Corticoid Injection for Subacromial Impingement Syndrome Treatment

Shoulder impingement syndrome (subacromial impingement) is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and infl amed as they pass through the subacromial space, the passage beneath the acromion [1,2]. The most common symptom is pain around the acromion and spreads to deltoid muscle. There are a lot of damage levels of shoulder impingement, including in a latestage subacromial impingement often accompanies with rotator cuff tendon, and this syndrome is the main reason leading to rotator cuff tear [2]. On examination, the shoulder is slightly swollen around the acromion and coracoid process. Neer test and Hawkin test is a clinical sign to diagnose [2], furthermore Impingement test could diagnose and this test is described by Neer [1,3]. by the way using subacromial space anesthesia and if the patient is less painful, the test is positive. Corticosteroids injection is considered as a basic treatment for subacromial impingement [4-6]. This study aims to: Evaluate the results of shoulder impingement syndrome outcome by using local corticosteroid at Hanoi Medical University.


Introduction
Shoulder impingement syndrome (subacromial impingement) is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and infl amed as they pass through the subacromial space, the passage beneath the acromion [1,2]. The most common symptom is pain around the acromion and spreads to deltoid muscle. There are a lot of damage levels of shoulder impingement, including in a latestage subacromial impingement often accompanies with rotator cuff tendon, and this syndrome is the main reason leading to rotator cuff tear [2]. On examination, the shoulder is slightly swollen around the acromion and coracoid process. Neer test and Hawkin test is a clinical sign to diagnose [2], furthermore Impingement test could diagnose and this test is described by Neer [1,3]. by the way using subacromial space anesthesia and if the patient is less painful, the test is positive. Corticosteroids injection is considered as a basic treatment for subacromial impingement [4][5][6]. This study aims to: Evaluate the results of shoulder impingement syndrome outcome by using local corticosteroid at Hanoi Medical University.

Results
Comment: The proportion of female is a majority, the average age is 52,9. The duration of symptoms till treatment is 11,5. The right shoulder injury is prevalent (Table 1) Comment: The outcome of patients based on VAS score and Constant score after treatment signifi cantly improve (Table 2).

Discussion
In table 1, the majority of patients were female, accounts for 60%. The average age was 52,3 ± 6,84 years old. Many studies of other authors also pointed out that middle-age occupies a majority and female is prevalent [1,3,4]. De Quervain syndrome and hurt fi nger springs often occur in female and middle-age as well as other lesions of tendon and synovial fl uid because of the same mechanism [5]. Other factors are referred as a shoulder injury, we saw 6 cases, 4 males and 2 females. Injuries are considered as great factors and the onset of the damage. The mechanism of shoulder impingement syndrome was described by Neer in 1972 [1].
The majority of pain happens on the right shoulder. Some authors reported the same results or equivalent between 2 positions but they have not shown a signifi cant difference or relevant factors yet [3,4].
Clinical symptoms of this injury are usually painful, pain increases when movement. The location of pain is unclear, around the acromion and coracoid, may be spread to deltoid muscle. The etiology of pain is rubbing of supraspinatus tendon between great tubercle, acromion and coracoacromial ligament, then the onset of infl ammation process of synovial fl uid at subacromial space [2]. In early stages, this syndrome does not have rotator cuff injury and this is an important factor related to treatment indications. Besides clinical examination, Lidocaine test injection to subacromial space to evaluate is called Impingement test which helps to diagnose shoulder impingement syndrome. There are several methods to treat shoulder impingement syndrome such as medication, physical therapy, oriental treatment, local injection, arthroscopy or surgery and so on [1,5,8]. In which surgery is often performed in late-stage, much degeneration, rotator cuff tears which requires surgery such as suture the tendon tears, take out degenerated issues and sub-acromial space plasty [1]. Internal medicine is indicated at early-stage when no tendon injury and no mechanical narrow space [4][5][6]. The patients who we indicated to treatment with hard criteria, was diagnosed by the clinical test, positive test Impingement, ultrasound and MRI to confi rm the diagnosis and exclude rotator cuff tear, cartilage rim tear. Patient selection with above criteria have a good outcome and clearly improve compared to pre-surgery based on VAS score and Constant score.
Using local Corticoid injection was accepted in a majority of author due to the effective treatment and less systemic adverse side effects [4][5][6], some authors reported some local adverse side effects on rotator cuff tendon but not much, especially only one injection and using methylprednisolone [6,9]. Injection technique is an interesting problem, some researchers showed that 21% of injection is unsatisfi ed anatomy require, means we injected medicine to deltoid muscle, not subacromial space [7,8], and then suggested the injection under ultrasound [10], and showed the exact results, as well as better, improve as.
However, in reality, we did not have an ultrasound at clinical examination room and we performed surgery and arthroscopy into subacromial space achieving a high outcome based on individual experience. Naredo et al. [10]. Showed that the group of injection without ultrasound guidance depending signifi cantly on the experience of the doctor.

Conclusion
We conducted a research with 30 patients of shoulder impingement syndrome by injecting Corticoid to subacromial space results in improving symptoms of pain and functional shoulder joint, and the change of VAS and Constant has a statistically signifi cant difference.  The duration of symptoms till treatment 11,5 ± 8,92 (3 -24 months )