Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ 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 GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options