. AIMS. Subacromial joint. Subacromial space 9-10mm Force couple to counteract downward pull of deltoid Thompson et al (1996) Jarjavay (1867)
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Subacromial space 9-10mm
Force couple to counteract downward pull of deltoid Thompson et al (1996)
Neer (1972), anatomical variations in build, strain and repetitive microtrauma.
Degeneration of the rotator cuff, oedema, bleeding, fibrosis and calcification → ruptures, osteophyte formation, and spur formation.Anatomy
Bigliani Classification (1991)
Aetiology of SIS is multifactoral (Lewis et al 2001).
Labrum tear Cervical/Thoracic spine RA Bursitis
Polymyalgia Rheumatica Rotator cuff tear #
Biceps tendon rupture/tendinopathy Calcific tendinitis
Adhesive capsulitis AC arthritis Glenohumeral arthritis
Septic arthritis Gout Lyme disease Long thoracic nerve injury
Visceral: PE, pleuritis, pericarditis, angina, MI, cholecystitis, pancreatitis, adnexitis.
Lupus erythematosus Spondylo-arthropathy AVN
Cervical radiculopathy Tumor/Malignancy Thoracic outlet Brachial plexus neuropathy Trigger points Post CVA Glenohumeral instability Humeral subluxation
“Living within a window”
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