Impingement Syndrome Thread:
I've always thought that as younger #shoulder surgeons emerged that they would stop whacking out the acromion. Most all research shows that classic impingement is not the cause of shoulder pain. I was wrong. The acromion is till abused. :-(
1/?

Classic impingement theory taught us that a bone spur on the acromion is the cause of shoulder pain. Furthermore, it was felt that the spur would mechanically erode the rotator cuff and cause a tear. That seems intuitive. 2/?

Many studies have shown that the classic impingement theory is not the cause of rotator cuff tears. Most rotator cuff tears begin on the undersurface, clearly not due to erosion. Experiments to prove spur caused classic RC changes failed. https://www.sciencedirect.com/science/article/abs/pii/S105827469890026X 3/?

Decades of research points to degeneration of the rotator cuff enthesis (attachment) as the most common cause of rotator cuff tears. That would also mean we shouldn't call them tears... which implies trauma and causes fear in patients. https://journals.lww.com/clinorthop/Fulltext/2003/10000/Pathologic_Evidence_of_Degeneration_as_a_Primary.15.aspx 4/?

But, but the CA ligament is frayed! Surely you're wrong! Nope .. rotator cuff weakness, dynamic or static will cause the humeral head to migrate, thus narrowing the SubAc space. Removing a part of the acromion only gave the humerus more room to move up 5/?

Surely if we remove the anterior acromion and repair the rotator cuff there is a better chance that the repair will heal. Again, not proven. Mechanical thinking, ignoring biology has gotten us to where we are. https://www.sciencedirect.com/science/article/abs/pii/S1058274604000527 6/?

So many chronic diseases have been linked to metabolic dysregulation... and lipid abnormalities. Not surprisingly... the same has been shown to occur in tendons. Genetics, metabolic and lipid disorders all contribute to disease burden in the shoulder https://www.sciencedirect.com/science/article/abs/pii/S1058274611005192 7/?

Partial thickness rotator cuff 'tears" are extremely common... if impingement theory held true then acromioplasty should prevent partial tears from progressing. It didn't! https://www.sciencedirect.com/science/article/pii/S0749806305012971 8/?

As @JeremyLewisPT and @PhysioChris point out often .. We still do not know exactly what the cause of subacromial pain is. Is it the cuff? The bursa? etc... there is still much to learn. 9/?

One thing that seems to stand out and is supported by the majority of contemporary literature is that the acromion is not the cause of shoulder pain. We should stop telling people they have a spur in their shoulder. This can cause "harm". 10/?

We should continue to elucidate the cause and prevention of rotator cuff disease. Metabolic and lipid abnormalities as a potential cause of age-related changes need to be explored further. Westernized shoulder pathology?? :-( 11/?

Most patients will improve with #PT . CSI may improve short term pain but can induce deleterious metabolic changes that might worsen cuff pathology.
Bursectomy, debridement, repair, PRP, patches etc may have a role in those who have pain despite PT. Basically ... @GetPT1st

Summed up here a while ago. Time for an update. https://www.howardluksmd.com/shoulder-pain/subacromial-decompression-useful-treating-shoulder-pain/