Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 41-02: Musculoskeletal Injuries of the Shoulder + Key Features Download Section PDF Listen +++ ++ Syndrome is 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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