Painful arc and impingement syndrome ? | cyriax.eu

Painful arc and impingement syndrome ?

Body: 

Impingement syndrome ? Is it a diagnosis?

No , it isn't, it just means that, during e.g. arm elevation, pain is provoked, usually between 80° and 110°, due to compression of a sensitive or inflammed structure between the tuberosities and the acromion. Clinically we often see a painful arc on elevation. 

What exactly is a painful arc ?

This is a painful passage which occurs during an active or passive movement, mostly midrange and always inbetween two painfree zones within the same movement. This is a very common sign in shoulder pathology, but we can also find it in relation to lumbar problems (e.g. a painful arc on Straight Leg Raise).

A painful arc must be regarded as an accessory sign. Once the tissue at fault is singled out, the arc shows which part of the structure is affected.

Impingement in the shoulder may be due to stenosis, inflammation and/or fibrosis of the content in the subacromial space.

Young athletes using the arm in an overhead position are at risk of impingement because of the repetitive microtrauma of the structures under the acromion.

Impingement may also be secondary to minor instability, possibly involving labral tears. 

Impingement ? What is the clinical meaning of a painful arc in the shoulder ?

A painful arc is the result of a momentary impingement, the question however is : “Which structure is impinged ?” 

Most common reasons of a painful arc during lateral elevation :

  • Impingement of the tenoperiosteal aspect of the supraspinatus muscle ; in that case there will also be pain on resisted abduction
  • Impingement of the tenoperiosteal aspect of the infraspinatus muscle ; in that case there will also be pain on resisted lateral rotation
  • Impingement of the cranial tenoperiosteal aspect of the subscapularis muscle ; in that case there will also be pain on resisted medial rotation
  • Impingement of the caudal part of the acromioclavicular joint
  • Impingement of the subdeltoid bursa in case of a chronic subdeltoid bursitis (Cave : in an acute bursitis there is never a painful arc

 A painful arc can also be found during passive medial rotation, pointing in the direction of a chronic subdeltoid bursitis.

In order to detect a painful arc we need to perform our tests in a good way : stop at the first pain, inform about the localisation and the quantity of the pain, but…then continue the testmovement and interpret whether or not we can provoke a painful arc.

  • If we perform the lateral elevation in a normal way, we mainly compress supraspinatus.
  •  If we elevate and simultaneously build in lateral rotation (so, palm up), then we compress more subscapularis.
  •  If we build in more medial rotation, we compress more infraspinatus. 
  • If we do an anterior elevation + lateral rotation, we compress more the long head of biceps.

 So, impingement syndrome is not a diagnosis, it is merely a statement, but more to the point examination is preferred in order to determine which structure is impinged. This will also allow a more specific treatment.

 

Keep one important message in mind : one single positive test has no clinical meaning at all ; focus on the complete image : history, inspection and a cluster of positive and negative tests.
For more detailed analysis and recent scientific background of the clinical images described above, I refer to the ETGOM training programs in Modern Orthopaedic Medicine Cyriax and to our publications.

We wish to respect your privacy at all times

PRIVACY GDPR

How do we collect your personal data such as name and email address ?

  • When you are an ETGOM course participant automatically you enter the ETGOM newsletter
  • When you send us an email with an information request regarding the ETGOM seminars or publications
  • When you participate at an ETGOM webinar
  • When you download the free ebook
  • When we meet in person (e.g. conference)
  • Or when you register on our “Tips and Tricks in orthopaedic medicine” newsletter

How do we use your personal data

  • Your data are exclusively used by the ETGOM Teaching Team and organisation partners to inform you about ETGOM activities and publications
  • Your data will not be transferred to any third party which is not related to orthopaedic medicine continuing education

Your rights

  • You have the right at all times to view, to update or to delete your personal data
  • You can unsubscribe from our newsletters, mailing list, at any time
  • You can refuse or limit the use of your personal data

You can visit the website of OM Consult bvba/ETGOM unrestricted and furthermore consult information about our company, products and services without giving any personal data of you. Only if you want to contact us via the web form, you have to share you personal data. Each time you provide personal information, OM Consult bvba will handle them in accordance with the policy written down in here and the legal liabilities concerning the handling of personal data.


1. Confidential handling of personal data 
The personal data collected by OM Consult bvba/ETGOM, are saved on a protected place, which is not open for the public. The file can only be consulted by a restricted number of persons who are in service of OM Consult bvba/ETGOM and only if they need this information for practice there job. The data will only be processed for internal purposes. Om Consult bvba ordinarily doesn’t give any personal data to third persons, except to comply with legal liabilities and in case of an express request from the judicial authority or police. In the exceptional case that OM Consult bvba/ETGOM gives information to organizations or companies with which they work together, it will be expressly mentioned or you will be expressly asked for your agreement.


2. Purpose of handling 
OM Consult bvba/ETGOM handles the collected personal data to identify you and if necessary to contact you and to give you an optimal service. The data can also be used to give you information about news items, new services and new products of OM Consult bvba/ETGOM. If you don’t want to receive such information, you can mention this to OM Consult bvba/ETGOM by e-mail ( info@cyriaxcourses.com) or by letter.


3. Permission for handling
By providing your personal data you give permission to OM Consult bvba/ETGOM to handle them for the above purposes. If OM Consult bvba/ETGOM wants to use your personal data for other purposes or if they want to pass them to organizations or companies with which they work together, then OM Consult bvba/ETGOM will ask for your express agreement, and you can resist against this.


4. Right to inspection, correction and removal of personal data
You have the right to have a look at the data Om Consult bvba/ETGOM registered about you and to let correct them incomplete or inaccurate data about you. Furthermore you can ask on every moment to delete your personal data of the file of Om Consult bvba/ETGOM. For that you can send an email (info@cyriaxcourses.com) or a letter to Om Consult bvba/ETGOM.