Materiały źródłowe

• #1 Subacromial (shoulder) impingement syndrome – UpToDate

  https://www.uptodate.com/contents/shoulder-impingement-syndrome

  Subacromial impingement syndrome (SIS; commonly referred to as shoulder impingement) refers to a combination of shoulder symptoms, examination findings, and radiologic signs attributable to the compression of structures around the glenohumeral joint that occurs with shoulder elevation. Such compression causes persistent pain and dysfunction. Shoulder pain is a common presenting complaint in primary care clinics, and SIS is likely the most common cause of shoulder pain in this setting. […] The diagnosis of SIS implies a spectrum of clinical findings, not injury to a specific structure. […] The pathophysiology, diagnosis, and management of SIS is reviewed here. […] Shoulders pain is highly prevalent within the general population, second only to lower back pain. Studies suggest that SIS is the most common cause of shoulder pain, accounting for approximately 30 to 35 percent of shoulder disorders. […] Risk factors — Repetitive activity at or above the shoulder during work or sports represents the main risk factor for SIS.

• #1 Shoulder Impingement | Symptoms, Tests & Diagnosis | Spire Healthcare

  https://www.spirehealthcare.com/conditions/shoulder-impingement/

  Shoulder impingement can happen without warning or begin gradually. […] Make an appointment to see your doctor or a physiotherapist if your shoulder pain lasts more than a few weeks or is affecting your everyday life. […] Your doctor may ask you lots of questions about the nature of your pain eg: The impact the pain is having on your everyday activities, When it started, Where the pain is, Whether you’ve injured yourself. […] They will carry out a thorough physical examination and may also ask you to carry out certain movements with your arms, hands and shoulders. This will help them determine what kind of shoulder impingement you have based on criteria including: The location of your shoulder impingement ie on the joint side of the rotator cuff (articular sided impingement) or on the outer side of the rotator cuff (bursal impingement).

• #1 Patient education: Shoulder impingement syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/shoulder-impingement-syndrome-beyond-the-basics/print

  Shoulder impingement syndrome (SIS) is a condition that causes shoulder pain. To diagnose SIS, health care providers look for a specific set of shoulder symptoms and certain clinical findings, which together suggest that the patient has the condition. […] If you have symptoms of shoulder impingement, your health care provider will examine you to learn what movements elicit symptoms. As part of the evaluation, he or she will likely ask to watch as you move your own arm and shoulder (called active motion), and also explore what you feel if he or she moves your arm and shoulder for you (called passive motion). […] In most cases, health care providers can tell when a person has shoulder impingement syndrome (SIS) based on the results of the physical exam. Still, in some cases it’s hard to tell the difference between SIS and other shoulder problems. If your health care provider is uncertain about your diagnosis or thinks that you might need surgery, they might refer you to a doctor who specializes in muscle and joint problems, such as an orthopedist, rheumatologist, or rehabilitation and physical medicine specialist.

• #1 Shoulder Exam Tutorial | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/shoulder.html

  Shoulder impingement syndrome, the tendon of the supraspinatus is inflamed as a consequence of repetitive trauma to its subacromial portion. […] We can use three tests to check for the presence of shoulder impingement: – Neers Test – Empty Can Test – Hawkins-Kennedy Test […] In Neers test, first we ask the patient to fully pronate the forearm, then we passively flex the arm until it is over the patients head. This maneuver reduces the subacromial space and reproduces pain if shoulder impingement is present. […] This is the same test that is used to check for the supraspinatus tendon integrity. It reduces the subacromial space thus eliciting pain if impingement is present. […] To perform this test both the elbow and the shoulder should be flexed at 90. The examiner must support the arm of the patient at the level of the elbow so that the upper extremity can be as much relaxed as possible. Then the examiner has to internally rotate the shoulder while at the same time perform a cross-body adduction of the arm. The test is positive if pain is elicited. […] Patients with shoulder impingement may also have tenderness upon palpation of the anterior joint line. […] Also, scapular movement asymmetries are frequently associated with shoulder impingement.

• #1 Rotator cuff injury – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/drc-20350231

  During the physical exam, health care providers will press on different parts of the affected shoulder and move your arm into different positions. They’ll also test the strength of the muscles around your shoulder and in your arms. […] Imaging tests may include: […] X-rays. Although a rotator cuff tear won’t show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain such as arthritis. […] Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows a provider to assess the structures of your shoulder during movement. It also allows a quick comparison between the affected shoulder and the healthy shoulder. […] Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail.

• #1 Shoulder Impingement Test: Physical Exams That Help Diagnose Injury

  https://www.healthline.com/health/sprains-and-strains/shoulder-impingement-test

  Studies show that imaging tests are highly effective at pinpointing the precise location of an injury. […] If there are tears, or lesions, in the rotator cuff, imaging tests can show the degree of the injury and help doctors determine whether a repair is needed to restore your abilities. […] The term shoulder impingement syndrome is just the starting point to a correct diagnosis and treatment plan. […] What a good physical therapist will do is determine which tendons and muscles are involved. […] A test is considered positive if it elicits the same pain you’ve been experiencing in your shoulder. […] During the physical exam, a PT will take you through a series of motions to try to replicate the pain you’re feeling as you move your arm in different directions. These tests help the PT find out where you’re injured. […] Doctors and PTs use diagnostic imaging and physical examinations to identify where and to what degree your shoulder may be injured.

• #1 Shoulder Impingement Syndrome: Symptoms & Treatment | HSS

  https://www.hss.edu/condition-list_shoulder-impingement.asp

  How is shoulder impingement diagnosed? […] Your doctor will diagnose shoulder impingement based on your medical history (typically the most important part of the intake and can lead to the right diagnosis), a physical examination and, usually, imaging tests such as an X-ray or MRI to confirm a diagnosis. The physical exam for shoulder impingement will likely include the following tests. If pain is felt during either, the diagnosis is positive: […] Neer impingement shoulder test: Your doctor will place your arm downward and hold your shoulder blade in place, then slowly lift your arm upward in a forward semicircle. Pain suggests impingement […] Hawkins-Kennedy test: The doctor will position your upper arm straightforward and perpendicular to your body with your elbow bent inward toward your chest at 90 degrees. Supporting your upper arm at the elbow, the doctor will then gently push down on your forearm to passively rotate your shoulder inward. […] Imaging will often be ordered to distinguish symptoms from those in other conditions that may overlap with or be discrete from an impingement, such as shoulder arthritis, bursitis, rotator cuff tendinopathy and cervical radiculopathy.

• #1 10 Essential Tests for Evaluating for Shoulder Impingement | Medbridge

  https://www.medbridge.com/blog/10-essential-tests-for-evaluating-for-shoulder-impingement

  Learn 10 essential tests for evaluating for shoulder impingement in your patients and modern treatment methods. […] Knowing which evidence-based tests to perform throughout the entire shoulder girdle is essential. This knowledge allows you to communicate with referral sources to determine whether radiographic testing is needed, plan for therapeutic intervention, and make referrals to other healthcare professionals if required. […] After reviewing the reliability and diagnostic accuracy of certain tests for SAIS, researchers determined: 1. The Neer test is useful to rule out SAIS. 2. The Jobe (empty can) test is useful to confirm a diagnosis of SAIS. 3. The painful arc test is useful to rule out and confirm SAIS. 4. The ER resistance test is useful to rule out and confirm SAIS. […] Following the above study, another study looked at the diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon, the most involved tendon with impingement.

• #1 Shoulder Impingement Diagnosis – Sportsinjuryclinic.net

  https://www.sportsinjuryclinic.net/assessment-tests/impingement-diagnosis

  Shoulder impingement syndrome occurs when the rotator cuff tendons in the shoulder are compressed or impinged. Here we explain some assessment tests that indicate impingement syndrome. […] A professional therapist will perform a number of assessment tests to diagnose the cause of your shoulder pain. […] A common sign with shoulder impingement is a pain in a 60-degree arc when lifting your arm out sideways and up above the shoulder. […] If you experience pain or discomfort, you may have an impingement of supraspinatus tendon. […] If this causes pain you probably have an impingement of Supraspinatus. […] The therapist will ask you to raise your arm whilst they resist your movement. This tests the Supraspinatus tendon. […] An X-Ray or MRI may be used to identify what is causing the impingement.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4935057/

  Clinical examination techniques need to allow the physician to determine the underlying pathology of a patients condition with confidence. This review examines the evidence for two common conditions: impingement and rotator cuff disease. […] The diagnosis of impingement aims to isolate the pathological process to the subacromial space; it does not, however, define the cause. […] The two most commonly used tests for impingement are Neer’s Sign and the HawkinsKennedy test. […] A significant reduction or abolition of the pain is seen as a positive test. […] Hegedus et al. also used a similar meta-analysis including a number of studies to demonstrate that, although neither test had sufficient sensitivity to diagnose impingement, there was evidence to conclude that a negative HawkinsKennedy test was sufficiently powerful to rule it out.

• #1 Diagnosing Shoulder Impingement

  https://www.sports-health.com/sports-injuries/shoulder-injuries/diagnosing-shoulder-impingement

  Medical imaging that may be ordered to confirm or rule out a shoulder impingement diagnosis include: […] X-rays do not show soft tissue and cannot be used to definitively diagnose shoulder impingement. However, they may be used to identify bone spurs or other bone abnormalities that can lead to shoulder impingement. […] An MRI will show a detailed view of the soft tissue around the shoulder. MRIs can show inflammation and/or tearing of the rotator cuff and bursa. An MRI of the shoulder can sometimes be preceded by another medical imaging procedure called an arthrogram. During the arthrogram, contrast dye that is visible on MRI images is injected into the joint. The dye can sometimes help tissue damage stand out on MRI results. […] Once a diagnosis is made, a doctor will recommend a treatment plan.

• #1 Shoulder Impingement Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554518/

  Shoulder impingement syndrome is primarily diagnosed by history and physical examination. […] A thorough history and physical examination are key to the diagnosis of shoulder impingement syndrome. […] While the overall diagnostic sensitivity of the physical exam is reportedly as high as 90%, imaging studies are often performed to confirm the diagnosis and rule out other pathologies. […] If the decision to obtain radiographs is made, they should be obtained bilaterally, rather than only on the affected side, to evaluate potential anatomic differences and to rule out other pathologies such as calcific tendinitis or arthritic changes. […] Other imaging modalities to consider include ultrasound and magnetic resonance imaging (MRI). Consideration for advanced imaging with MRI is recommended after 6 weeks of therapy without clinical improvement.

• #1 Shoulder Impingement Rotator Cuff Tendinitis

  https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis

  MRI scans provide better images of the rotator cuff tendons and surrounding soft tissue structures. They can show fluid or inflammation in the bursa or rotator cuff. In some cases, tears in the rotator cuff tendons will be seen. […] When nonsurgical treatment does not relieve pain, your doctor may recommend surgery. […] The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will: […] These procedures are typically performed arthroscopically and may be performed along with other procedures. […] After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing.

• #1 Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0107-7

  Subacromial impingement is the most frequent cause of shoulder pain, accounting for up to 60% of all shoulder complaints; dynamic high-resolution ultrasonography can be used in the detection of different abnormalities causing and related to shoulder impingement. This is compared to MRI, which we considered as a standard in our cases. […] The addition of dynamic ultrasound examination for diagnosis of the painful shoulder showed the highest sensitivity in the assessment of impingement syndrome and for detection of different abnormalities affecting the shoulder joint (e.g., 85.7% for rotator cuff partial-thickness tear, 90% for rotator cuff full-thickness tear). […] Based on our results, the static US combined with dynamic study can be a helpful tool in detecting different abnormalities of the painful shoulder especially impingement syndrome and its different causes.

• #1 Shoulder Impingement Syndrome Workup: Imaging Studies

  https://emedicine.medscape.com/article/92974-workup

  The following are the standard radiographic studies: […] MRI is considered the imaging study of choice for shoulder pathology. […] This study frequently is used in evaluating rotator cuff tears. […] If dye escapes out of the joint and into the subacromial space, it is diagnostic of a full-thickness rotator cuff tear. […] Diagnostic arthroscopy includes the following: […] Workup for other more systemic processes may be included as clinically indicated.

• #1 Shoulder impingement syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Shoulder_impingement_syndrome

  Impingement syndrome can be diagnosed by a targeted medical history and physical examination, but it has also been argued that at least medical imaging (generally X-ray initially) and/or response to local anesthetic injection is necessary for workup. […] However, imaging studies are unable to show cause of shoulder pain in diagnosing. For example, MRI imaging would show rotator cuff pathology and bursitis but is unable to specify the cause. […] On physical exam, the physician may twist or elevate the patient’s arm to test for reproducible pain (the Neer sign and Hawkins-Kennedy test). These tests help localize the pathology to the rotator cuff; however, they are not specific for impingement. […] The physician may inject lidocaine (usually combined with a steroid) into the bursa, and if there is an improved range of motion and decrease in pain, this is considered a positive „Impingement Test”. It not only supports the diagnosis for impingement syndrome, but it is also therapeutic.

• #1 Management of Shoulder Impingement Syndrome and Rotator Cuff Tears | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/0215/p667.html

  Rotator cuff impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. […] Family physicians who understand rotator cuff pathology and can perform a concise examination of the shoulder can readily diagnose and treat impingement and tears of the rotator cuff. […] The key feature of the physical examination is an assessment for signs of impingement. […] Plain radiographs can be useful in depicting anatomic variants or calcific deposits. […] Ultrasonography and arthrography have been used when rotator cuff tears are suspected. […] Magnetic resonance imaging, although expensive, provides the best imaging mode for rotator cuff pathology but, ultimately, arthroscopy is the best diagnostic modality. […] Many conditions can mimic impingement. […] Not all cuff tears diagnosed clinically, or by arthography or MRI require surgical repair.

• #1 Shoulder Impingement Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554518/

  Classically, the foundation of management for shoulder impingement syndrome has been rehabilitative exercise programs with subsequent surgical intervention if indicated by underlying anatomy, pathology, or failure of response to physiotherapy. […] A systematic review of randomized controlled trials comparing surgical intervention versus conservative therapy yielded moderate evidence that surgical intervention was not more effective for reducing pain than impingement-directed physical therapy. […] Arthroscopic subacromial decompression (ASD) consists of acromioplasty at the anterolateral edge, bursal debridement, and resection of the coracoacromial ligament. […] When comparing surgical intervention with physiotherapy to that of surgery alone, no statistically significant or clinically significant difference between the two arms was observed with respect to pain at 3 months, 6 months, 5 years, and 10 years.

• #1 Shoulder Impingement Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/shoulder-impingements

  The main shoulder impingement treatments are rest and physical therapy, along with medicine to help relieve pain. […] Surgery is a rare treatment option for shoulder impingement. Doctors only pursue surgery when other treatments don’t work. […] Up to 90% of people with shoulder impingement improve with nonsurgical treatments.

• #1 10 Essential Tests for Evaluating for Shoulder Impingement | Medbridge

  https://www.medbridge.com/blog/10-essential-tests-for-evaluating-for-shoulder-impingement

  Regardless of the setting you work in or your level of clinical experience, an accurate and detailed history is essential. In addition, these tests will guide therapists to an understanding of which structures are involved in a particular case. […] These special tests along with evaluation of all the aspects that affect the shoulder girdle (for example, the kinetic chain, the role of the scapula, and the thoracic spine) will allow the therapist to perform a comprehensive evaluation and develop a customized treatment plan based on the patient’s occupational demands.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/physicaltherapy/comments/ppv6eb/what_are_your_thoughts_on_the_diagnosis_of/

  So I’ve seen this topic come up in this subreddit before where people say that subacromial impingement syndrome (SIS) is essentially just a myth that is no longer supported by research and should stop being given as a diagnosis. […] However, after watching a few videos on the topic it does seem like that is what recent research is indicating, which is kind of throwing me for a loop. […] The findings that keep coming up that don’t seem to support the diagnosis of SIS are:-Fraying of the supraspinatus tendon is almost always found on the underside of the tendon rather than the top where you would expect it to be if it were rubbing against the acromion-Research doesn’t show any link between acromion types and symptoms associated with SIS. If SIS was „legit” there should be an increase of pain reported with type 3 acromions.-And the biggest one is that after subacromial decompression surgeries are performed there is no significant difference in reduction of pain levels/symptoms compared to sham surgery or PT on its own. […] This obviously conflicts with a lot of what I was actually taught in school and about a million other videos and articles that are out there.

• #1 Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0107-7

  In this study, we stated that ultrasonography is relatively less sensitive than MRI in the detection of rotator cuff tendinosis (83.3% sensitivity) that appears as a focal or diffuse area of decreased reflectivity, with no disruption of the fiber continuity. […] In this study, results showed accepted accuracy (about 94.7% sensitivity) of dynamic ultrasonography in detection of acromio-clavicular joint osteoarthritic changes compared to MR. […] The study has proved that dynamic ultrasonography is a highly accurate, highly sensitive diagnostic modality in different types of the painful shoulder.

• #1 Diagnosing Shoulder Impingement

  https://www.sports-health.com/sports-injuries/shoulder-injuries/diagnosing-shoulder-impingement

  A pinching sensation in the shoulder when reaching the arm up may indicate impingement. However, the only way to know for sure is with a diagnosis, which requires a visit to a health care provider. […] A health care provider will take the patients medical history, conduct a physical examination, and order any necessary medical imaging tests. […] During a physical exam, a doctor will check the shoulders range of motion and look for symptoms, such as tenderness or swelling. Orthopedic tests may be used to trigger the pain a person experiences in day-to-day activities. […] After a thorough physical examination, a doctor may be able to rule out certain other potential causes of the shoulder pain, such as a rotator cuff tear or shoulder osteoarthritis. To make a definitive diagnosis, the doctor will order diagnostic testing.

• #1

  https://link.springer.com/article/10.1007/s11932-004-0049-2

  A comprehensive review of shoulder impingement reveals numerous causes, contributing factors, and therapeutic options for the resolution of symptoms and return to optimal shoulder function. […] The clinical diagnosis of shoulder impingement is rather straightforward, but the challenge arises in identifying causative factors and directing treatment options to alleviate symptoms and restore normal function. […] As the most diagnosed shoulder ailment an understanding of shoulder anatomy, supporting musculature and function, inciting factors, and individual demands are critical in directing the appropriate treatment plan. […] Medications, therapeutic exercise and surgical interventions all have their place in the treatment of shoulder impingement.

• #2 Diagnosing Shoulder Impingement

  https://www.sports-health.com/sports-injuries/shoulder-injuries/diagnosing-shoulder-impingement

  A pinching sensation in the shoulder when reaching the arm up may indicate impingement. However, the only way to know for sure is with a diagnosis, which requires a visit to a health care provider. […] A health care provider will take the patients medical history, conduct a physical examination, and order any necessary medical imaging tests. […] During a physical exam, a doctor will check the shoulders range of motion and look for symptoms, such as tenderness or swelling. Orthopedic tests may be used to trigger the pain a person experiences in day-to-day activities. […] After a thorough physical examination, a doctor may be able to rule out certain other potential causes of the shoulder pain, such as a rotator cuff tear or shoulder osteoarthritis. To make a definitive diagnosis, the doctor will order diagnostic testing.

• #2 Patient education: Shoulder impingement syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/shoulder-impingement-syndrome-beyond-the-basics/print

  Shoulder impingement syndrome (SIS) is a condition that causes shoulder pain. To diagnose SIS, health care providers look for a specific set of shoulder symptoms and certain clinical findings, which together suggest that the patient has the condition. […] If you have symptoms of shoulder impingement, your health care provider will examine you to learn what movements elicit symptoms. As part of the evaluation, he or she will likely ask to watch as you move your own arm and shoulder (called active motion), and also explore what you feel if he or she moves your arm and shoulder for you (called passive motion). […] In most cases, health care providers can tell when a person has shoulder impingement syndrome (SIS) based on the results of the physical exam. Still, in some cases it’s hard to tell the difference between SIS and other shoulder problems. If your health care provider is uncertain about your diagnosis or thinks that you might need surgery, they might refer you to a doctor who specializes in muscle and joint problems, such as an orthopedist, rheumatologist, or rehabilitation and physical medicine specialist.

• #2 The Painful Shoulder: Part I. Clinical Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0515/p3079.html

  Family physicians need to understand diagnostic and treatment strategies for common causes of shoulder pain. […] Examination of the shoulder should include inspection, palpation, evaluation of range of motion and provocative testing. […] A complete history begins with the patient’s age, dominant hand and sport or work activity. […] Distinguishing between an acute and a chronic problem is diagnostically helpful. […] A complete physical examination includes inspection and palpation, assessment of range of motion and strength, and provocative shoulder testing for possible impingement syndrome and glenohumeral instability. […] Provocative tests provide a more focused evaluation for specific problems and are typically performed after the history and general examination have been completed.

• #2 Special Diagnostic Tests for Shoulder Pain

  https://www.verywellhealth.com/special-tests-for-shoulder-pain-2696489

  Your healthcare provider may use one or several special tests in order to pinpoint the problem. […] Special shoulder tests are then used to narrow down the possible causes and the most effective treatments. Your healthcare provider will then know a more precise cause of your pain, whether it be muscle or tendon problems, joint impingement, or shoulder instability. […] The Neer test is quite simple. It is designed to look for shoulder impingement. […] One study found that a modified form of the Neer test has an accuracy rate of 90.6% for identifying subacromial impingement syndrome (SAIS). […] The Hawkins-Kennedy test is another test for shoulder impingement. […] Pain in the shoulder points to a rotator cuff, bursa, or other structure that’s getting pinched. […] Specific tests for shoulder pain are used to pinpoint the exact cause among many possibilities. […] Exams like the Neer test or Crank test will give them a more precise idea of the reason for your pain.

• #2 10 Essential Tests for Evaluating for Shoulder Impingement | Medbridge

  https://www.medbridge.com/blog/10-essential-tests-for-evaluating-for-shoulder-impingement

  Learn 10 essential tests for evaluating for shoulder impingement in your patients and modern treatment methods. […] Knowing which evidence-based tests to perform throughout the entire shoulder girdle is essential. This knowledge allows you to communicate with referral sources to determine whether radiographic testing is needed, plan for therapeutic intervention, and make referrals to other healthcare professionals if required. […] After reviewing the reliability and diagnostic accuracy of certain tests for SAIS, researchers determined: 1. The Neer test is useful to rule out SAIS. 2. The Jobe (empty can) test is useful to confirm a diagnosis of SAIS. 3. The painful arc test is useful to rule out and confirm SAIS. 4. The ER resistance test is useful to rule out and confirm SAIS. […] Following the above study, another study looked at the diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon, the most involved tendon with impingement.

• #2 Shoulder Impingement Syndrome: Symptoms & Treatment | HSS

  https://www.hss.edu/condition-list_shoulder-impingement.asp

  How is shoulder impingement diagnosed? […] Your doctor will diagnose shoulder impingement based on your medical history (typically the most important part of the intake and can lead to the right diagnosis), a physical examination and, usually, imaging tests such as an X-ray or MRI to confirm a diagnosis. The physical exam for shoulder impingement will likely include the following tests. If pain is felt during either, the diagnosis is positive: […] Neer impingement shoulder test: Your doctor will place your arm downward and hold your shoulder blade in place, then slowly lift your arm upward in a forward semicircle. Pain suggests impingement […] Hawkins-Kennedy test: The doctor will position your upper arm straightforward and perpendicular to your body with your elbow bent inward toward your chest at 90 degrees. Supporting your upper arm at the elbow, the doctor will then gently push down on your forearm to passively rotate your shoulder inward. […] Imaging will often be ordered to distinguish symptoms from those in other conditions that may overlap with or be discrete from an impingement, such as shoulder arthritis, bursitis, rotator cuff tendinopathy and cervical radiculopathy.

• #2 Shoulder Impingement Syndrome Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/92974-clinical

  Patients older than 40 years – Consider glenohumeral impingement syndrome/rotator cuff disease and glenohumeral joint degenerative disease. […] Individuals at highest risk for shoulder impingement are laborers and those working in jobs that require repetitive overhead activity. […] Onset: Sudden onset of sharp pain in the shoulder with tearing sensation is suggestive of a rotator cuff tear. Gradual increase in shoulder pain with overhead activities is suggestive of an impingement problem. […] A painful arc of motion may be experienced with elevation above the shoulder level in patients with impingement. […] Neer test: Forcefully elevate an internally rotated arm in the scapular plane, causing the supraspinatus tendon to impinge against the anterior inferior acromion. […] Hawkins-Kennedy test: Forcefully internally rotate a 90 forwardly flexed arm, causing the supraspinatus tendon to impinge against the coracoacromial ligamentous arch. Note: Pain and a grimacing facial expression indicate impingement of the supraspinatus tendon, indicating a positive Neer/Hawkins impingement sign.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4935057/

  The tests that aim to diagnose rotator cuff disease are numerous. […] Pain elicited from these tests may be a result of either tendinitis/tear or subacromial impingement. […] In the determination of an accurate assessment from each test, two basic requirements are adequate pain relief (else pain inhibition may mimic true weakness) and a sufficient range of passive movement to allow appropriate positioning of the arm in which to perform the test. […] Park et al. calculated the sensitivity of the empty can test to be 44% but with a specificity of 90%. […] This gives the test significant validity but it should be noted that, although the review stated a positive predictive value (PPV) of 88%, it was almost 50% when the negative predictive value was calculated. […] An additional examination is the lateral Jobe test which has a reported 81% sensitivity and 89% specificity, with a PPV of 91%, and should considered a useful addition to the examination.

• #2 Shoulder Impingement Syndrome Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/92974-clinical

  A systematic review and meta-analysis used the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, and 10 studies met the criteria to be included in the final analysis and review. The Hawkins-Kennedy test, Neer sign, and empty can test were determined to be best to negate the diagnosis of impingement. A negative Neer sign reduced the probability of subacromial impingement from 45% to 14%. The drop arm test and lift-off test were thought to be more useful for confirming the diagnosis of impingement if the test results were positive.

• #2 Shoulder Impingement Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554518/

  Shoulder impingement syndrome is primarily diagnosed by history and physical examination. […] A thorough history and physical examination are key to the diagnosis of shoulder impingement syndrome. […] While the overall diagnostic sensitivity of the physical exam is reportedly as high as 90%, imaging studies are often performed to confirm the diagnosis and rule out other pathologies. […] If the decision to obtain radiographs is made, they should be obtained bilaterally, rather than only on the affected side, to evaluate potential anatomic differences and to rule out other pathologies such as calcific tendinitis or arthritic changes. […] Other imaging modalities to consider include ultrasound and magnetic resonance imaging (MRI). Consideration for advanced imaging with MRI is recommended after 6 weeks of therapy without clinical improvement.

• #2 Shoulder impingement syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Shoulder_impingement_syndrome

  Plain x-rays of the shoulder can be used to detect some joint pathology and variations in the bones, including acromioclavicular arthritis, variations in the acromion, and calcification. However, x-rays do not allow visualization of soft tissue and thus hold a low diagnostic value. […] Ultrasonography, arthrography and MRI can be used to detect rotator cuff muscle pathology. MRI is the best imaging test prior to arthroscopic surgery. […] Due to lack of understanding of the pathoaetiology, and lack of diagnostic accuracy in the assessment process by many physicians, several opinions are recommended before intervention. […] Plain x-rays of the shoulder may show a proximal humeral pseudocyst. This localized area of bone atrophy is the result of increased blood circulation which demineralizes the bone at the attachment of the rotator cuff tendon. It is evidence of chronic inflammation of the rotator cuff.

• #2 Shoulder Impingement Syndrome Workup: Imaging Studies

  https://emedicine.medscape.com/article/92974-workup

  The following are the standard radiographic studies: […] MRI is considered the imaging study of choice for shoulder pathology. […] This study frequently is used in evaluating rotator cuff tears. […] If dye escapes out of the joint and into the subacromial space, it is diagnostic of a full-thickness rotator cuff tear. […] Diagnostic arthroscopy includes the following: […] Workup for other more systemic processes may be included as clinically indicated.

• #2 Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0107-7

  MRI is considered an effective technique for the evaluation of the different causes of painful shoulder, with its main disadvantage being a static evaluation of the shoulder joint. […] Dynamic ultrasonography is a beneficial technique for the evaluation of many disorders affecting musculoskeletal organs, including painful shoulder syndrome. […] The role of diagnostic imaging is to help guide surgical or non-surgical management. The ideal imaging technique should have a high rate of true positive and an acceptable rate of false positive to limit unnecessary surgical intervention. […] According to results obtained, the U/S is superior to MRI in two conditions: dynamic evaluation of subacromial impingement and in addition to the detectable increased synovial vascularity by added color-Doppler examination.

• #2 Understanding Shoulder Impingement: Symptoms, Diagnosis, and Effective Treatment – Central Ohio Spine and Joint

  https://cospineandjoint.com/shoulder-impingement-symptoms-diagnosis-treatment-dry-needling/

  Diagnostic Tests: In some cases, your doctor may recommend specific tests, like an injection of a local anesthetic into the affected area (diagnostic injection). If the pain is significantly reduced or eliminated after the injection, it can help confirm the diagnosis of shoulder impingement. […] Shoulder impingement is a common and treatable condition, but early diagnosis and appropriate management are essential. If youre experiencing shoulder pain or limited mobility, consult a healthcare professional for a thorough evaluation.

• #2

  https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement

  indications […] first line and mainstay of treatment of subacromial impingement alone without rotator cuff tear. […] Operative […] subacromial decompression / acromioplasty […] indications […] subacromial impingement syndrome that has failed a minimum of 4-6 months of nonoperative treatment.

• #2 Choosing the Best Clinical Tests for Shoulder Impingement Syndrome – eOrthopod.com

  https://eorthopod.com/news/choosing-the-best-clinical-tests-for-shoulder-impingement-syndrome/

  All five of these tests are useful for diagnosing subacromial impingement syndrome. […] Three of these tests (Hawkins-Kennedy, Neers, empty can) were better at ruling out (rather than ruling in) subacromial impingement syndrome (SIS). […] A negative Neers sign is very reliable in showing that SIS is not the problem. […] The authors advise us that the Neers sign, Hawkins-Kennedy test, and drop-arm test may provide some useful information but by themselves cannot yield an accurate diagnosis. […] The lift-off arm test is the most informative in confirming a subacromial impingement. […] Other diagnostic test such as MRIs or arthroscopic exam may be needed to get the full picture of severity and underlying cause of the shoulder impingement. […] With an accurate diagnosis the most appropriate treatment can be prescribed whether that is physical therapy or surgery.

• #2 Shoulder Impingement – Why This Is A Lazy & Unhelpful Diagnosis For You & Your Patient | New Grad Physio

  https://newgradphysio.com/shoulder-impingement-why-this-is-a-lazy-unhelpful-diagnosis-for-you-your-patient/

  Impingement is NOT a diagnosis. […] This was until I realised its not even a diagnosis. […] The diagnosis of impingement fails because it does not identify a specific structure. […] Regardless of where this impingement is happening it is not a diagnosis you should you and give to your patients. […] A diagnosis is describing what structure is causing a patients problem. […] But what if your patient has positive impingement signs like pain with overhead activities […] First of all […] Dont label their injury as impingement as this is not a diagnosis. […] Tell them that some of the structures between the ball and the socket joint of their shoulder that are irritated and that when they do x, y or z, these positions or movements put additional pressure on this region of the shoulder

• #2 Shoulder Impingement (Rotator Cuff Tendinitis)

  https://my.clevelandclinic.org/health/diseases/shoulder-impingement-rotator-cuff-tendinitis

  Shoulder impingement happens when bones in your shoulder rub against or pinch your rotator cuff. […] Shoulder impingement happens when the top outer edge of your shoulder blade (scapula) pinches your rotator cuff beneath it. […] A healthcare provider will diagnose shoulder impingement with a physical exam. […] Your provider might use imaging tests to take pictures of your shoulder joint, including: X-rays, MRI (magnetic resonance imaging), Ultrasound. […] Imaging tests will help your provider see the bones and tissue in your shoulder joint. […] Your provider will suggest treatments that manage your symptoms and help your shoulder heal and regain its usual function. […] Your provider might recommend surgery if other treatments don’t relieve your symptoms. […] Yes, all types of shoulder impingement including rotator cuff tendinitis are very treatable. […] Visit a healthcare provider as soon as you notice symptoms like pain, swelling or a decreased range of motion in your shoulder.

• #2 Shoulder Pain Diagnosis Chart | Diagnosis & Treatment Options: Pain Medicine Consultants: Pain Specialists

  https://www.painmedicineconsultants.com/blog/shoulder-pain-diagnosis-chart-diagnosis-treatment-options

  Achieving an accurate diagnosis is pivotal in the management of shoulder pain. The diversity of potential underlying conditions ranging from rotator cuff disorders, impingement syndrome, and adhesive capsulitis (frozen shoulder), to arthritis and tendinitis makes pinpointing the precise cause of pain a critical step. […] An accurate diagnosis not only facilitates the formulation of an effective treatment plan but also helps in avoiding interventions that might be unnecessary or even harmful. […] Addressing shoulder pain effectively requires an accurate diagnosis. Here’s how medical professionals at Pain Medicine Consultants approach the diagnosis of shoulder pain: […] By combining these diagnostic methods, doctors can identify the cause of your pain, whether it’s nerve pain, posterior shoulder pain, or pain between the shoulder blades.

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