Painful Arc Syndrome

1. PAINFUL ARC SYNDROME
Prashant Badiger

2. PAINFUL ARC SYNDROME
• Shoulder Impingement Syndrome
• Supraspinatus Syndrome
• Swimmer's Shoulder
• Thrower's Shoulder

3. PAINFUL ARC SYNDROME
• It is a clinical syndrome which occurs when the tendons of the rotator cuff muscles
become irritated and inflamed as they pass through the subacromial space.

4. PAINFUL ARC SYNDROME
• Occurs when one of the rotator cuff tendons (supraspinatus) or bursa is pinched
between the humeral head and the undersurface of the acromion.
• This happens because as we raise our arm, the narrow space between the humeral
head and the acromion naturally compresses.
• It is the repetition of such movements that leads to the condition developing,
causing swelling and an excess of fluid in the joint.

6. PAINFUL ARC SYNDROME
• Result of painting, carpentry,
construction work or any other jobs
that involve overhead work.
• Take many years before someone
begins to notice the symptoms of the
condition.

7. CAUSES - BONY STRUCTURES
• Subacromial spurs (bony projections from the acromion)
• Osteoarthritic spurs on the acromioclavicular joint
• Variations in the shape of the acromion.

10. CAUSES
• Thickening or calcification of the
coracoacromial ligament

11. CAUSES
• Loss of function of the rotator cuff
muscles, due to injury or loss of
strength, may cause the humerus to
move superiorly.

12. CAUSES
• Inflammation and subsequent
thickening of the subacromial bursa
may also cause impingement.

13. SIGNS AND SYMPTOMS
• The most common symptoms are:
1. pain
2. weakness
3. loss of movement at the affected
shoulder

14. SIGNS AND SYMPTOMS
• The pain is often worsened by shoulder
overhead movement and may occur at
night, especially if the patient is lying
on the affected shoulder.

15. SIGNS AND SYMPTOMS
• The onset of the pain maybe:
1. Acute, due to an injury.
2. Insidious onset, due to a gradual
process like an osteoarthritic spur.

16. SIGNS AND SYMPTOMS
• Other symptoms:
• Grinding or popping sensation during
movement of the shoulder.

17. SIGNS AND SYMPTOMS
• The range of motion at the shoulder
may be limited by pain. A painful arc of
movement may be present during
forward elevation of the arm from 60°
to 120°.

18. SIGNS AND SYMPTOMS
• Passive movement at the shoulder will
appear painful when a downwards
force is applied at the acromion but the
pain will ease once the downwards
force is removed.

19. DIAGNOSIS
• By history and physical examination
• Neer Test
• Hawkins-Kennedy Test
• X-ray
• Arthrography
• Ultrasonography
• MRI

20. NEER TEST
• With the patient seated, the
examiner raises the affected arm in
forced forward elevation while
stabilizing the scapula, causing the
greater tuberosity to impinge
against the acromion.
• Pain Positive test

22. HAWKINS-KENNEDY TEST
• Elevate the arm to 90 degrees, bend the
elbow and force the shoulder into
internal rotation, grinding the greater
tuberosity under the coraco-acromial
arch impinging supraspinatus tendon.
• Pain Positive test

24. DIAGNOSIS - PLAIN X-RAY
• Joint pathology and variations in the bones,
• Acromioclavicular arthritis
• Variations in the acromion
• Calcification

25. DIAGNOSIS-MRI
• MRI showing subacromial impingement
with partial rupture of the
supraspinatus tendon.

26. TREATMENT
1. Stop any activity that can/may aggravate symptoms
2. Medicate with anti-inflammatory medicine
3. REST
4. Gentle stretching exercises
5. Exercises to STRENGTHEN the rotator cuff
6. If all else fails after 6 to 12 months, arthroscopic or open surgery to repair damage
and relieve the pressure on the tendons and bursae

27. TREATMENT - CONSERVATIVE
• Rest.
• Cessation of painful activity.
• Physiotherapy focused at maintaining range of movement and avoid shoulder
stiffness.
• NSAID's and ice packs may be used for pain relief.

28. TREATMENT - CONSERVATIVE
• Therapeutic injections of corticosteroid and local anesthetic may be used for
persistent painful arc syndrome.
• The total number of injections is limited to three due to possible side effects from
the corticosteroid like tendon damage.

29. TREATMENT - SURGERY
• Done arthroscopically or as open surgery.

30. TREATMENT - SURGERY
• The impinging structures may be removed in surgery.
• The subacromial space may be widened by resection of the distal clavicle and
excision of osteophytes on the under-surface of the acromioclavicular joint.
• Also, damaged rotator cuff muscles can be surgically repaired.

31. THANK YOU