Shoulder Conflict Syndromes

What is a shoulder conflict?


 

The term conflict is used in shoulder pathology when there is a compromise in space between the bone and tendon structures, which occurs in certain positions of the arm and can lead to wear and tear of these structures.

What types of shoulder impingement syndrome are there?

The most common impingement syndrome in the shoulder is subacromial impingement, which is due to abnormal contact between the acromion and the tendons of the rotator cuff, particularly the supraspinatus tendon.  Between these structures is a bursa that aims to reduce friction, but which can become inflamed in these circumstances. Abduction (opening the arm) reduces the available space and is usually the movement that causes the most symptoms. 

Subcoracoid impingement is relatively rare and is caused by a reduction in the space under a bony prominence in the anterior region of the shoulder. The most affected tendon is the subscapularis, with pain occurring mainly during internal rotation movements, such as reaching behind the back.  In the long term, it can lead to tendon inflammation (tendinitis) or even ruptures that can lead to greater functional limitations.

 

What treatments are there for conflict syndromes?


Initial treatment is aimed at controlling pain and reestablishing balance in the shoulder between the rotator cuff stabilizing muscles, the deltoid muscle responsible for the main movements of the shoulder, and the scapula stabilizing muscles in the dorsal region, to avoid abnormal contact positions that can cause pain.  Analgesic medication, such as non-steroidal anti-inflammatory drugs, avoiding painful efforts and physiotherapy aimed at this problem are effective in most cases.

Infiltrations may be an option when pain persists, and are performed in a consultation setting by a specialist orthopedist.
Arthroscopic surgery will play a role in the treatment of these syndromes when they do not respond to other therapeutic options, which happens in a small percentage of cases.

To learn more about conservative or surgical treatment options for conflict syndromes, click here .