Management of Humeroscapular Roughness.
Last updated Thursday, January 27, 2005
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Figure 1 - Arch made of bone and ligaments Figure 2 - Coracoacromial arch Figure 3 - Subacromial abrasion Shoulder roughness
Roughness on movement of the shoulder is not uncommon. In fact, many
normal shoulders creak and snap on motion. However, if roughness
interferes with use of the shoulder, it may need treatment. In most
instances, the function of the shoulder can be regainCauses Problematic roughness may be related to interruption of the smooth
sliding of the upper arm bone (humerus) and the tendons attached to it
(the rotator cuff) beneath an arch made of bone and ligaments. If this
is the cause and if the exercise program is not effective,
consideration can be given to surgery to smooth this interface.Nonoperative management Because shoulder roughness is usually of insidious onset, there is
usually a good opportunity to try nonoperative management. Unless the
diagnostic evaluation dictates otherwise, the patient is reassured that
crepitus and occasional catching do not mandate surgical intervention.
Crepitus on moving the humerus with respect to the deltoid and
coracoacromial arch is very common and often of little functional
significance; some form of subacromial roughness can be found in most
adult shoulders. Occasionally, patients demonstrate compromised
smoothness of various aspects of the humeroscapular motion interface
after injury or surgery, for example, roughness at the site of surgical
reattachment of the subscapularis as it passes beneath the coracoid
muscles on rotation.
In patients with functionally significant roughness of the
nonarticular humeroscapular motion interface, the aim of nonoperative
management is to restore normal kinematics. The first goal is
flexibility, eliminating adhesions or posterior capsular tightness that
may cause obligate anterosuperior humeral translation and subacromial
abrasion. As flexibility is improved, attention is also directed at
optimizing the normal stabilizing effect of the rotator cuff
musculature by strengthening exercises, emphasizing internal and
external rotation strength and endurance. Operative management Persistent, functionally limiting subacromial crepitance may require consideration of surgical subacromial smoothing.
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