PAINFUL ARC SYNDROME

PAINFUL ARC SYNDROME

DEFINITION

– Arc of shoulder abduction elevation from 45 to 160° is painful but painless up to initial 45° as well as pain free terminal range from about 160° to full elevation.

– Passive ROM is free .

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• CAUSE

 

– mechanical and tender structures are gets nipped in between the tuberosity of humerus and acromion process or coracoacromial ligament.

• 5 types of lesions which can give rise to painful arc syndrome are ;

1) Incomplete Supraspinatus tendon tear

2) Supraspinatus tendinitis

3) Calcified deposits on the Supraspinatus tendon

4) Subacromial bursitis.

5) Crack fracture of greater tuberosity.

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• Differential diagnosis

– Supraspinatus strain or fracture of greater tuberosity

– Tendinitis or Subacromial bursitis

– Acromioclavicular joint arthritis.

 

Treatment

 

– Rest in sling initially

– SWD can be used

– In supine lying, Full range relaxed passive pain-free elevation .

– Abduction is progressed gradually, In gravity eleminated begin with active assisted movement

* If the conservative management fails , surgery may be required.

 

It includes ;

1) Open anterior acromioplasty : a part of anteroinferior undersurface or acromion is removed.

 

2) Arthroscopic acromioplasty

* Space between humeral head and acromion is widened. Neck of scapula is divided and glenoid fragment with glenohumeral joint is displaced downwards.

* Repair of rupture

 

• Physiotherapy management

 

1) Immobilization ( 2 – 3 weeks )

– Vigorous exercises for the joints free from Immobilization

 

2) Mobilization

– Relaxed pendular flexion and extension with sling ( passively )

– Assisted abduction in gravity eleminated position

– Strong Isometrics to abduction movement

– Gradually progress to active resisted abduction.

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