Which of the following is not true about impingement syndrome?

Ans. is 'd' i.e., Surgical decompression of the subacromial space is frequently indicated Impingement syndrome* Tendinitis of the rotator cuff is the major cause of a painful shoulder and is currently thought to be caused by inflammation of the tendon(s).* The rotator cuff consists of the tendons of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles, and inserts on the humeral tuberosities.* Of the tendons forming the rotator cuff, the supraspinatus tendon is the most often affected, probably because of its repeated impingement between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament above as well as the reduction in its blood supply that occurs with abduction of the arm.* This phenomenon is described as impingement syndrome.* The tendon of the infraspinatus and that of the long head of the biceps are less commonly involved.* The process begins with edema and hemorrhage of the rotator cuff, which evolves to fibrotic thickening and eventually to rotator cuff degeneration with tendon tears and bone spurs.* Subacromial bursitis also accompanies this syndrome.* Symptoms usually appear after injury or overuse, especially with activities involving elevation of the arm with some degree of forward flexion.* Impingement syndrome occurs in persons participating in baseball, tennis, swimming, or occupations that require repeated elevation of the arm.* Those over age 40 are particularly susceptible.* Patients complain of a dull aching in the shoulder, which may interfere with sleep. Severe pain is experienced when the arm is actively abducted into an overhead position.* The arc between 60deg and 120deg is especially painful. This is also described as "painful arc syndrome".* Tenderness is present over the lateral aspect of the humeral head just below the acromion.* NSAIDs, local glucocorticoid injection, and physical therapy may relieve symptoms.* Surgical decompression of the subacromial space may be necessary in patients refractory to conservative treatment.