الفهرس 
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Abstract
Summary
Subacromial impingement syndrome is a common disorder about the shoulder involving the soft tissue compromising the subacromial space; accounting for 44-65% of all shoulder complaints. The syndrome is caused by many factors resulting from an impingement on the rotator cuff, the overlying subacromial bursa and occasionally the tendon of the long head of biceps against the anterior edge of the acromion and its associated coracoacromial arch.
Neer described three progressive stages in the spectrum of rotator cuff impingement. Stage I consists of oedema and haemorrhage of the subacromial bursa and it is commonly seen in patients younger than 25 years of age. Stage II is usually seen in patients aged 25–40 years and represents a progression of stage I to thickening and fibrosis of the bursa and tendinitis of the cuff, this stage may not respond to conservative treatment. Stage III results from further impingement producing degeneration or incomplete or complete cuff tears. These changes are commonly seen in patients older than 40 years of age.
The subacromial space is determined by the humeral head inferiorly, the anterior edge and bottom of the anterior third of the acromion, coracoacromial ligament (CAL) and the acromioclavicular (AC) joint superiorly. The structures that occupy the subacromial space are supraspinatus tendon, subacromial bursa, long head of the biceps brachii tendon and the capsule of the shoulder joint. Any or all of these structures may be affected by SIS. The factors that cause impingement have been classified as direct or indirect, intrinsic or extrinsic, primary or secondary, static or dynamic.
Categorization of the anatomical factors is based upon their location in the subacromial space, their ability to generate force, and whether or not there is a superimposed pathology. There is overlap with all of these systems and their terminology is not synonymous, therefore these systems cannot be used interchangeably to present the anatomical and biomechanical mechanisms of SAIS. A thorough history, physical examination, scoring system and appropriate imaging are crucial for accurate diagnosis of impingement.
Once clinical assessment and the appropriate investigations have been reviewed, management of the condition must be tailored to each individual case. The natural course of shoulder impingement is poorly described and there are a variety of treatment options available. These can be categorised into non operative treatment modalities which includes; analgesia, steroid injection, shock-wave therapy and physical therapy, and operative treatment which includes both arthoscopic and open procedures.
In Beni Suef university hospital and for one year follow up, 60 patients with Stage II impingement were randomized into arthroscopic and open treatment groups. 30 patient in the arthroscopic group, 30 in the open group. Comparisons of pain, function, motion, and strength were made preoperatively and at 2 weeks, 1 month, 3 months, 6 months, and 1year postoperatively. Final analysis showed that the main benefits of arthroscopic acromioplasty were evident in the first 3 months postoperatively. Arthroscopic patients regained range and strength more rapidly than did open patients and returned more quickly to activities of daily living.
By 6 months postoperatively, open patients tended to “catch up” with arthroscopic patients, and further recovery was equivalent. In both groups, full recovery after one year follow up and patients in both groups achieved a satisfactory results.