Impingement Syndrome: Case Study and SOAP Note

Pages: 19 (4944 words) Published: June 1, 2014


Impingement Syndrome Case Study and SOAP Note
Impingement Syndrome Case Study and SOAP Note
Case Scenario
Samantha, a 68 year old presents with right shoulder pain, (impingement syndrome). Description of the Problem
The shoulder is made up of three bones, several joints, along with several muscles and tendons. This combination of structures allow for great range of motion in your arm. In addition to the many different structures being beneficial, this also makes the shoulder susceptible to many different injuries or problems. The three bones that make up the shoulder are the humerus, the clavicle, and the scapula. The arm is kept in its place in the shoulder socket by a part called the rotator cuff. The rotator cuff is made of up muscles and tendons. The upper arm bone is attached to the shoulder blade by the rotator cuff. “The acromion is the bone on the top of the shoulder. Between the rotator cuff and the acromion is a lubricating sac called the bursa. The purpose of the bursa is to assist the tendons to glide freely when the arm is moved” (American Academy of Orthopaedic Surgeons, 2011). Shoulder impingement occurs when the arm is raised to shoulder height. When the arm is raised there is a narrowing of the space between the rotator cuff and the acromion. “During this narrowing, the acromion may impinge on the bursa and the tendon. This impingement can lead to pain and irritation” (American Academy of Orthopaedic Surgeons, 2011). “The area known as the impingement interval is the area between the superior aspect of the humeral head and the undersurface of the acromion. This normally narrow space is maximally narrowed when the arm is abducted. Any factor or condition that causes a further narrowing of that space can result in impingement” (Fongemie, Buss, Rolnick 1998). Impingement may result from weakness or loss of competency of the rotator cuff. Several extrinsic factors can lead to the impingement. Once the rotator cuff is weakened, that leads to a superior movement of the humeral head. “The superior movement of the humeral head increases the impingent, which leads to an ongoing cycle, thus reinforcing the impingement” (Fongemie, Buss, Rolnick 1998). Inflammation of the bursa is referred to as bursitis. This leads to pain and a loss of motion. The loss of motion can lead to a thickening of the rotator cuff and its bursa. This thickening causes the surrounding tissue to impinge upon the bones around the shoulder. This is more commonly referred to as impingement syndrome (American Society for Surgery of the Hand, 2007). There are many processes that may compromise the normal gliding function of the shoulder’s tendons thus causing an impingement. Simple degeneration and weakening within the tendon can occur due to age. In some people there is a normal variant to the anatomy of the acromion. Acute trauma to the shoulder can cause impingement. The normal acromion is flat. Type II and type III acromion are curved or hooked and dip downward. This variation in shape causes an obstruction at the outlet for the supraspinatus tendon leading to impingement. Calcification of the coracoacromial ligament, which can be due to trauma or joint arthritis, has been associated with impingement syndrome. The formation of bone spurs in the subacromial space will lead to further narrowing of the space. Other causes can be a buildup of calcium deposits within the space, or poor posture and poor muscle strength (Fongemie, Buss, Rolnick 1998). One of the most common causes of shoulder impingement is overuse injury. This cause is seen mostly in people who often use there arm in a repetitive overhead motion. “Certain sports such as tennis, baseball, especially pitching, and swimming in which the athlete uses there arm overhead repetitively are very susceptible to impingement syndrome. Also professions or hobbies such as painting, paper hanging, and many construction jobs make the shoulder more vulnerable” (American Academy of...
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