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Subacromiale klachten [evidence statement]

Definitie

De term subacromiale klachten omvat klachten voortkomend uit aandoeningen van structuren in de subacromiale ruimte, meestal veroorzaakt door inklemming van de rotatorcuffpezen in de subacromiale ruimte (Stevenson & Trojian, 2002). Tijdens het heffen van de schouder is voornamelijk sprake van inklemming van de pees van de musculus (m.) supraspinatus, wat leidt tot het ‘painful arc’ fenomeen. Provocerende houdingen of bewegingen, zoals werpen, leiden vooral tot inklemming van de pezen van de m. infraspinatus, de m. subscapularis en de m. biceps brachii (caput longum) (Cools & Walraven, 2006). Door dit fenomeen worden subacromiale klachten in de dagelijkse praktijk vaak omschreven als impingement van de schouder.

Dit schouderstatement betreft subacromiale klachten op basis van extern impingement (inklemming in de subacromiale ruimte); intern impingement (inklemming tussen de humeruskop en de cavitas glenoidalis scapulae) wordt buiten beschouwing gelaten.

Neer (1972) was de eerste die subacromiaal impingement beschreef als een diagnose of (rotatorcuff)pathologie, met als behandeling ‘raise the roof’ (acromionplastiek). Tegenwoordig wordt subacromiaal impingement meer gezien als een symptoom en moet de oorzaak van de klachten worden gezocht. Behulpzaam hierbij is de onderverdeling in ‘primair’ impingement (structurele vernauwing van de subacromiale ruimte, bijvoorbeeld vanwege zwelling van de rotatorcuffpezen of de bursa of vanwege osteofytenvorming ter hoogte van het acromioclaviculair gewricht) en ‘secundair’ impingement (inklemming tijdens specifieke houdingen en/of bewegingen). Bij secundair impingement kunnen de volgende aandoeningen een rol spelen: glenohumerale instabiliteit, glenohumerale hypomobilteit, scapulothoracale disfuncties, bicepspathologie (Superior Labrum Anterior to Posterior (SLAP) pathologie) of beperking van het posterieure schouderkapsel (Glenohumeral Intern Rotation Deficit (GIRD)). 

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