Shoulder Impingement Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 19 жов 2016
- Dr. Ebraheim’s educational animated video describes shoulder impingement syndrome. Shoulder impingement can have many symptoms and there are many shoulder impingement tests and exercises that can be done. Shoulder impingement treatment and shoulder impingement surgery is explained .bankart lesion is shown .shoulder examination and rehab is shown .shoulder animation is also shown.
This is a common source of pain in the shoulder; you’ll find it in about 50% of the patients who come to the doctor with a complaint of shoulder problem.
Sometimes we call it cuff tendonitis, or shoulder bursitis, the patient is more familiar with shoulder bursitis, so we use that term.
It’s really an irritation of the rotator cuff and it can lead to break down and tear of the tendon.
It could be an overuse syndrome.
Shoulder anatomy:
- Scapula
- Glenoid
- The head of the humerus
- The rotator cuff muscles inserted into the greater tuberosity
- Above it is the bursa
- Above that is the acromion
You can see the shoulder joint different than the area where the bursa is, and in this dynamic view, as you lift the arm up, the tendons can be easily irritated, because there is bone above these tendons, and bone below these tendons, and as these tendons squeeze and irritate, it cause pain.
You diagnose this case by starting with the history:
Pain in the shoulder that increase by overhead activity.
If the patient has night pain, probably non-operative treatment will not work, it’s probably a cuff tear.
Examination:
- Warn the patient before moving the arm.
- These are called impingement tests.
- The whole idea with this test the head of the humerus will rise up and squeeze the tendons, and the patient will have pain and will stop lifting the arm up, and keep in mind; these tendons can progress to a full thickness cuff tear with the continuation of the irritation.
- Neer impingement sign: is when you get the impingement.
- Neer impingement test: when the pain is relieved after injecting numbing medication.
- Hawkin’s sign: bring the greater tuberosity under the acromion will lead to impingement.
Imaging:
- X-rays can show the bone spur of the acromion which is a prominence on the under surface of the acromion.
- This spur digs into the cuff.
- We get the true anteroposterior view x-ray.
- Get the scapular Y view lateral.
- The supraspinatus outlet view.
- MRI: is helpful as well.
Treatment:
• Non-operative treatment:
- NSAIDS
- Physiotherapy
- Subacromial injection: numbing medicine and cortisone
• Surgery: when do we do surgery?
- We do the surgery when you fail conservatively for about 4-6 months
- The surgery outcome is not as good usually with worker’s compensation claims.
- So we’ll shave the under surface of the acromion to make more room, we call that: subacromial decompression.
- If there is pain from the AC joint associated with the impingement, then you probably need to excise the outer part of the clavicle.
- You got the biceps next to the impingement, is connected to the rotator cuff associated tendonitis, then you may want to work on the biceps like biceptinotomy or biceps tenodesis.
The result of surgery is usually very good if you have:
- The proper patient.
- The proper clinical situation.
- Proper diagnosis.
- Positive injection test.
After surgery you give the patient a sling for few days, patient will return to normal daily activity in a day or two, in two weeks the patient will be able to lift the arm above the head.
At two months, the patient will have a near normal condition.
Complications of surgery:
- Usually it involve the deltoid, deltoid disruption, either the doctor will do acromionectomy, or excise an OS and that will lead to deltoid dysfunction.
- In the OS excision, you may Want that to heal first then later on you do the acromioplasty, axidently you will see that OS in an axillary view.
- Another complication is if you excise the CA ligament, in a patient with a massive cuff tear, in these type of patients, try to avoid the acromioplasty and the coracoacromial ligament release to preserve the coracoacromial arch.
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I have watched many many videos and yours is the first that has given me complete helpful information regarding my shoulder pain. I feel like I am able to make a better informed decision for my health. I thank you so much
Great work! May gold bless you and your team with good health, longevity and more success for years to come. Amen!
Superb educational video
Thank you. Respect from Thailand.
Thank you so much for going through the different views and explanations!!
thank you ... great explanation, spoke slowly enough w/pictures to understand. GREAT!
These are really useful and comprehensive videos. Thank you for your service 👍🏼
Very thankful to you Dr. Nabil it's very simple way you use to understand and very useful. Thanks a lot
I'm no expert in this area, but your analysis seems thorough and well thought out. Thanks for your input.
Superbly done! Thank you.
Thank you!! I am a nurse practitioner working in pain management and this really helped me understand
Why would workers comp cases have a bad outcome? It's not about workers comp, it's about suing industry out of business so no one else is ever injured on the job again. Workers comp is a mafia organization that protects corrupt businesses that injured people from being sued out of business. When the first man that was injured on the job, the automobile companies should have been sued out of business before the first person was killed in a car accident. Do you really believe workers compensation has enough money to pay for my job injury? The Bible says an eye for an eye, tooth for tooth, life for life. If I lose an arm for the use of an arm they must lose the use of an arm. Gospel of Timothy
I appreciate your knowledgeable and user friendly videos. Good luck.
Excellent work Dr. Nabil.
I love all your videos. I am an occupational therapist and your videos are great educational tools. Thank you for making them. Clearly you love what you do and you love to share your knowledge.
Starting pickle ball
Excellent explanation with images... congratulations.. good morning.
As a visual learner, thanks for showingthe osteokinematics huhu
Greate video. Very educational. The best video i have found so far for thiw problem. Greetings from Cyprus.
Great education to lay persons, thank you professor.
Thank you for making these amazing videos!
thanks man very informative
IT IS REALLY INFORMATIVE, THANK YOU VERY MUCH, I AM REALLY GLAD AND IT IS THE FIRST TIME I CAN UNDERSTAND THIS DIFFICULT CONDITION THOROUGHLY.
Thank you v much your exercises were easy n v good explanation was able to understand everything thanks once again
After having impinged shoulder aka bursitis of the shoulder for over 2 month i started brachiating . Hanging from a bar for 10 minutes a day and after 2 weeks the pain went away completely. I now include it as part of my workout routine. I hope this helps someone out there suffering from shoulder pain.
Os Cj did you have pain across chest are where you feel the clavicle bone
uno dimple seasons not on chest. It was pain in the outer part of shoulder deep inside shoulder
You get it operated on. I don't know how hanging from a bar would help.
How about it would tear the rotator cuff?
Sir i.am.watching dr nabil Ibrahim s educational videos on all orthopaedic aspects since last 2 -3 years . I love there lecture and way to teach the whole functioning and layout and the follow ups after any complications in related ligament ,tissue, other injuries . I have been also passed through torn meniscus menisectomy and partial rim balancing of right knee due to torn meniscus of accidental injury and now I have been going shoulder right side immobilized with inflammation due to rhomboid and tendonitits ,bursitis and inflammation to the joint and the MRI reports shows first grade tare of muscle associated with bursa and I am following the treatment for that
.I want to know that it can be heal by medications or I have to go for surgery ?
Excellent video. Could you upload ultrasound of hip joint : DDH and septic arthritis of the hip? Thanks
This was super helpful. I was wondering if you could please make a video comparing the different types of shoulder impingements (i.e. primary vs. secondary vs. undersurface) (the existence of these 3 different types are mentioned in "Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review")
Could you add a reference for the review paper please.
Nice explaining, thank you
thanx alot you provided us with benificial information
best vids on youtube
thank you so much, I am really grateful
Great work sir ,thnx alot👏
جزاك الله خيرا د. ابراهيم جدا فيديوهاتك مفيدة انا معالجه حكميه ا شكرك جزيل الشكر وكثر الله من امثالك
very helpful and informative
Superbly presented content. Very informative with depth. Valuable. Thanks
Thank you again- Exercise Physiologist, Yoga Synthesis Inst.,&Swim&Dive teacher
Thank you sir very helpful 😊👍👌
Enjoying...
Thankyou so much
Wow excellent work.
Beautifully explained 🧘♂️🧘♀️🙏 thanks for sharing your knowledge 🌹🧘♂️🙏
“Surgical outcome is usually not as good in patients with workers’ compensation claims” LOL
Thank you, Doc!
Bella lezione,grazie
Thanks a million
Thank you.
thanks for this ...
Thank you. Please give some information about Tendo Achilles problems.
I'm a therapeutic massage therapist n this helps alot
When I know that they need to see the Dr
nice video
Thank you very much dr nabeel ❤️❤️
Thank you
excellent. thanks.
Very helpful God bless you well done🌹😘
You are great ♡ thank you
I was told by my surgeon that bursitis was a separate thing. I'm having only bursitis issues post surgery after a smith and nephew patch was placed on previous tearing
Sir, What you explain in this video, does it apply to posterior shoulder impingement ? Is the impingement is this video is the same as posterior shoulder impingement ? Thanks a lot
Thanks sir.great vedio
تشخيصك لحالة ممتاز بس ممكن مع ترجمه عربية لو ممكن حضرتك اية اهم التدريبات اللى تقدر تقوى مع اى فيديو بتنزلة انا متابعك كلامك صحيح عن التشريح الحالة جزاك الله خيرا
Thank you, i could understand from this video.
すごくわかりやすい動画。やっと理解出来ました。ありがとうございます。
tq its helped me in study
Hello Dr,
Can you please explain why “The surgical outcome is usually not as good in patients with workers compensation claims?”
Excellent explanation of things, thanks 🙏
- If the patient get
night pain, it is probably
a rotator cuff tear and
nonoperative
treatment will not
work.
Dr Ibraheem thank you for awesome videos. Can you elaborate more on that please. I have been experiencing a lot of pain for a long time especially at night. Thank you
Doctor can you make vid about impingment of ligament corocoacromial plz وشكر سلف
Sounds like Orson Welles. great stuff.
bị tổn thương dây thần kinh C5 - C6 làm vậy tốt hơn không?
Excellent video.. explained everything and cleared all doubts regarding shoulder impingement syndrome.
Good, thanks
Excellent method of teaching
God of kabbah bless u
Ultimately, glenohumural centration is a vital key for the overall dynamic strength of the Rotator-Cuff.
Thank you!
thankyou for the video. i had an arthroscopic acromioplasty decompression, bursectomy and tenotomy. i have had 2 cortisone injections and none of these treatments have helped. my orthopedic surgeon didnt sufficiently answer my questions - so i still dont understand why my bicep tendon was cut when all my imaging said it was unremarkable. i had the surgery in Feb 23 and i still cant put my arm up to top shelf and other stuff.
i am workers comp as u mentioned and dont get why that matters.
Tnq for the info.
You are fantastic 🎉
Thank you sir
helpful!
Thank You
Can I got this lecture in written notes so I can keep It?
Thank you for a better understaning very lnformative
Is there pain in abduction or in forward flexion and adduction or in all
But there could also be trapezius muscle involvement, too. Tight traps can also be a possible red flag to shoulder impingement - I had that impingement problem 1 year ago with subsequent "lock neck" syndrome, so it was a bit like having muscular dystrophy disease of a slight kind.
Yes, its posible. As any tight scapular stabilizer would restrict the free gliding of scapula, therefore it will change GH rythm.
Did you manage to resolve the impigment with workout? How long it took, please !
Thanku so much ❤️
Thanks but do you have exercises for this
You have surgery for this. I had physical therapy for years. It will waste your time. Get it operated on.
@@Meanoldwoman2013 True I'm thinking about getting a surgery as well. I've been doing PT for 8 years lol. Waste of time and money
nice vidio thanks
I have this in both shoulders for about 25 years... Have done every exercise possible, had 2 cortisone injectiojns, bs physical therapy crap, rest, ice, heat..... Most doctors don't really have a clue. I have diagnosed myself as either bone spurs or I was just born with a curved acronium at top which would explain both shoulders. Most have flat acroniums. If you have a curved; the tendons can "catch" on acromium... It's general research that is the best bet. Don't think all of these doctors even know. Now; I just know certain small exercises that make it feel a little better. Like simply letting your shoulder hang and moving it in circles. All you really need is somehow create some space in that joint.
Thanks doctor for everything 🌹🥀
abduction in the scapula plane reduces the risk of shoulder impingement as compared to abduction in the frontal plane, does this mean that if i perform abduction in the scapula plane for patient with shoulder impingement syndrome they would feel lesser pain or no pain at all? if testing for shoulder impingement, is it best to only do it in shoulder abduction in frontal plane to check?
Yeah. I have this lol. Only after bench pressing very heavy though. I can keep full range, it just hurts a few days after.
Has it got better?
A possible cause of this impingement is the improper use of rucksacks or backpacks. Using too-heavy backpacks inappropriate to your body weight or height could cause shoulder impingement issues. This problem could be worsened with existing poor posture. So if you use only one shoulder to carry a very heavy backpack for too long, one of your shoulders will likely be in real trouble and can end up impinged.
Does anyone knows whether the shoulder bursa grows back if it is removed.
Why is the surgical outcome “is usually not as good in patients with workers’ compensation claims”.
Why would workers comp cases have a bad outcome? It's not about workers comp, it's about suing industry out of business so no one else is ever injured on the job again. Workers comp is a mafia organization that protects corrupt businesses that injured people from being sued out of business. When the first man that was injured on the job, the automobile companies should have been sued out of business before the first person was killed in a car accident. Do you really believe workers compensation has enough money to pay for my job injury? The Bible says an eye for an eye, tooth for tooth, life for life. If I lose an arm or the use of an arm they must lose the use of an arm. Gospel of Timothy
Because they go back to work and the shoulder is damaged again. Plus worker’s compensation don’t want to pay for a reoccurring problem due to the patients type of work.
I have impingement syndrome for 3 years, conservative and non conservative treatment so far without any long help. Surgical doctor said, that there will be more operation but guarantee to solve. I am getting afraid I have to live with my crippled arm. :(
Hmm, if you have tried everything so far. Try Shoulder pain Hypnosis. I have heard many positive results and since inflammation and healing is body's own mechanism it may heal you subconsciously through hypnosis. I am a physiotherapist and i try to consider all aspect of being human as our bodies are spiritual antennas aswell. Apart from physical side, we have great spiritual power hidden inside our body. Also, try to rub castor oil and peppermint oil and apply heat to help penetrate the oil deeper it will help your healing process as it is natural anti inflammatory oil. Good Luck
I only have poping sound in shoulder no pain..please tell what I have?
Why would workers compensation case surgery be worse than other normal people? Don't make sense
جتني إصابة بسيطه جدا في الكتف الأيمن بسبب التمرين الخاطئ واستغرقني سنين حتى يختفي بدون تدخل طبي، وقبل سنتين تعرضت لحادث تشافيت منه بس بقي معاي إصابة الكتف الأيسر ورجعت للتمرين هذا الشهر لكن الإصابة بتعيقني لكن بحاول أقوي العضل لعل وعسى يختفي معاي، شكرا دكتور لمحتواك كان أفضل شرح وجدته عن هذه الإصابة اللعينة.
Can this cause tiny boney lumps to form along the top?
i got stabbed in the side of the neck and it resolved in limitation on movement with my arm also have no neck/shoulder muscle due to this,wat should i do it has bin a year and its only getting worse.
Do you have a surgeon?
There is no such thing as overuse. The only reason a muscle/tendon would wear out is because if mechanical disadvantage or weakness, such as imbalance in rotator cuff muscles or most commonly bad posture and forward head. Rarely do doctors address this, so poor patients go under the
knife and end up with a failed surgery(approx 59%) because the root cause was never addressed.
anyone have any input on osteomyelitis, that will be helpful to me
...
I can easily see people doing shoulder raise with internal rotation of shoulder in a gym. They are breaking their shoulders. However, body building trainers just teach their methods without study.
Raising a dumbbell with internal rotation of shoulder should tear rotator cuff tendon sooner or later. To raise shoulder, external rotation of shoulder and tilting scapula anteriorly should be done to protect your shoulder.
To find out root cause of your shoulder pain, hiring licensed physical therapist should be needed rather than hiring body builders.
Worse pain I've ever had in my life. And I have Multiple Sclerosis.
Why would someone doing this on workers compensation have any different affect from surgery then someone non on workers comp?? You said surgery outcome isnt as good in workmans comp claims?? WHY IS THAT?????????????????????
In my experience because necessary care is denied and or delayed.
The reasons for poorer results in workers' compensation cases are multifactoral but include secondary gain (getting paid not to work, fear of returning to work, etc.), pressures to return the patient to work activity too soon (employers sometimes, insurance carriers or their care coordinators, and return to the work activities/environment that caused the problem. Getting patients back to non-exacerbating work early seems to improve overall outcomes. Poorer outcomes in workers' compensation cases are not unique to the shoulder, rather these are well documented across a large spectrum of musculoskeletal problems. It Can be from delayed care due to insurance management delays, but often that is not the prime reason.
I'm no expert in this area, but your analysis seems thorough and well thought out. Thanks for your input.
Insurance companies and companies don't care about the injured worker. Main goal is to get them to Return to work. That's why many patients end up sueing the company and getting retrained to do something else...elsewhere.
Insurance NEVER wants to pay.