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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)
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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
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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
However, the value of acromioplasty alone for rotator cuff problems is not supported by evidence