Primary Compressive Disease

Primary Compressive Disease

Primary compression disease or impingement is a direct result of compression of the rotator cuff tendons between the humeral head and the overlying anterior third of the acromion, coracoachromial ligament, coracoid, or acromioclavicular joint. The physiological space between the lower acromion and the upper surface of the rotator cuff tendons is called the subacromial space. It was measured by anteroposterior radiographs and was found to be 7 to 13 mm in shoulder pain patients and 6 to 14 mm in normal shoulders. The biomechanical analysis of the shoulder produced theoretical estimates of the compressive forces against the acromion with shoulder elevation. Poppen and Walker calculated this force at 0.42 times the weight of the body, and Lucas estimated this force at 10.2 times the weight of the arm. Peak forces against the acromion were measured between 85 and 136 elevation, a position inherent in sport-specific movement patterns and commonly used in ergonomic and daily activities. Shoulder positions in forward flexion, horizontal adduction, and internal rotation during the acceleration and drag phases of the throwing motion can produce subacromial impingement caused by abrasion of the supraspinatus, infraspinatus, or biceps tendon. These data provide a scientific basis for the concept of impingement or compression disease as a cause of rotator cuff injury. Neer described three stages of primary impingement regarding rotator cuff injury. Stage I, edema and hemorrhage, is the result of mechanical irritation of the tendon due to the impact that occurs with air activity. This phase is characteristically seen in younger patients who are more athletic and is described as a reversible condition with conservative physical therapy. The primary symptoms and physical signs of this impingement stage or compression sickness are similar to those of the other two stages and consist of a positive impingement sign, a painful range of motion, and varying degrees of muscle weakness. The second stage of the compression disease described by Neer is called fibrosis and tendonitis. This stage is the result of repeated episodes of mechanical inflammation and can include thickening or fibrosis of the subacromial pockets. The typical age range for this stage of the injury is 25 to 40 years. Neer's stage III impingement injury is called a bone spur and tendon rupture and is the result of continuous mechanical compression of the rotator cuff tendons. Full-thickness rotator cuff tears, partial-thickness rotator cuff tears, biceps tendon tears, and bony abnormalities of the acromioclavicular and acromioclavicular joint may be associated with this stage. In addition to the bone alterations, which are acquired with repeated strain on the shoulder, the native form of the acromion is relevant. The specific shape of the overlying acromion process, referred to as the acromial architecture, was studied in relation to full-thickness rotator cuff tears. Bigliani et al described three types of acromion: type I (flat), type II (curved) and type III (hook-shaped). A type III acromion or hook was found in 70% of cadaveric shoulders with a full-thickness rotator cuff tear, while type I acromions were associated with only 3% of cadaveric shoulders. In a series of 200 clinically examined patients, 80% with an abnormal arthrogram had a type III acromion. Surgical treatment of primary compressive disease generally involves decompressing 8mm of the anterior acromion, preserving the deltoid insertion and blunting approximately 2cm posteriorly to provide additional space for inflamed tendons. Open repairs of associated full-thickness rotator cuff tears are routinely performed in conjunction with decompression acromioplasty to treat the offensive overlying acromion and to repair the full-thickness rotator cuff defect. The open repair method has specific ramifications for postoperative rehabilitation. Specifically, the open-type surgical approach can separate the origin of the deltoid from the lateral aspect of the clavicle and acromion, a procedure that may be called the traditional anterior approach, or the deltoid can be divided vertically along the direction of its fibers. a procedure commonly known as the deltoid division approach or the miniopen approach. Retention of the deltoid origin used during the deltoid division approach is advantageous because rehabilitation can begin earlier with active assisted range of motion (AAROM) and active ROM (AROM) than with the traditional deltoid detachment approach. The arthroscopic rotator cuff repair technique further reduces tissue morbidity and allows access for rotator cuff repair in patients with deltoid trauma. This technique is fast becoming the method of choice for nearly all types of rotator cuff repair, as advances in instrumentation and suture anchors continue to develop. The traditional open approach often takes 6 to 8 weeks without active or resistance exercise to protect not only the healing rotator cuff, but also the origin of the healing deltoid, which is reattached after the repair rotators. headphones. Knowledge of the specific surgical technique used in a patient referred for physical therapy after open repair of a full-thickness rotator cuff tear is critical for optimal progression in postoperative rehabilitation.

Post a Comment

0 Comments