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Incidence and Natural History

Shoulder pain is a common presenting complaint for patients of all ages and activity levels. In clinical frequency it is exceeded only by low back pain and neck pain. About 50% of the adult population will have at least one episode of shoulder pain each year.

The most common source of shoulder pain originates in the subacromial space, with the most prevalent diagnosis being impingement syndrome. The spectrum of pathologies includes rotator cuff tendonosis, calcific tendonititis, and subacromial bursitis.

The natural course of subacromial impingement varies somewhat. Long term outcome suggests that it is not self limiting and without treatment, symptoms will persist and usually progress. The impingement process has been described as having three chronologic stages . Stage 1 is characterized by acute bursitis with subacromial edema and hemorrhage.

As the irritation continues, the bursae loses its capability to lubricate and protect the underlying cuff and tendonitis of the rotator cuff develops. This leads to stage II, which is characterized by inflammation and possible partial thickness tears of the rotator cuff. As the process continues the wear on the tendon results in a full thickness tear (stage III). Several authors have shown that this progressive process can be interrupted with surgical acromioplasty.

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