Materiały źródłowe

• #1 Shoulder Impingement Syndrome – StatPearls – NCBI Bookshelf

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

  Shoulder impingement syndrome is a painful condition of the upper extremity resulting from a structural narrowing of the subacromial space. […] The most basic clinical differentiation between the former and the latter is defined by the rotator cuff as the anatomic boundary of the external and internal forms. […] External impingement, often commonly referred to by clinicians and providers as shoulder impingement, is best described as a painful condition of the shoulder that results from the inflammation, irritation, and degradation of the anatomic structures within the subacromial space. […] Its anatomic borders define the subacromial space. […] The acromion shape is thought to play a role in the development of external, or „outlet-based” impingement syndrome. […] During the actions of shoulder abduction, forward flexion, and internal rotation, normal shoulder girdle movement results in narrowing of the subacromial space.

• #2 Impingement Syndrome of the Shoulder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5729225/

  Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice. It is usually due to a defect of the rotator cuff and/or an impingement syndrome. […] Patients with shoulder impingement syndrome suffer from painful entrapment of soft tissue whenever they elevate the arm. The pathological mechanism is a structural narrowing in the subacromial space. […] The impingement hypothesis assumes a pathophysiological mechanism in which different structures of the shoulder joint come into mechanical conflict. […] Primary subacromial impingement is due to mechanical narrowing of the subacromial space, while secondary subacromial impingement is due to a functional disturbance. […] The subacromial impingement syndrome has both primary and secondary forms. Primary impingement is due to structural changes that mechanically narrow the subacromial space; these include bony narrowing on the cranial side (outlet impingement), bony malposition after a fracture of the greater tubercle, or an increase in the volume of the subacromial soft tissues due, e.g., to subacromial bursitis or calcific tendinitis on the caudal side (non-outlet impingement).

• #3 Subacromial (shoulder) impingement syndrome – UpToDate

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

  Shoulder 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. However, epidemiologic calculations can vary depending upon how SIS is defined. […] Risk factors — Repetitive activity at or above the shoulder during work or sports represents the main risk factor for SIS. As with many shoulder disorders, increasing age also predisposes to SIS. SIS is common among athletes who participate in overhead sports. These sports may include swimming, throwing, tennis, weightlifting, golf, volleyball, and gymnastics. Overhead work activities that can increase risk for developing SIS include painting, stocking shelves, and mechanical repair.

• #4 Shoulder Impingement Explained | Shoulder Assessment

  https://www.physiotutors.com/wiki/shoulder-impingement-explained/

  Shoulder impingement is an outdated term (when it comes to the subacromial space) that used to be described as being a diagnosis but the view on the condition has shifted towards considering it to be a cluster of symptoms rather than a pathology itself. […] Various studies have identified underlying pathological mechanisms like rotator cuff pathology, scapular dyskinesis, shoulder instability, biceps pathology, SLAP lesions, and glenohumeral internal rotation deficit, which is abbreviated as GIRD. These conditions are suggested to cause impingement symptoms. […] The literature describes two types of impingement: subacromial or external impingement and internal impingement. Subacromial impingement is the mechanical encroachment of soft tissue structures like bursa or rotator cuff tendons in the subacromial space between the humeral head and the acromial arch.

• #5 APA | Subacromial impingement: is it time we finally abandoned the term?

  https://australian.physio/inmotion/subacromial-impingement-it-time-we-finally-abandoned-term

  The term SAI can be traced back to Dr Charles Neer in 1972 who stated 95 per cent of rotator cuff tears are initiated by impingement wear of the rotator cuff and bursa against the overlying acromion (Neer 1983), based solely on anecdotal observation. […] By the late 2000s some rumblings among the physiotherapy community on the nebulous concept of SAI began to emerge, culminating in a seminal narrative review by Jeremy Lewis, PhD (Lewis 2011), which challenged the accepted pathogenesis, diagnosis and management of SAI. […] This raises an awkward question: if SAD surgery is not superior to placebo or exercise therapy for pain and function, or leads to reduced incidence of rotator cuff tears (Kolk et al 2017), does the impingement component of the condition, which is fundamental to the philosophy of SAI, become obsolete?

• #6

  https://shouldersurgeon.com/shoulder-impingement/

  Shoulder impingement is the subject of much debate amongst orthopedic surgeons, and it is probably incompletely understood at this time. Shoulder impingement is a nonspecific term that may be used to describe one of several conditions that cause shoulder pain. The mechanism of impingement in a young athlete is not likely the same as that in an older, more sedentary patient. […] Typically, impingement is felt to be caused by pressure on one of the rotator cuff tendons that occurs as the arm is lifted. As the arm is lifted, the acromion bone and/or coracoacromial ligament rub or impinge on the surface of the rotator cuff. This causes pain and limits movement. […] Spurring of the acromion bone that lies on top of the rotator cuff has also been implicated as one of the causes of shoulder pain. Often the spurring seen on x-ray actually represents abnormal calcification of one of the ligaments of the shoulder called the coracoacromial ligament. Some surgeons feel that the spur can cause compression and wear into the rotator cuff tendons when the shoulder is moved. This is called outlet impingement because it occurs at the shoulder outlet where the supraspinatus muscle passes beneath the acromion bone. It is not known whether the spurring is the cause or the result of other pathology in the shoulder.

• #7 Shoulder Impingement Explained | Shoulder Assessment

  https://www.physiotutors.com/wiki/shoulder-impingement-explained/

  Internal impingement describes an encroachment of the rotator cuff tendons between the humeral head and the glenoid rim. […] Apart from the distinction based on the site of encroachment, shoulder impingement is further classified based on the cause of the problem dividing it into primary and secondary impingement. In primary impingement, the source of pain and dysfunction is a structural narrowing of the subacromial space occurring due to acromioclavicular arthropathy, due to a type I or III acromion, which is a flat acromion lagging the natural curvature or a hooked acromion respectively or due to swelling of soft tissue within the subacromial space. In secondary impingement, there are no structural abnormalities causing the dysfunction, but rather functional problems occurring in specific positions.

• #8 Impingement Syndromes: Subtypes | Shoulder Made Simple™

  https://www.shouldermadesimple.com/impingement-syndromes-subtypes/

  By definition shoulder impingement syndrome was considered, Subacromial outlet obstruction resulting in irritation of the supraspinatus tendon. In other words the supraspinatus tendon of the rotator cuff (RTC) would be pinched against the undersurface of the acromion portion of the scapula during elevation of the arm overhead. […] Primary impingement or external-Subacromial impingement is the closest thing to Neers original description of shoulder impingement syndrome. The area of the RTC that is torn or irritated in primary impingement is typically the superior or bursal side of the RTC. This is referred to as Extra-articular RTC pathology. This means the source of pathology is outside of the glenohumeral joint itself and confined to the Subacromial space. […] Secondary Impingement by definition implies that there is a problem with keeping the humeral head centered in the glenoid fossa during movement of the arm. Generally is caused by weakness in the RTC muscles (functional instability) combined with a glenohumeral joint capsule and ligaments that are to loose (micro-instability). The impingement generally occurs at the coracoacromial space secondary to anterior translation of the humeral head as opposed to the Subacromial space that is seen in primary impingement.

• #9

  https://www.shoulderphysio.com/blog/internal-impingement-of-the-rotator-cuff-the-new-subacromial-impingement

  Internal impingement is proposed to explain the articular surface side rotator cuff tear that is commonly observed during radiological and arthroscopic evaluation. […] It differs from subacromial impingement in its mechanism, which should be self-explanatory. Subacromial impingement occurs when the superior rotator cuff/bursa abrades the overlying coracoacromial arch. Internal impingement occurs when the articular surface of the rotator cuff gets pinched or kissed by the glenoid/labrum. Thus, it has been referred to as a kissing lesion. […] The authors mention that the location of rotator cuff/glenoid kissing approximated the area where most degenerative rotator cuff tears are thought to originate (10-15mm posterior to bicipital groove). They conjecture this can’t be a coincidence and state that internal impingement may be a common mechanism of rotator cuff pathology.

• #10 Understanding Shoulder Internal Impingement – Mike ReinoldInstagramTikTokFacebookTwitterYouTubeExpandExpandSearchToggle MenuSearchScroll to topScroll to topExpandExpandInstagramFacebookTwitterYouTubeToggle Menu CloseSearch

  https://mikereinold.com/shoulder-internal-impingement/

  One of the most common injuries we see in baseball players is shoulder internal impingement. […] Internal impingement is a very specific pathology. The key to treating it is to understand it first. […] Internal impingement is also known as posterior impingement. So it’s impingement of the rotator cuff in the back of the shoulder versus the top of the shoulder. So it’s not subacromial impingement. […] It’s an overuse injury to the back of the shoulder and now we figured that out, hopefully, with our exam or an MRI, and now we get to figure out why this is happening. […] Internal impingement is quite specific, right? It’s one thing. […] If you think about the rotator cuff, it’s classic impingement with a rotator cuff pathologies is technically external, which means it’s on the outside or the top layer of the rotator cuff. It’s extra-articular, internal impingement is intra-articular. So it’s on the undersurface of the rotator cuff now.

• #11 Impingement Syndromes: Subtypes | Shoulder Made Simple™

  https://www.shouldermadesimple.com/impingement-syndromes-subtypes/

  Internal Glenoid Impingement is probably the most common cause of posterior shoulder pain (pain in the back of the shoulder) in the throwing or overhead athlete. It is commonly misdiagnosed as rotator cuff (RTC) tendonitis. It is also called posterior-superior glenoid impingement or PSGI for short. PSGI is caused by the impingement of the articular surface (intra-articular) of the RTC (posterior edge of the supraspinatus and the anterior edge of the infraspinatus) against the posterior-superior-glenoid and glenoid labrum. […] Subcoracoid Impingement: Impingement of the coracoid process against the humerus (usually the lesser tuberosity) in a coracoid impingement position (humerus is flexed, adducted and internally rotated). Subcoracoid impingement may cause undersurface Subscapularis tears via the Roller-Wringer Effect. This is caused by the bowstringing of the Subscapularis across the prominent coracoid process.

• #12 Sports Injury Bulletin – Diagnose & Treat – Uncommon Injuries: Subcoracoid impingement

  https://www.sportsinjurybulletin.com/diagnose–treat/uncommon-injuries-subcoracoid-impingement

  Many conditions can account for anterior shoulder pain in the athlete. The involvement of the coracoid process, however, is an unusual source of anterior shoulder pain and pathology. The two underlying mechanisms that may cause SCI are: […] Subcoracoid stenosis. Created by a smaller distance in the CHD that closes the space, leading to impingement of the soft tissues (bursa and tendon). […] Anterior humeral head translation due to a rotator cuff dysfunction, which abuts the humeral head into the coracoid process. […] Gerber et al believed that the primary cause of SCI was a narrowing between the coracoid process and humeral head (the CHD), and also unique differences in shape and size of the actual coracoid process. […] Differences also exist in coracoid morphology as someone ages. The subcoracoid space becomes narrower and hooked in older shoulders. These skeletal changes may make older joints more prone to SCI – a consideration in aging athletes.

• #13 Shoulder Impingement Syndrome – StatPearls – NCBI Bookshelf

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

  Repetitive pathologic compression, degeneration, and fraying of the rotator cuff tendons are known to contribute to the narrowing of the subacromial space, but it is unknown whether or not the inflamed and damaged tendons cause impingement, or if the narrowed subacromial space causes the tendon inflammation. […] Shoulder impingement syndrome can be described according to either the location of the impingement, characterized as external or internal, and/or the underlying cause of the impingement, referred to as primary or secondary impingement. […] In primary impingement, there is a structural narrowing of the subacromial space. […] Secondary shoulder impingement syndrome is characterized by normal anatomy at rest and onset of impingement during shoulder motion, likely secondary to rotator cuff weakness, permitting uncontrolled cranial translation of the humeral head. […] Neer classified shoulder impingement in three categories or stages of severity.

• #14 Subacromial impingement syndrome: management challenges | ORR

  https://www.dovepress.com/subacromial-impingement-syndrome-management-challenges-peer-reviewed-fulltext-article-ORR

  Shoulder impingement results from an inflammation and degeneration of the anatomical structures in the region of the subacromial space. […] Different hypotheses were considered to describe the pathogenesis of the SAIS; however, a clear explanation has not been found yet. […] First of all, it is not clear yet if the damage to the rotator cuff tendons leads to the impingement (intrinsic mechanism) or if the impingement causes the damage to the tendons (extrinsic mechanism). […] The theories supporting the intrinsic mechanism are becoming more and more popular in the last few years. […] These theories argue that the poor vascularity of the supraspinatus tendon (SSP) insertion could be a significant factor in the pathogenesis of degenerative rotator cuff tears. […] The source of pain is mediated by the free nerve endings which are in the bursa and is thought to be related to the degree of damage to the SSP tendon.

• #15 On the pathogenesis of shoulder impingement syndrome – OuluREPO

  https://oulurepo.oulu.fi/handle/10024/37532

  The pathomechanism of the shoulder impingement syndrome has been under debat. Two main theories of the pathogenesis of the disease exists; mechanical (extrinsic) and degenerative (intrinsic) theory. […] The good results of 14 shoulders of 96 operated with an open acromioplasty turned painful after an average of 5 (210) years postoperatively and had developed 6 full-thickness and 4 partial rotator cuff tears. Initially good result is not permanent in all cases, suggesting that a degenerative process is involved in the pathogenesis of impingement syndrome. […] Shoulder muscle strengths of 48 patients, who had undergone an open acromioplasty, restored to near normal within one year after open acromioplasty, suggesting that mechanical compression plays a role in the pathogenesis of impingement syndrome.

• #16 Shoulder Impingement Syndrome: Practice Essentials, Etiology, Epidemiology

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

  In 1972, Neer first introduced the concept of rotator cuff impingement to the literature, stating that it results from mechanical impingement of the rotator cuff tendon beneath the anteroinferior portion of the acromion, especially when the shoulder is placed in the forward-flexed and internally rotated position. […] In all Neer stages, etiology is impingement of the rotator cuff tendons under the acromion and a rigid coracoacromial arch, eventually leading to degeneration and tearing of the rotator cuff tendon. […] Impingement implies extrinsic compression of the rotator cuff in the supraspinatus outlet space. […] Abnormalities of the supraspinatus outlet have been attributed as a cause of impingement syndrome and rotator cuff disease, though other causes have been discovered. […] These impingement sites in the supraspinatus outlet are compressed further when the humerus is placed in the forward-flexed and internally rotated position, forcing the greater tuberosity of the humerus into the undersurface of the acromion and coracoacromial arch.

• #17 Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM) | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-12-282

  The Subacromial Impingement Syndrome (SIS) is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. […] We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion), a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma), or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes). […] The second theory is based on a degenerative intrinsic mechanism: SIS can be caused by ischemia at the watershed zone of the supraspinatus tendon. This is enhanced by micro traumata or overuse, tensile overload on degenerating rotator cuff tendons, a subacromial inflammatory reaction, or insufficient cuff function leading to an imbalance between glenohumeral mobility and joint stability, with consequent glenohumeral destabilization or altered arm-shoulder kinematics.

• #18 Impingement Syndrome of the Shoulder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5729225/

  Advanced subacromial impingement syndrome is associated with rotator cuff defects. […] The extrinsic compression theory postulates pressure damage due to pathological contact of the shoulder roof with the supraspinatus tendon in subacromial impingement syndrome. In contrast, the intrinsic compression theory postulates degenerative processes in the supraspinatus tendon itself, leading to defects. […] It is now thought that both of these pathological mechanisms are active, and that they reinforce each other. […] The development of outlet impingement may be favored by certain bony constellations of the roof of the shoulder, e.g., a hooked acromion. […] A further risk factor is excessive coverage of the shoulder joint by the acromion, which can be assessed quantitatively by the critical shoulder angle or the acromiohumeral index.

• #19 Impingement Syndrome of the Shoulder (10.11.2017)

  https://swww.aerzteblatt.de/archiv/194351/Impingement-Syndrome-of-the-Shoulder

  Advanced subacromial impingement syndrome is associated with rotator cuff defects. The relation between these two entities is a controversial matter. Rotator cuff defects have been attributed to both intratendinous (intrinsic) abnormalities and extratendinous (extrinsic) factors. The extrinsic compression theory postulates pressure damage due to pathological contact of the shoulder roof with the supraspinatus tendon in subacromial impingement syndrome. In contrast, the intrinsic compression theory postulates degenerative processes in the supraspinatus tendon itself, leading to defects. Rotator cuff damage can lead secondarily to narrowing of the subacromial space and to the development of subacromial impingement syndrome. It is now thought that both of these pathological mechanisms are active, and that they reinforce each other.

• #20 The Major Biological Pain… – Physio Meets ScienceFacebookShared with Public

  https://www.facebook.com/physiomeetsscience/posts/the-major-biological-pain-mechanisms-behind-rotator-cuffrelated-shoulder-pain-%EF%B8%8F-/1455005675805882/

  Rotator cuff‐related shoulder pain (RCRSP) was proposed to encompass complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP. […] Among the nociceptive mechanism, current research does not support mechanical irritation as the primary source of RCRSP, since traditional mechanical factors such as decrease in the subacromial distance, scapular dyskinesia and acromial shapes were found to have no correlation with RCRSP. […] Based on the available research literature, the main component of RCRSP may be a biochemical disorder which triggers inflammatory changes at the tissue level and pain, rather than a mechanical overuse injury. Mechanical factors, neuropathic changes and central sensitisation can occur simultaneously as contributing factors to a certain extent. Any of these three aspects may have a greater effect in individual cases of RCRSP.

• #21 Shoulder impingement syndrome – Wikipedia

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

  Shoulder impingement syndrome is a syndrome involving tendonitis (inflammation of tendons) of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder. […] When the arm is raised, the subacromial space (gap between the anterior edge of the acromion and the head of the humerus) narrows; the supraspinatus muscle tendon passes through this space. Anything that causes further narrowing has the tendency to impinge the tendon and cause an inflammatory response, resulting in impingement syndrome. Such causes can be bony structures such as subacromial spurs (bony projections from the acromion), osteoarthritic spurs on the acromioclavicular joint, and variations in the shape of the acromion. Thickening or calcification of the coracoacromial ligament can also cause impingement. Loss of function of the rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly, resulting in impingement. Inflammation and subsequent thickening of the subacromial bursa may also cause impingement.

• #22 Shoulder Impingement – Pure Physiotherapy

  https://purephysiotherapy.co.uk/conditions/shoulder-impingement-2/

  During the normal movements of the shoulder, narrowing of the subacromial space occurs. […] The term impingement refers more to a mechanism where the subacromial space (space between the top of humeral head and bottom of acromion) narrows causing increased compression/rubbing of the rotator cuff (muscles of the shoulder) resulting in inflammation and degeneration. Over time this repeated compression (impingement) can cause changes in the soft tissues that lead to pain and movement problems. […] The exact cause of shoulder impingement is not always fully understood. The problem appears to be within the tendon and it starts to fray and split, but what leads to this is multifactorial. There are many theories as to what causes shoulder impingement or damage to the tendons. It is not clear yet if the damage to the rotator cuff tendons leads to the impingement, or if the impingement causes the damage to the tendons.

• #23 Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM) | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-12-282

  Concluding, the ongoing debate on the aetiology of SIS, its varying clinical presentations, the diagnostic difficulties and the highly variable treatment outcomes of SIS suggest there might be multiple pathophysiologic mechanisms leading to complaints clinically diagnosed as SIS that need specific approaches in clinical practice. […] The extrinsic pathophysiologic mechanism is only valid for a subgroup of SIS patients, and consequently acromionplasty is the wrong treatment for at least a part of the patients suffering from SIS symptoms. The complaints observed in SIS are presumably a compilation of symptoms that originate from different shoulder pathologies and etiologic mechanisms. […] In theory, impingement („a disbalance between acromial space and the space needed for subacromial structures”) can be caused by 1) A dynamically reduced subacromial space due to a pathologic pattern of arm-shoulder movements (e.g. scapular dyskinesia), resulting in relative cranialisation of the humerus with respect to the scapula/acromion, or 2) A more statically reduced subacromial space, due to 2a) structural anatomic variations (e.g. a hooked acromion), eventually in combination with altered arm-scapula motion patterns; 2b) A subacromial inflammatory reaction (e.g. caused by micro-trauma or overuse) causing subacromial oedema, fibrosis and tendinosis; 2c) Encroachment of subacromial tissues by an adjoining pathology or structures other than the acromion (e.g. acromioclavicular (AC)-joint osteoarthritis and subacromial osteophytes, calcifying tendinitis, and coracoid impingement).

• #24 The Painful Shoulder: Shoulder Impingement Syndrome

  https://openorthopaedicsjournal.com/VOLUME/7/PAGE/347/FULLTEXT/

  The degenerative cuff constitutes the commonest cause of cuff failure and usually occurs in the older individual following a chronic repetitive process which has been previously outlined. […] The shape of the acromion, the attachment of the coracoacromial ligament and changes in the acromioclavicular joint have all been implicated as causes for extrinsic causes of primary shoulder impingement. […] It has been demonstrated that patients with a type 3 acromion have increased risk of impingent. […] Any cause which leads to a dysfunction of either glenohumeral and/or scapulothoracic movement may lead to subacromial impingement also.

• #25 Shoulder Impingement Syndrome in Rock Climbers (SIS, Pinching in Shoulder) — Hooper’s Beta

  https://www.hoopersbeta.com/library/shoulder-impingement-syndrome-in-rock-climbers

  SIS is any compression or impingement of structures around the glenohumeral joint that occur with shoulder elevation. This may be your: Subacromial Bursa, Supraspinatus, Subscapularis and/or Long head of biceps. […] Primary impingement is more anatomical. As in, the space is closed down due to an anatomical variation. The most common mophology is related to your acromion. We have three types: Type I – Flat, Type II – Curved, Type III – Hooked. If you have a hooked acromion, you are more prone to SIS. […] Secondary impingement on the other hand is due to instability or biomechanical deficits causing the humerus to translate inappropriately into the subacromial space causing compression. Your shoulder is quite unstable. […] Often, SIS is a biomechanical issue. For complete overhead motion we need rotation of the humerus as well as of the scapula. If we are lacking either, the acromion, or the roof of the shoulder, doesnt elevate, this causes a compression of the underlying structures. […] Mechanism of injury is also important. A rotator cuff (RTC) tear may also be more trauma related whereas impingement can develop over time due to poor biomechanics.

• #26 Subacromial Impingement Syndrome (Shoulder Impingement) – Frisco, TX – Knee, Hip, Shoulder, Joint Surgery

  https://doldmd.com/shoulder-and-elbow/subacromial-impingement-syndrome-shoulder-impingement/

  Subacromial impingement syndrome was originally described by Dr. Neer in 1972 as shoulder pain, weakness, and dysfunction caused by chronic impingement of the rotator cuff beneath the coracoacromial arch. Repetitive microtrauma of the supraspinatus tendons hypovascular area causes progressive inflammation and degeneration of the tendon, resulting in bursitis, tendinopathy, and progressive rotator cuff tearing (partial-thickness tears that progress into full-thickness tears with time). Extrinsic compression of the rotator cuff tendon can occur at the undersurface of the acromion (usually due to subacromial impingement spurs or abnormal morphology of the acromion), the coracoacromial (CA) ligament, and the acromioclavicular (AC) joint. […] Extrinsic or outlet impingement of the rotator cuff is caused by abnormalities of the CA arch, resulting in an overall decreased area for the rotator cuff tendons within the supraspinatus outlet. Other processes or pathologies that narrow the supraspinatus outlet must be considered when assessing a patient for impingement syndrome of the shoulder. These include: Osteophytes of the AC joint, due to progressive osteoarthritis of the AC joint, Hypertrophy of the CA ligament, Malunion of a greater tuberosity or a clavicle fracture, Inflammatory subacromial bursitis, Calcific rotator cuff tendinitis, A flap from a bursal-sided rotator cuff tear, An unstable os acrominale (failure of fusion in one of the acromial ossification centers).

• #27 Shoulder Impingement Boise | Shoulder Stiffness | Shoulder Specialist Eagle

  http://www.boiseshoulderclinic.net/shoulder-impingement/

  Shoulder impingement is a nonspecific term that may be used to describe one of several conditions that cause shoulder pain. The mechanism of impingement in a young athlete is not likely the same as that in an older, more sedentary patient. Typically, impingement is felt to be caused by pressure on one of the rotator cuff tendons that occurs as the arm is lifted. As the arm is lifted, the acromion bone and/or coracoacromial ligament rub or impinge on the surface of the rotator cuff. This causes pain and limits movement. […] Spurring of the acromion bone that lies on top of the rotator cuff has also been implicated as one of the causes of shoulder pain. Often the spurring seen on x-ray actually represents abnormal calcification of one of the ligaments of the shoulder called the coracoacromial ligament. Some surgeons feel that the spur can cause compression and wear into the rotator cuff tendons when the shoulder is moved. This is called outlet impingement because it occurs at the shoulder outlet where the supraspinatus muscle passes beneath the acromion bone. It is not known whether the spurring is the cause or the result of other pathology in the shoulder.

• #28 Shoulder impingement syndrome – Wikipedia

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

  The scapula plays an important role in shoulder impingement syndrome. It is a wide, flat bone lying on the posterior thoracic wall that provides an attachment for three different groups of muscles. The intrinsic muscles of the scapula include the muscles of the rotator cuff- the subscapularis, infraspinatus, teres minor and supraspinatus. These muscles attach to the surface of the scapula and are responsible for the internal and external rotation of the glenohumeral joint, along with humeral abduction. […] Abnormal scapular function is called scapular dyskinesis. One action the scapula performs during a throwing or serving motion is elevation of the acromion process in order to avoid impingement of the rotator cuff tendons. If the scapula fails to properly elevate the acromion, impingement may occur during the cocking and acceleration phase of an overhead activity. The two muscles most commonly inhibited during this first part of an overhead motion are the serratus anterior and the lower trapezius. These two muscles act as a force couple within the glenohumeral joint to properly elevate the acromion process, and if a muscle imbalance exists, shoulder impingement may develop. […] The scapula may also be misplaced if a rib deep to it is not moving correctly. Often in the case of Shoulder impingement syndrome, the scapula may be anteverted such that the shoulder on the affected side appears protracted.

• #29 Subacromial Impingement Syndrome – Diagnosis – Management – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/shoulder/subacromial-impingement-syndrome/

  Scapular musculature – Reduction in function of the scapular muscles, that normally allow the humerus to move past the acromion on overhead extension, may result in a reduction in the size of the subacromial space. […] Glenohumeral instability – Any abnormality of the glenohumeral joint or weakness in the rotator cuff muscles can lead to superior subluxation of the humerus, causing an increased contact between the acromion and subacromial tissues.

• #30 Reddit – The heart of the internet

  https://www.reddit.com/r/Fitness/comments/2vrm3t/a_brief_guide_to_shoulder_impingement/

  Rotator cuff strength is one the areas we need to work on to prevent/treat shoulder impingement. The rotator cuff works to stabilise the shoulder during movements. It does this by working against the deltoid, the deltoid works to move the humerus upwards, while the rotator cuff works to pull humerus downwards. If the deltoid is overpowering the rotator cuff then the humerus moves upwards and can lessen the subacriomial space during elevation. […] Short muscles can contribute to shoulder impingement by pulling the acromion down and lessening the acromial space. […] Weak rotator cuff and scapular stabilisers can lead to impingement syndrome. Work on these areas to prevent/improve the condition.

• #31

  https://www.orthobullets.com/shoulder-and-elbow/3055/glenohumeral-internal-rotation-deficit-gird

  Glenohumeral internal rotation deficit (GIRD) is a condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral shoulder, most commonly seen in the throwing athlete. […] Diagnosis is made clinically with a decrease in internal rotation, increase in external rotation, with a decrease in total arc of rotation compared to the contralateral shoulder. […] Treatment consists of physical therapy with a focus on posteroinferior capsular stretching. […] Mechanism caused by repetitive throwing thought to occur during the late cocking and early acceleration phase. […] Tightening of posterior capsule or posteroinferior capsule leads to translation of humeral head (capsular constraint mechanism). […] Translation of humeral head is in the OPPOSITE direction from area of capsular tightening.

• #32

  https://www.orthobullets.com/shoulder-and-elbow/3055/glenohumeral-internal-rotation-deficit-gird

  Posterior capsular tightness leads to anterosuperior translation of humeral head in flexion. […] Posterorinferior capsular tightness leads to posterosuperior translation of humeral head in ABER. […] Abutment of the greater tuberosity against the posterosuperior glenoid during abduction and external rotation leads to pinching of posterosuperior rotator cuff. […] Internal impingement. […] Anterior capsule is stretched.

• #33 Subacromial Impingement Syndrome – Diagnosis – Management – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/shoulder/subacromial-impingement-syndrome/

  The underlying cause of subacromial impingement syndrome can be divided into intrinsic and extrinsic mechanisms. […] Intrinsic mechanisms involve pathologies of the rotator cuff tendons due to tension, which include: Muscular weakness – weakness in the rotator cuff muscles can lead to muscular imbalances resulting in the humerus shifting proximally towards the body. […] Overuse of the shoulder – repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa, leading to friction between the tendons and the coracoacromial arch. […] Degenerative tendinopathy – degenerative changes of the acromion can lead to tearing of the rotator cuff, which allows for proximal migration of the humeral head. […] Extrinsic mechanisms involve pathologies of the rotator cuff tendons due to external compression, such as: Anatomical factors – Congenital or acquired anatomical variations in the shape and gradient of the acromion.

• #34 Common Shoulder Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/common-shoulder-injuries/

  Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. […] Impingement is caused by excessive rubbing of the shoulder muscles against the parts of the shoulder blade called the acromion and coracoid. […] Impingement problems can occur during activities that require excessive overhead arm motion. Seek medical care immediately for inflammation in the shoulder because it could eventually lead to a more serious injury. Repetitive rubbing of the muscles against the bone can lead to tendinitis, which is a form of inflammation, and even possibly lead to tears that may require surgery in the future.

• #35 People over 50 should not overlook shoulder impingement syndrome. | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/content/impingement-syndrome

  An increasing age, especially over 50 substantially leads to degenerative conditions including bones and joints which are susceptible to be damaged due to reduced bone mass density. If bones are damaged or broken, calcification process at the affected bones takes place as normal mechanism of the body in order to repair the broken parts. As a result, calcified bones grow irregularly and cause the compression and pinching of muscle, nervous tissue or bursa between the bony structures of the shoulder. This condition leads to irritation and inflammation of the soft tissue surrounding the shoulder. Friction and pressure may eventually produce micro-tears within the tissues. […] Impingement syndrome of shoulder and calcified tendonitis, a disorder characterized by deposits of a crystalline calcium phosphate in any tendon of the body. It is most commonly found in the tendons of the rotator cuff. Impingement syndrome is typically caused by:

• #36 Why Shoulder Impingement Syndrome Hurts | Physical Therapy located in Houston and Friendswood, TX | Bowman Physical Therapy

  https://www.bowmanphysicaltherapy.com/post/why-shoulder-impingement-syndrome-hurts

  Impingement means two objects encroach on each other or collide together. […] In shoulder impingement syndrome, the two bones that collide together are the acromion (roof over the shoulder) and the head of the humerus (long bone in your upper arm). The amount of distance between these two bones is the sub-acromial space. Therefore, the condition can be referred to as sub-acromial impingement. […] The problem is not just that the acromion and humeral head impinge. The pinched soft tissue in between the bones manifests the syndrome. The soft tissue which gets encroached upon is defined as the supraspinatus (rotator cuff) tendon, the sub-acromial bursa and the long head of the biceps tendon. This explains why tendonitis and bursitis are considered components of impingement syndrome. […] Little room exists in the sub-acromial space. When a soft tissue gets pinched, the tissue becomes swollen and inflamed. The swelling and inflammation leaves even less space between the two bones. This creates a self-perpetuating cycle of further impingement and pain.

• #37 The Truth About Shoulder Impingement: Part 2 – EricCressey.com

  https://ericcressey.com/newsletter131html/

  External impingement, also known as outlet impingement, is the one we hear about the most. Here, we’re dealing with compression of the rotator cuff usually the supraspinatus, and over time, the infraspinatus (and biceps tendon) by the undersurface of the acromion. This impingement can lead to bursal-sided rotator cuff tears and happens a lot more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations). […] Secondary impingement, on the other hand, is usually related to poor scapular stability (related to both tightness and weakness, as described in last week’s newsletter), which alters the position of the scapula. […] Conversely, internal impingement, also known as posterosuperior impingement, really wasn’t proposed until the early 1990s. This form of impingement is more common in younger individuals who are involved in overhead sports, making it more of an athletic impingement. Adaptive shortening and scarring of the posterior rotator cuff in these athletes causes a loss of internal rotation and an upward translation of the humeral head during the late cocking phase of throwing (or swimming): external rotation and abduction.

• #38 Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: Pathogenesis, clinical features, and MR imagining findings | IAOM-US

  https://iaom-us.com/posterosuperior-glenoid-internal-impingement-of-the-shoulder-in-the-overhead-athlete-pathogenesis-clinical-features-and-mr-imagining-findings/

  Posterosuperior glenoid internal impingement (PGII) is a type of impingement syndrome that often affects throwing or overhead athletes in sports such as baseball, softball, water polo, tennis, and javelin. PGII occurs when there is contact of the greater tuberosity of the humerus and the posterosuperior labrum, compressing the rotator cuff between the two surfaces. This contact can occur during the late cocking phase of throwing where the shoulder can be maximally externally rotated to 170-180 degrees and abducted to 90-100 degrees. […] The authors of the study also discussed theories regarding the pathophysiology of PGII. The first theory, postulated by Jobe, suggested that repeated and excessive strain to the anterior capsuloligamentous structures during the late cocking phase of throwing eventually lead to the failure of these structures. According to Jobe, the injured anterior capsule structures are unable to properly restrain the humeral head during throwing, which would lead to posterior displacement of the humerus and increase the contact of between the greater tuberosity and the posterosuperior labrum, compressing the rotator cuff between the two structures when in the abducted-external rotation (ABER) position.

• #39 Internal shoulder impingement | Diagnosis & Treatment

  https://www.physiotutors.com/conditions/internal-shoulder-impingement/

  Internal impingement of the shoulder is a term used to describe a group of symptoms that occur when the soft tissues of the rotator cuff and joint capsule in the shoulder get pinched or compressed between the glenoid (part of the shoulder blade) and the humerus (upper arm bone). This usually happens when the shoulder is in a certain position, such as when it is abducted (moved away from the body) and externally rotated (turned outward). […] The exact cause of internal impingement is still debated, but it seems to be a normal occurrence in certain shoulder positions. Imaging findings in internal impingement may include partial-thickness cuff tears, labral pathology, and bone changes. […] There are two types of internal impingement syndromes that have been recognized: posterosuperior impingement and anterosuperior (anterior) impingement. Posterosuperior internal impingement occurs when the posterosuperior rotator cuff, close to the junction of the supra and infraspinatus tendons, comes into contact with the posterosuperior glenoid. Anterosuperior impingement, on the other hand, involves impingement between the anterior rotator cuff and the anterosuperior glenoid. These conditions are characterized by the impingement of the soft tissues of the rotator cuff and joint capsule on the glenoid or between the glenoid and the humerus.

• #40

  https://www.orthobullets.com/shoulder-and-elbow/3054/internal-impingement

  Internal impingement is a cause of shoulder pain in overhead athletes caused by repetitive impingement between the undersurface of the rotator cuff and the posterosuperior glenoid. […] Impingement occurs during maximum arm abduction and external rotation during late cocking and early acceleration phases of throwing. […] Internal impingement covers a spectrum of injuries including fraying of the articular side of the posterior rotator cuff (supraspinatus-infraspinatus interval), posterior and superior labral lesions, hypertrophy and scarring of posterior capsule glenoid (Bennett lesion), and cartilage damage at posterior glenoid. […] Pathologic micromotion of the humeral head allows the rotator cuff to become impinged between the humeral head and glenoid.

• #41 Understanding Shoulder Internal Impingement – Mike ReinoldInstagramTikTokFacebookTwitterYouTubeExpandExpandSearchToggle MenuSearchScroll to topScroll to topExpandExpandInstagramFacebookTwitterYouTubeToggle Menu CloseSearch

  https://mikereinold.com/shoulder-internal-impingement/

  Internal impingement essentially is going to happen anytime you have excessive translation of the glenohumeral joint. […] So I think the big issue with this is we have some underlying static stability issues. Either the person is excessively loose, or maybe they just have a really bad job dynamically stabilizing. […] What it is with internal impingement is you have to be having some sort of excessive glenohumeral translation or your internal rotator cuff wouldn’t impinge. […] It’s usually not about mobility because they probably have too much mobility.

• #42 Shoulder impingement syndrome | PPT

  https://www.slideshare.net/slideshow/shoulder-impingement-syndrome-237952472/237952472

  The term Impingement Syndrome was popularized by Charles Neer in 1972 Neer defined impingement as pathologically compression of rotator cuff against the anterior structure of coracoacromial arch, anterior 1/3 of the acromion, coraco-acromial ligament AC joint. Progression of syndrome is defined by a narrowing of the sub-acromial outlet by spur formation in coracoacromial ligament. […] Shoulder impingement : It is compression mechanical abrasion of supraspinatus as they pass beneath the coracoacromial arch during elevation of the arm. […] Impingement causes Mechanical irritation of cuff tendons -resulting in haemorrhage and swelling (commonly known as tendonitis of rotator cuff) The supraspinatus muscle is usually involved. This also affect the bursa resulting in bursitis. […] Painful arc syndrome : Pain in the shoulder and upper arm during the midrange of glenohumeral abduction(45-120 degrees) with freedom from pain at extremes of the range due to supraspinatus damage.

• #43 The Painful Shoulder: Part II. Acute and Chronic Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0601/p3291.html

  The impingement syndrome was described by Neer as a series of pathologic changes in the supraspinatus tendon: stage I causes hemorrhage and edema; stage II, tendonitis and fibrosis; and stage III, tendon degeneration of the rotator cuff and biceps, bony changes and tendon rupture. […] Pain related to impingement usually occurs over the anterolateral aspect of the shoulder, often with some radiation to, but not usually beyond, the elbow. Typically, the pain is aggravated by overhead activity and is worse at night. Patients often report a clicking or popping sensation in the affected shoulder. […] The examiner should distinguish between primary and secondary impingement. Initial treatment of both conditions is conservative, but when conservative treatment fails, the surgical approach to the two problems differs markedly. Symptoms in older patients usually reflect chronic overuse and degeneration of the supraspinatus tendon. This process is referred to as primary impingement.

• #44 Shoulder Impingement Syndrome: From Pathology to Treatment by Ioannis Koukoulithras, Spyridon Kolokotsios, Minas Plexousakis :: SSRN

  https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3676373

  Shoulder impingement syndrome is a very common disorder and it is encountered by the doctor on a daily basis. […] The etiology of SIS is multi-factorial. The exact mechanism is not clear yet, but many researches support that a combination of instrict and extrinsic factors contribute to the Rotator Cuff tendinopathy. […] Clinical examination and medical imaging have a key role in the diagnosis of Shoulder Impingement syndrome.

• #45 On the pathogenesis of shoulder impingement syndrome – OuluREPO

  https://oulurepo.oulu.fi/handle/10024/37532

  The local subacromial contact pressures measured in 14 patients and 8 controls with a piezoelectric probe were elevated in the impingement syndrome, supporting the mechanical theory. […] On the basis of this study, both mechanical and degenerative factors are involved in the pathogenesis of impingement syndrome.

• #46

  https://link.springer.com/article/10.1007/s00590-017-1919-7

  Understanding the mechanisms of shoulder impingement created by clinical tests is crucial to accurately evaluate the condition. […] The objective of this study was to relate mechanisms of subacromial and coracoid impingement occurring in positions of the shoulder during clinical examination, in quantitative and qualitative terms. […] Shoulder movements of forward flexion and internal rotation (Hawkins test) and abduction and internal rotation (horizontal impingement test) can lead to different coracoid impingement mechanisms during clinical examination. […] The Hawkins, Neer, and horizontal impingement tests lead to comparable narrowed acromiohumeral distances and subacromial contact of the RC.

• #47 APA | Subacromial impingement: is it time we finally abandoned the term?

  https://australian.physio/inmotion/subacromial-impingement-it-time-we-finally-abandoned-term

  The term SAI can be traced back to Dr Charles Neer in 1972 who stated 95 per cent of rotator cuff tears are initiated by impingement wear of the rotator cuff and bursa against the overlying acromion (Neer 1983), based solely on anecdotal observation. […] By the late 2000s some rumblings among the physiotherapy community on the nebulous concept of SAI began to emerge, culminating in a seminal narrative review by Jeremy Lewis, PhD (Lewis 2011), which challenged the accepted pathogenesis, diagnosis and management of SAI. […] This raises an awkward question: if SAD surgery is not superior to placebo or exercise therapy for pain and function, or leads to reduced incidence of rotator cuff tears (Kolk et al 2017), does the impingement component of the condition, which is fundamental to the philosophy of SAI, become obsolete?

• #48 APA | Subacromial impingement: is it time we finally abandoned the term?

  https://australian.physio/inmotion/subacromial-impingement-it-time-we-finally-abandoned-term

  Evidence is also starting to accumulate suggesting a relationship between rotator cuff-related shoulder pain and metabolic syndrome, which highlights a potential systemic physiological influence in the pathogenesis of SAI (Burne et al 2019). […] The term subacromial impingement may not only be tenuous from a pathogenesis perspective, but perversely, it may act as a barrier to recovery. […] The physical aspect of SSP still has an important influence on pain and function of the shoulder, no question; it just may not be as strong a relationship as we once thought and there is no strong evidence it is more important than the aforementioned factors.

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