PAINFUL ARC SYNDROME
– 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 .
– 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.
• Differential diagnosis
– Supraspinatus strain or fracture of greater tuberosity
– Tendinitis or Subacromial bursitis
– Acromioclavicular joint arthritis.
– 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
– 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.