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Shoulder Impingement Syndrome Workup

  • Author: Thomas M DeBerardino, MD; Chief Editor: Craig C Young, MD  more...
Updated: Jun 23, 2015

Imaging Studies

Standard radiographic studies (4 views to rule out glenohumeral/acromioclavicular arthritis)

See the list below:

  • Anterior-posterior (AP) view of the glenohumeral joint
  • Internal rotation view of the humerus with 20° upward angulation to show acromioclavicular joint
  • Axillary view is most useful to rule out subtle signs of instability (eg, glenoid avulsion, Hill-Sachs lesion) and to visualize presence of an os acromiale.
  • Supraspinatus outlet view is most useful to assess the supraspinatus outlet space. If the space is less than 7 mm, then an increased risk for impingement syndrome exists. Also, assess morphology of the acromion (hooked acromion more at risk for impingement).

MRI is considered the imaging study of choice for shoulder pathology.

Advantages include the following:

  • Noninvasive
  • No radiation
  • Able to detect intrasubstance tendon degeneration or partial rotator cuff tears
  • Able to detect inflammation, edema, hemorrhage, or scarring
  • Able to be used with an intra-articular contrast agent (eg, gadolinium), improving the MRI ability to detect partial rotator cuff tears

Disadvantages include the following:

  • Not able to accommodate patients with claustrophobia
  • Not able to accommodate larger patients
  • Not able to accommodate patients with pacemakers or other metal implants or particles
  • Dependent on quality of the MRI machine
  • Dependent on skill of technician performing the imaging and the radiologist interpreting the images
  • Expensive


Dye is injected into the glenohumeral joint and postinjection radiographs are filmed to assess the integrity of the glenohumeral joint.

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.

Advantages include the following:

  • Can be used in conjunction with CT scan or MRI to evaluate intra-articular pathology (eg, Bankart tears)
  • Low cost

Disadvantages include the following:

  • Size of the tears cannot be quantified.
  • Patient is exposed to radiation.
  • Contrast dye exposure
  • Invasive procedure

Diagnostic arthroscopy includes the following:

  • Minimally invasive visual surgical procedure to assess shoulder pathology
  • Able to visualize and assess majority of shoulder lesions
  • May give the patient and physician a chance to diagnose and treat the pathology in one procedure

Workup for other more systemic processes may be included as clinically indicated.

Contributor Information and Disclosures

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.


Wing K Chang, MD Physician, Peachtree Orthopaedic Clinic

Wing K Chang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American College of Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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