Topic: Rotator Cuff Impingement Syndrome
In 1972 Neer first described this very common shoulder condition as an impingement of the shoulder. Some articles state that Rotator Cuff Impingement Syndrome (RCIS) affects 200-250,000 people per year.
RCIS occurs when the interspace between the humeral head and the subacromial space (normally 8-10mm) is decreased by either mechanical occlusion and/or increase of the contents within the interspace.
There are causative factors contributing to RCIS, plus the pitfalls of failing to recognize the arthrodial biomechanics of the shoulder. Current research unequivocally supports the biomechanics.
What are the truths and the myths of allopathic and physical therapists? According to an MD Radiologist friend of mine, he reports that RCIS is the diagnosis he renders as x-rays and MRI evinces patients have less than the normal 8-10 mm subacromial space. In his radiology report provided to the surgeon, patients typically follow with the surgical procedure known as acromioplasty. Here the orthopedic surgeon shaves the inferior aspect of the acromion process and in numerous cases also dissects a distal portion of the clavicle as well to further open the space to increase range of motion.
I explained the biomechanics to my radiologist friend, and he looked at me with such dismay knowing he has sent countless patients for what he now believes is an unnecessary procedure. While yes, the acromion may in fact be an underlying issue, however it is what I term an “optical delusion”. If the subacromial space is less than the accepted normal 8-10mm is it because the acromion has 1) grown, or 2) the humerus has ascended beneath the acromion, or 3) possibly the acromion is being pulled inferiorly by the action of the scapula being displaced. Notwithstanding, an increase of contents in the subacromial space is also a consideration that could be the result of calcium accumulating such as CPPD, or degenerative spurs on the inferior surface of the acromion and/or clavicle at the A-C joint, or possibly tendinopathy, subacromial bursitis or adhesive capsulitis.
Now, with the absence of any additional contents found on MRI, what is the biomechanical rationale for RCIS? As I explain in my learning platform (ExtremityExperts.com) the injury mechanism causing RCIS involves a very unique presentation, whereby the implicated acromion is in most cases optically tricking the radiologist and orthopedic surgeon. A scapula that subluxates in a protracted and antetilted direction elevates the acromion and coracoid processes. The coracoid serves as a major attachment site for the pectoralis minor. With the inherent stretch reflex the pectoralis minor contracts repositioning the coracoid and acromion in an anterior and inferior direction. This thereby reduces not only the subacromial space, but also the retro pec minor space, contributing to another very common yet not well understood condition known as Wright’s Hyper-abduction Syndrome which results in Thoracic Outlet Syndrome (T.O.S). As a first step, treat RCIS brilliantly with the Mally Method. You’ll likely save your patient from surgery.
