Impingement syndrome

Shoulder impingement syndrome, also called painful arc syndrome, supraspinatus syndrome, swimmer’s shoulder, and thrower’s shoulder, is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. This can result in pain, weakness and loss of movement at the shoulder.
Impingement syndrome can usually be diagnosed by history and physical exam. On physical exam, the physician may twist or elevate the patient’s arm to test for reproducible pain (Neer’s sign and Hawkin’s sign). These tests help localize the pathology to the rotator cuff, however they are not specific for impingement. Neer’s sign may also be seen with Subacromial bursitis (Starr & Harbhajan, 2001).

Plain x-rays of the shoulder can be used to detect some joint pathology and variations in the bones, including acromioclavicular arthritis, variations in the acromion, and calcification. However, x-rays do not allow visualization of soft tissue, thus hold a low diagnostic value. Ultrasonography, arthrography and MRI can be used to detect rotator cuff muscle pathology.

MRI is the best imaging test prior to arthroscopic surgery. Due to lack of understanding of the pathoaetiology, and lack of diagnostic accuracy in the assessment process by many doctors, several opinions are recommended before intervention.

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