Shoulder Impingement Syndrome Workup

Updated: Oct 23, 2018
  • Author: Thomas M DeBerardino, MD, FAAOS, FAOA; Chief Editor: Craig C Young, MD  more...
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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.