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Key Features

  • Describes a collection of diagnoses that cause mechanical inflammation in the subacromial space

  • Causes of impingement syndrome can be related to

    • Muscle strength imbalances

    • Poor scapula control

    • Rotator cuff tears

    • Subacromial bursitis

    • Bone spurs

Clinical Findings

  • Pain, instability, weakness, or loss of range of motion

  • Classically presents with one or more of the following:

    • Pain with overhead activities

    • Nocturnal pain with sleeping on the shoulder

    • Pain on internal rotation (eg, putting on a jacket or bra)

  • Numbness and pain radiation below the elbow are usually due to cervical spine disease

  • Atrophy in the supraspinatus or infraspinatus fossa may be appreciable

  • Mild scapula winging or "dyskinesis" may be present

  • Patient often has a rolled-forward shoulder posture or head-forward posture

  • Tenderness over the anterolateral shoulder at the edge of the greater tuberosity may be present

  • Symptoms can be elicited with the Neer and Hawkins impingement signs (Table 41–1)

Diagnosis

  • Four radiographic views should be ordered

    • Anteroposterior scapula view can rule out glenohumeral joint arthritis

    • Anteroposterior acromioclavicular view evaluates the acromioclavicular joint for inferior spurs.

    • Scapula Y view evaluates the acromial shape

    • Axillary lateral view visualizes the glenohumeral joint as well and for the presence of os acromiale

  • MRI of the shoulder may demonstrate full or partial thickness tears or tendinosis

  • Ultrasound evaluation may demonstrate thickening of the rotator cuff tendons and tendinosis

Treatment

  • Most patients respond well to conservative treatment, including education, activity modification, and physical therapy exercises

  • Procedures include arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, or debridement or repair of rotator cuff tears

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