Shoulder Impingement Syndrome Workup

  • Author: Thomas M DeBerardino, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 30, 2012
 

Imaging Studies

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

  • 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

Arthrography

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.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds None; Musculoskeletal Transplant Foundation Grant/research funds None; Histogenics Grant/research funds None; Advanced Biomedical Technologies Stock Options Medical Director, North America

Coauthor(s)

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, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. Jan 1972;54(1):41-50. [Medline].

  2. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and rotator cuff: importance. Orthopedic Trans. 1986;10:228.

  3. Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. Feb 2012;93(2):229-36. [Medline].

  4. Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. Jul 2009;89(7):643-52. [Medline].

  5. Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. Jul-Aug 2009;18(4):652-60. [Medline].

  6. [Best Evidence] Ketola S, Lehtinen J, Arnala I, et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. Oct 2009;91(10):1326-34. [Medline].

  7. Andrews JR, Harrelson GL, Wilk KE. Physical Rehabilitation of the Injured Athlete. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998:478-553.

  8. Boyles RE, Ritland BM, Miracle BM, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. Aug 2009;14(4):375-80. [Medline].

  9. Brotzman SB. Clinical Orthopaedic Rehabilitation. St. Louis, Mo: Mosby; 1996:92-98.

  10. Doiron Y, Delacroix S, Denninger M, Simoneau M. Kinetic strategies of patients with shoulder impingement syndrome. J Orthop Res. Jul 7 2009;epub ahead of print. [Medline].

  11. Fu FH. Stone DA, ed. Sports Injuries: Mechanisms, Prevention, Treatment. Pittsburgh, Pa: Lippincott Williams & Wilkins; 1994:895-923.

  12. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. May-Jun 1980;8(3):151-8. [Medline].

  13. Ho CY, Sole G, Munn J. The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Man Ther. Oct 2009;14(5):463-74. [Medline].

  14. Miller MD, Cooper DE, Warner JJ. Review of Sports Medicine and Arthroscopy. First ed. Philadelphia, Pa: WB Saunders Co; 1995:113-164.

  15. Perez-Palomares S, Olivan-Blazquez B, Arnal-Burro AM, et al. Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial. BMC Musculoskelet Disord. Jul 24 2009;10:92. [Medline]. [Full Text].

  16. Youm T, Hommen JP, Ong BC, Chen AL, Shin C. Os acromiale: evaluation and treatment. Am J Orthop. Jun 2005;34(6):277-83. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.