Subacromial Impingement Syndrome

Key Features

Essentials of Diagnosis

• Shoulder pain with overhead motion

• Night pain with sleeping on shoulder

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

General Considerations

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

• Causes can be related to

  • Muscle strength imbalances

  • Poor scapula control

  • Rotator cuff tears

  • Subacromial bursitis

  • Bone spurs

• Because shoulder injuries may present differently depending on the demands placed on the shoulder joint, establishing the patient's hand dominance, occupation, and recreational activities is important

Clinical Findings

• 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)

• On inspection, there may be appreciable atrophy in the supraspinatus or infraspinatus fossa

• Mild scapula winging or "dyskinesis" may be present

• A rolled-forward shoulder posture or head-forward posture is commonly seen

• On palpation, the patient can have tenderness over the anterolateral shoulder at the edge of the greater tuberosity

• The patient may lack full active range of motion (Table 41–1) but has preserved passive range of motion

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