ReviewShoulder impingement syndrome
Section snippets
Clinical presentation
Although impingement symptoms may arise following trauma, the pain more typically develops insidiously over a period of weeks to months. The pain is typically localized to the anterolateral acromion and frequently radiates to the lateral mid-humerus. Patients usually complain of pain at night, exacerbated by lying on the involved shoulder, or sleeping with the arm overhead. Normal daily activities such as combing one’s hair or reaching up into a cupboard become painful, and a general loss of
Examination findings
A thorough examination of the neck and shoulder is critical to properly diagnosing SIS. Strength testing of the upper extremities as well as neck and shoulder ranges of motion should be carefully assessed. In SIS, active and passive shoulder range of motion is typically normal. The muscles of the rotator cuff are best isolated with 3 separate maneuvers. To isolate the subscapularis, the patient places their hand behind the back and attempts to push away the examiner’s hand (Figure 1), a
Differential diagnosis
Narrowing the etiology of shoulder pain can be difficult as a number of conditions often coexist in older individuals. The etiology of adhesive capsulitis is unknown, although thought to be inflammatory in nature. The disease is more commonly encountered among women in their 50s and 60s. It is 5 times more likely to occur in patients with diabetes mellitus4 and has been associated with hypothyroidism. Adhesive capsulitis often presents with unremitting shoulder pain at rest, and early stages of
Management
The natural course of SIS is poorly described, but evidence suggests that the condition is not self-limiting.5 The initial management of shoulder impingement has traditionally included physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injection. A recent systematic review of 8 randomized controlled trials (RCTs) evaluated the efficacy of corticosteroid injection in the treatment of rotator cuff tendonitis (Koester MC, Dunn WR, Spindler KP, Kuhn JE. Does
Indications for referral and surgical options
When conservative management fails to relieve the symptoms associated with SIS or a complete cuff rupture is seen on MRI, operative intervention may be warranted. Historically, open anterior acromioplasty with resection of the coracoacromial ligament and the subacromial bursa achieved excellent pain relief.7 Today, arthroscopic subacromial decompression with release of the coracoacromial ligament and resection of the subacromial bursa has been shown to achieve similar results without the
Summary
Subacromial impingement syndrome is common, yet it is important to differentiate this condition from a number of other conditions that affect the shoulder. Nonoperative treatment includes NSAIDs, physical therapy, and subacromial injections of corticosteroids, yet there is little evidence-based medicine research to support their use. Surgical subacromial decompression may help patients who fail nonoperative treatment.
References (8)
- et al.
An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs
J Shoulder Elbow Surg
(2000) Arthroscopic subacromial decompressionanalysis of one to three year results
Arthroscopy
(1987)Impingement lesions
Clin Orthop Rel Res
(1983)- et al.
Acromioplasty for impingement with an intact Rotator cuff
J Bone Joint Surg Br
(1988)