Further to these findings, the radiologist noted that the patient's pain decreased only minimally with diagnostic intra-articular anaesthetic (5 cc of 1% Xylocaine) suggesting that intra-articular pathology may not be the primary pain generator, but rather the moderate AC joint arthropathy and mild subacromial
bursitis as potential sources of pain.
Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment of rotator cuff tears, subacromial
shoulder pain is commonly treated non-operatively with exercise therapy, non steroidal anti-inflammatory drugs (NSAIDS), corticosteroid injection, shock-wave therapy, and other approaches [5-7].
Diagnosis of the shoulder pathology was based on the patient's history, a clinical examination, conventional radiography, a subacromial
injection test (SIT), and magnetic resonance imaging (MRI) as well as electroneuromyography when needed.
Internal impingement occurs at higher degrees of humeral elevation (greater than 105[degrees]) than does subacromial
(12) which in turn can bring about increased mechanical pressure on the subacromial
structures leading to shoulder impingement.
Classic clinical teaching suggests that these symptoms are more significant in patients with subacromial
bursitis and/or partial thickness RC tears compared to those with full thickness tears.
Treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and steroid infiltration into the subacromial
Patients with shoulder pain are commonly encountered in healthcare settings (van der Windt et al 1995, May 2003) and a number of diagnostic labels have traditionally been used, such as capsulitis, bursitis, and subacromial
impingement syndrome (Cyriax 1982).
Primary impingement occurs less often and is the result of a structural abnormality that implies bony or ligamentous encroachment on the subacromial
In addition to access to target anatomy that a percutaneous approach provides, this suture shuttling device is small enough to pass through an 18g spinal needle allowing precise placement of sutures without cannula restrictions in the limited working area of the subacromial
space and glenohumeral joint.
Arthroscopy is also covered for subacromial
decompression and acromioclavicular joint resection, thermal capsulorrhaphy, and other procedures.