Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Shoulder impingementImpingement syndrome shoulderSubacromial compression ++ 726.19 Other specified disorders of bursae and tendons in shoulder region ++ M75.80 Other shoulder lesions, unspecified shoulder ++ Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation +++ Description ++ Shoulder pain and dysfunction due to compression and abrasion of one or more of the rotator cuff tendons, the long head of the bicep tendon, and/or the subacromial bursa beneath the coracoacromial arch due to an abnormal mechanical relationship The coracoacromial arch consists of the undersurface of the acromion, coracoacromial ligament as well as the undersurface of the acromioclavicular (AC) joint.Impingement is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms, which can impact both treatment and prognosis. +++ Essentials of Diagnosis ++ Multifactorial and thought to be related to intrinsic and/or extrinsic mechanisms Extrinsic mechanisms (extratendinous, cause decreased sub-acromial space and subsequent micro-trauma with repetitive movements) Mechanical wear under the coracoacromial archAberrant movement patterns due to rotator cuff and or periscapular muscular dysfunctionCapsular abnormalities Capsular tightness (particularly posterior capsule)Capsular laxity (poor humeral head dynamic control)Sub-optimal posture Muscle imbalancesOveruse/repetitive motions occurring above 90 degrees of elevationIntrinsic factors (directly associated with the narrowing of the sub-acromial space) Vascular supply/changes to the cuff tendonsAcromial morphology (structural variations). Type I (flat)Type II (curved)Type III hooked)Degenerative and/or structural changes to the AC joint Other trophic changes in the coracoacromial arch or humeral head ClassificationPrimary impingement is usually associated with degenerative changes to any of the following tissues:Rotator cuff tendonsAC jointCoracoacromial archSecondary Impingement is the result of muscle imbalances and/or joint instability, which can result in altered dynamics and subsequent secondary impingement.Neer stagesStage I: Edema and hemorrhage of the subacromial bursa; patient is generally <25 years of ageStage II: Histologic changes of tendinosis to the effected tendons; patient usually between 25 to 40 years of ageStage III: Partial or complete rupture of the cuff and or bicep tendons and potential associated changed to the acromion and AC joint; patient usually >40 years of age.Third class of impingement, not subacromial in nature: internal impingementOccurs between the undersurface (articular side) of the rotator cuff tendons and the posterior/superior surface of the labrum in the position of abduction and external rotation that occurs with throwing. Regardless of classification, all types of impingement are proposed to be mechanisms of rotator cuff and biceps tendinopathyTreatment varies based on impingement type, contributing factors, and associated tissue quality.Diagnosis is usually made by clinical examination and often accompanies 3 or more special tests2Neer’s impingement testHawkins-Kennedy impingement sign/testPassive horizontal adduction testPain with resisted abductionPainful arc sign/testPain in the C5-C6 dermatome regionInfraspinatus muscle test1Diagnostic test properties ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth