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Medical Disability Advisor  >  Impingement Syndrome  >  Treatment  see more: ACOEM - Shoulder Disorders

Impingement Syndrome


Related Terms


  • Internal Impingement
  • Rotator Cuff Impingement Syndrome
  • Subacromial Impingement Syndrome
  • Subcoracoid Impingement

Differential Diagnoses


Specialists


  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions


  • Musculoskeletal disorders
  • Rheumatologic disorders
  • Rotator cuff impingement
  • Tear in the contralateral shoulder

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Factors Influencing Duration


Duration depends on job requirements and whether the dominant or nondominant arm is involved. Duration and disability also depend heavily on whether the contralateral shoulder has similar problems. Disability may be longer for individuals who perform repetitive actions and/or overhead work as part of their work duties. The individual's age, occupation, response to treatment, and compliance with treatment recommendations and rehabilitation programs will influence the duration of disability. Osteoarthritis in the glenohumeral joint is uncommon but, if present, will significantly delay return to heavy work or shoulder-intensive work.

Duration Trends from Reference Data


DURATION TRENDS
 ICD-9-CM: 726.2  
CasesMeanMinMaxNo Lost TimeOver 6 Months
36216602970.2%3.8%
 
  
 
Percentile:5th25thMedian75th95th
Days:12305489172
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes


ICD-9-CM:
726 - Peripheral Enthesopathies and Allied Syndromes
726.2 - Other Affections of Shoulder Region, Not Elsewhere Classified; Periarthritis of Shoulder; Scapulohumeral Fibrositis
840 - Sprains and Strains of Shoulder and Upper Arm
840.9 - Sprains and Strains of Shoulder and Upper Arm, Unspecified Site of Shoulder and Upper Arm; Arm NOS; Shoulder NOS

Treatment


In the early stages, impingement syndrome will resolve when the aggravating activity and any overhead work are avoided. Physical therapy to increase range of motion and strengthen shoulder stabilizers may also be helpful. Application of ice (cryotherapy) can relieve pain. Medications to control pain and inflammation are usually prescribed. Injection of corticosteroid and anesthetic agents into the subacromial space is often part of conservative treatment. If the shoulder becomes stiff (complicating adhesive capsulitis), manipulation of the shoulder under anesthesia can be helpful to improve flexibility.

Surgical intervention is an option when individuals fail to improve after several months of physical therapy and subacromial injections. The goal of surgery is to increase the size of the subacromial space and remove inflamed tissue. Reshaping the acromion (acromioplasty) combined with removing the subacromial bursae and cutting the coracoacromial ligament are common procedures. Removal (excision) of any bone spurs and inflamed rotator cuff tissue (débridement) may also be needed. This combination of procedures is often called subacromial decompression. These procedures can be performed either through open surgery (arthrotomy) or arthroscopically. Frequently an excisional arthroplasty of the acromioclavicular joint is also performed. If a labrum tear is present, it can be repaired or débrided at the time of the shoulder surgery. Typically, these are outpatient procedures.

Source: Medical Disability Advisor






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