F A Q
WHAT IS THE IMPINGEMENT SYNDROME?
It is an inflammatory painful process of the subacromial bursa or rotator cuff causing a reduced subacromial space . This clinical picture is referred as to subacromial impingement. There are some predisposing factors such as the acromial morphology, in some patients hooked, an unbalance of the muscle groups involved in shoulder movement. Another category at risk is the young people practicing sports such as baseball, basket, volleyball and swimming. In this case impingement is strictly connected to the characteristics of the athletic gesture.
HOW CAN ROTATOR CUFF IMPINGMENT BE DIAGNOSED?
Through an accurate patient history , a careful clinical examination , particular radiographic tests often correlated with an echography and a MRI scan.
WHICH IS THE INITIAL TREATMENT FOR CUFF DISORDERS AND IMPINGMENT?
In case of impingement or initial rotator cuff lesion resting is the first therapeutical treatment together with antinflammatory drugs and a cycle of physiokinesitherapy to reduce inflammation and regain good muscle balance; we rarely suggest to administer cortisone injections; sometimes applying ice can result useful.
IN CASE OF FAILURE OF THESE THERAPEUTICAL TREATMENTS WHICH IS THE NEXT STEP?
In case of hooked acromion, osteophytes in subacromial space, severe rotator cuff lesions, surgical arthroscopy is recommended being diagnostically and therapeutically useful.
WHAT HAPPENS IN CASE OF FAILED REPAIR OF THE ROTATOR CUFF?
For several biological and biomechanical reasons sometimes a well managed rehab cycle can cause relief and allows to regain good range of motion . In case of failed satisfying results after six months of physiokinesitherapy, surgery is suggested.
In older patients with massive “irrepairable” rotator cuff lesions a simple arthroscopy may result useful to remove osteophytes and the fragments of damaged tissue hindering rotator cuff movements; in this case strength will be certainly not regained but pain will be notably reduced.
HOW IS THE SHOULDER TREATED AFTER THE INTERVENTION?
In case of simple impingement the patient must wear a brace only for 3-4 days and a rehab protocol must start immediately. In case of rotator cuff repair the patient must wear a brace for 3-4 weeks, but already from the 10th day the patient starts following a cycle of passive kinesitherapy to avoid capsulitis and adherences, one of the most worrying complications of this intervention.
IS THE ROTATOR CUFF SURGERY ALWAYS SUCCESSFUL?
Remembering that every case is unique it results clear that treatment is very often successful in young people in good health with minimum rotator cuff lesions. The situation is different in case of old people with massive lesions, degenerated tissues with large calcifications inside the joint. However, we do believe that a correct surgical indication ,a technically well performed intervention, a well managed and correctly performed postoperative rehabilitation represent the most effective triad for a therapeutical success.