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Subacromial impingement is a very common problem relating to the shoulder area, accounting for almost 50% of the shoulder pain complaints. It is a very small space covered by bones on all spaces, and in fact, only when there is inflammation in this area does the space become evident on radiographs. There are various tendons and muscles, which work together to allow for shoulder movement upwards and downwards and front and the back. With repeated movements, these tendons get impinged or pinched and so cause limited motion, pain, swelling, instability, etc.
This injury is very common in people who use the shoulder repeatedly and in similar movements, especially with sportspersons like basketball, swimmers, etc. Non-sportspeople like painters and construction workers can also sustain this injury, given the repetitive motion of the shoulder joint.
What causes subacromial impingement?
- Irritation and impingement of the shoulder joint due to repeated motion
- Acute injury or accident involving the shoulder
- Poor posture where shoulders are constantly in a stooped position
- Shoulder instability
If a person has subacromial impingement, the symptoms will include:
- Pain in lifting shoulder to the front and above the head
- Weakness in the shoulder with gradual loss of function
- Swelling and stiffness of the shoulder
- Night pain, especially with rolling the shoulder
- Limited movement
- Hemorrhage in advanced cases
As the condition progresses, the symptoms worsen and gradually can lead to calcifications in the tendon space and loss of shoulder strength. The impingement can go through 3 stages, with both age and symptoms increasing with each stage.
Diagnosis: A combination of history, clinical presentation, x-ray, and MRI are used in diagnosis. Specific tests like empty can are also useful in arriving at a diagnosis.
Management: Conservative measures like resting, ice and heat therapy, medications, and exercise are the first line of therapy. When the condition persists even after 3 to 4 months, then surgical intervention is required.
- Avoid activities which cause repetitive movement of the shoulder.
- Ice the area for 10 to 15 minutes every 4 to 6 hours through the day to reduce the inflammation.
- Compression also can be used which will help in pain control.
- Keep the shoulder elevated like in a sling to help in pain relief.
- Nonsteroidal anti-inflammatory medications can help control inflammation and pain, improve movement, and reduce swelling or stiffness.
- Exercise can be included in the daily routine as it improves the shoulder strength and flexibility.
- Surgery is usually considered the last resort. It is only when all the conservative measures fail, surgery is advised.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Fractures are simply a break in a bone. They can be caused due to injury, (traumatic fractures) or a pre-existing condition like osteoporosis that causes weakening of bones (pathologic fractures). There are many ways to classify fractures. All fractures fall into the major categories of simple and compound fractures. Simple fractures are fractures where bones remain inside the skin and don’t jut out. They are also called closed fractures.
Compound fractures, also called open fractures, are broken bones that penetrate through the skin. These types expose the bone and deep tissues to the environment. Compound fractures are more serious of the two. The healing here may be affected due to deep infections for which antibiotics need to be used. There are many different sub types of fractures and we’re only going to skim through them here.
- Comminuted fractures: Severe fractures in which a bone breaks into several smaller pieces.
- Avulsion fractures: A small piece of bone is completely torn off from the main bone due to fierce pulling off a part of the body.
Other types of fractures are characterised by the many different angles the bone breaks into like transverse, oblique and spiral fractures.
When a bone is broken there are symptoms like swelling that doesn’t subside on its own and pain. In such a case it’s imperative that one goes to a doctor for a diagnosis. Doctors can usually recognise most fractures by examining the injury and taking an X-ray. The X-ray also provides a clear idea about the type of fracture and the degree of displacement of the bone. And, it’s important that the patient doesn’t wait too long before approaching a doctor. This is because bones begin to heal very quickly after a fracture and the bone tissue will heal using any tissue available. This can lead to a misalignment of broken pieces of bone and cause disability and loss of function.
There are cases when X-ray may not show a fracture. This is especially common in fractures in the hip and wrist in older people. For diagnosing these, doctors will get some other tests done such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or a bone scan.
Fractures have to be treated by doctors. The doctors set the fractured bones in their proper place and hold them there so that they can heal. Setting a bone is called "reduction." Reduction without surgery is called "closed reduction." But if the fracture is serious, it’s going to require surgery with bone repositioning, called open reduction.
In extreme cases, pins, plates, screws, rods, or glue are used to hold the fractured bones in place, inside the body. Once the bone abutment has been treated, the bone is immobilised to allow the broken pieces to heal. In most cases, the fractured part is set in a rigid cast. The fractured ends of the bone can be fixed into place using metal pins connected to an external frame. This is removed after the bone has healed. If you wish to discuss about any specific problem, you can consult an orthopedist.