EpistemisSubacromial friction syndrome
Specialty: Musculoskeletal.
Why it occurs
- Mechanical compression of the supraspinatus tendon and subacromial bursa against the coracoacromial arch during arm abduction
- Anatomical variations of the acromion (flat acromion type I, curved type II or hooked type III)
- Bone spurs in the acromioclavicular joint
- Microtraumatic glenohumeral instability
- Scapulothoracic dyskinesia (alteration of the rhythm of the scapula)
- Tendinous degeneration due to senescence (hypovascularity of the supraspinatus tendon in the critical zone)
Initial workup
Detailed physical examination (positive Neer, Hawkins-Kennedy, Jobe maneuvers) | Plain shoulder x-ray (AP projections, scapular axial and supraspinatus exit view) | Musculoskeletal ultrasound of the shoulder or MRI of the shoulder (gold standard for assessing tears and the degree of muscle atrophy).
red flags
Sudden intense pain in the shoulder with absolute inability to actively abduct the arm (pendulum arm), accompanied by visible hematoma and history of trauma or sudden traction effort (indicates acute full-thickness rupture of the supraspinatus tendon or rotator cuff, requires evaluation for early surgical repair).
Standard management
- Celecoxib — 200 mg once a day orally for 10 days, to control acute bursitis
- Ultrasound-guided subacromial infiltration of triamcinolone acetonide — 40 mg with local anesthetic; highly resolving if combined with subsequent physical therapy
- Chondroitin sulfate (800 mg daily orally).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3