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At least 19 recordsLinked to original sources
PubMed1995

Impingement relief test: an adjunctive procedure to traditional assessment of shoulder impingement syndrome.

Shoulder impingement syndrome, a common disorder directly related to the unique anatomy, mobility, and biomechanics of the shoulder girdle complex, is a condition that results from repetitive microtrauma to the structures within the subacromial space, primarily the supraspinatus, the long head of the biceps, and the subacromial bursa. Several factors contribute to shoulder impingement syndrome, including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. This article briefly reviews the biomechanics of the shoulder girdle complex and the pathology of shoulder impingement syndrome. The author introduces an adjunctive assessment procedure that assists the clinician in isolating the primary tissue and the structures involved with shoulder impingement syndrome. Conservative treatment management can then be directed to the involved contractile and/or noncontractile tissue involved with shoulder impingement syndrome.

Biomechanical Phenomena↗
PubMed1993

Nonoperative management of secondary shoulder impingement syndrome.

Shoulder pain secondary to impingement of the rotator cuff tendons underneath the coracoacromial arch is a common problem seen in athletes who perform repetitive overhead activities. Shoulder impingement has been classified into primary and secondary types. Several factors contribute to impingement, including rotator cuff weakness, posterior capsule tightness, and subacromial crowding. Recently, it has been proposed that scapulothoracic muscle weakness could be a factor that contributes to impingement. Traditional rehabilitation protocols for shoulder impingement syndrome stress individualized rotator cuff strengthening. The authors propose that individualized scapulothoracic muscle strengthening should be a part of any protocol for nonoperative treatment of secondary shoulder impingement syndrome.

Compartment Syndromes↗
PubMed2004

Shoulder impingement syndrome.

Shoulder rotator cuff impingement syndrome is treatable-nonoperatively or operatively if prompt diagnosis and treatment are undertaken.Proper evaluation includes a good history, physical examination, and appropriate diagnostic testing. The main goal in treatment is to return patients to their previous activity level, and the prognosis usually is good.Treatment usually is successful with nonoperative means, but if necessary operative intervention is successful with correct patient selection.

Biomechanical Phenomena↗
PubMed1998

The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.

Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.

Female↗
PubMed1988

Office evaluation and management of the shoulder impingement syndrome.

The shoulder impingement syndrome is the most common cause of shoulder pain. A complete office evaluation can be aided by a printed exam sheet. Careful consideration of the differential diagnosis is important, often employing the Xylocaine injection test. The impingement syndrome responds to conservative treatment the majority of the time. Long follow-up determines the need for an invasive evaluation or surgical treatment.

Adolescent↗
PubMed1996

Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement--an anatomic study.

OBJECTIVE: The purpose of the study was to investigate the relationship of the distal supraspinatus tendon to the coracoacromial arch on radiographs and MR imaging at various shoulder positions. MATERIALS AND METHODS: Radiopaque and gadolinium-impregnated markers were sutured to the distal aspect of the supraspinatus tendon and along the coracoacromial ligament in three cadavers. While varying positions of the shoulder, we obtained gross anatomic visualization, radiographs, and MR images. RESULTS: Impingement of the distal aspect of the supraspinatus tendon between the acromion and the greater tuberosity of the humerus was well visualized during forward flexion and abduction of more than 30 degrees. Shoulder impingement was best seen at 60 degrees forward flexion, 60 degrees abduction, and internal rotation. CONCLUSION: MR imaging of different shoulder positions may help reveal the pathogenesis of shoulder impingement syndrome.

Aged↗
PubMed1999

Shoulder impingement syndrome in relation to shoulder intensive work.

OBJECTIVES: To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. METHODS: A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by questionnaire and by physical examinations. Impingement syndrome was diagnosed when shoulder symptoms had been present for at least 3 months during the past year and there were signs of subacromial impingement in the corresponding shoulder at physical examination. Shoulder function was assessed at the same occasion with the Constant scoring technique. Prevalence of shoulder impingement syndrome was analysed according to job title and cumulative exposure. RESULTS: Prevalence ratio for shoulder impingement syndrome was 5.27 (95% confidence interval (95% CI), 2.09 to 12.26) among currently working and 7.90 (95% CI, 2.94 to 21.18) among former slaughterhouse workers. Transformed model based prevalence ratios according to years in slaughterhouse work showed an overall association between cumulative exposure and risk for shoulder impingement syndrome. CONCLUSIONS: This study supports the hypothesis that shoulder intensive work is a risk factor for impingement syndrome of the shoulder. Despite the historical cohort design healthy worker selection may have influenced the exposure-response relation found.

Abattoirs↗
PubMed1996

[Diagnosis of shoulder impingement syndrome].

This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Shoulder impingement is caused by compression of the supraspinatus tendon underneath the coracoacromial arch, mainly in forward flexion of the arm. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs may overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff.

Diagnosis, Differential↗
PubMed1988

Shoulder impingement syndrome: MR findings in 53 shoulders.

The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred. In an attempt to determine if MR can be used to depict the abnormalities associated with impingement syndrome (subacromial bursitis, supraspinatus tendinitis, and rotator cuff tear), we reviewed 107 MR scans of painful shoulders. Changes consistent with impingement syndrome were found in 53 patients (50%), 32 of whom underwent subsequent arthrography or surgery. MR was found capable of depicting several soft-tissue and bony abnormalities that have been clinically described in impingement syndrome. In regions of inflammation, we found that the supraspinatus tendon and/or the subacromial bursa were compressed by spurs (25 shoulders), capsular hypertrophy of the acromioclavicular joint (six shoulders), and/or low-lying acromion (14 shoulders). While T1-weighted MR imaging was highly sensitive to abnormalities of the supraspinatus tendon, tendinitis could be differentiated from a small tear of the supraspinatus tendon only with T2-weighted imaging. Large, full-thickness tears, especially if chronic, produced characteristic MR findings on both T1- and T2-weighted images. We conclude that MR can be used to detect several abnormalities associated with the shoulder impingement syndrome.

Bursitis↗
PubMed2006

Dynamic sonography evaluation of shoulder impingement syndrome.

OBJECTIVE: Our aim was to characterize shoulder impingement syndrome using dynamic sonography. CONCLUSION: Dynamic sonography allows direct visualization of the relationships between the acromion, humeral head, and intervening soft tissues during active shoulder motion and can provide useful information regarding potential intrinsic and extrinsic causes of shoulder impingement syndrome.

Adult↗
PubMedDate not supplied

[Acromial osteophyte in shoulder impingement syndrome. Diagnosis and prevalence].

INTRODUCTION: The shoulder impingement syndrome (SIS) is caused by the compression of the rotator cuff tendon tear and the subacromial bursa between the humeral head and the structures that conforms the subacromial arc. OBJECTIVE: To determine a proportion of the acromial spur in the SIS comparing it with the general population. A second one would be to evaluate the quality of the radiological technique. MATERIAL AND METHODS: A comparative cross-sectional study was made in 148 patients, divided in two groups: one conformed by 52 persons, for patients with SIS and the other, conformed by 96, for the general population of similar age. The technique used to detect the acromial spur was the anteroposterior shoulder plate with a ray at 30 degrees in caudal direction in a bilateral way that was blindly interpreted by an orthopedist in two occasions, obtaining a high concordance index of Kappa of 0.90. The criteria to consider positive spur was that the bone growth could exceed a prolongation of an imaginary line at the inferior edge of the clavicle. RESULTS: The average age in both groups was of 48.7 years +/- 14.5 years for the patients with SIS, and of 43.2 years +/- 12.9 for the patients of the control group. It was founded that 84.6% of the patients with SIS had acromial spur and in the ones of the control group, it was founded in a 36%, being this difference significant with OR of 9.3 times more frequent to have spur in patients with SIS. The quality of the technique was good in 92% of the Rx. CONCLUSION: The frequency of spur in SIS is high (84.6%), but it calls our attention that the frequency in general population was moderate (36%).

Acromion↗
PubMed2002

Is shoulder impingement syndrome a problem in otolaryngologists?

Shoulder problems are well-documented as an occupational illness. The incidence of occupational shoulder problems is increasing. A postal questionnaire survey was conducted to see if otolaryngologists are more susceptible to shoulder impingement syndrome because of their occupation. Endocrinologists were used as the control group. Among 556 questionnaires sent to otolaryngologists, 367 (64.6%) responses were returned compared with 210 questionnaires sent to endocrinologists, of which 138 (65.7%) responses were returned. A total of 88 (24.0%) of the otolaryngologists had suffered from impingement syndrome compared with 15 (10.9%) of the endocrinologists, which was significantly different. Of those with impingement syndrome, more endocrinologists gave a history of injury or overuse compared with otolaryngologists. There must be another factor, leading to increased incidence of impingement syndrome, which may be because of the continuous flexion, and abduction of their shoulders during examination and operating on patients.

Cumulative Trauma Disorders↗
PubMed2004

Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program.

BACKGROUND AND PURPOSE: Shoulder impingement syndrome is a common condition and is often managed with an exercise program. The purpose of this study was to examine an exercise program in patients with shoulder impingement syndrome. Specifically, the purpose was to identify changes that might occur in 3-dimensional scapular kinematics, physical impairments, and functional limitations. SUBJECTS: Fifty-nine patients with impingement syndrome were recruited, and 39 patients successfully completed the 6-week rehabilitation program and follow-up testing. Impingement was defined as having at least 3 of 6 predefined clinical signs or symptoms. METHODS: Subjects were assessed before and after a 6-week rehabilitation program and again at 6 months. Pain, satisfaction, and function were measured using the University of Pennsylvania Shoulder Scale. Range of motion, isometric muscle force, and 3-dimensional scapular kinematic data also were collected. Subjects were given a progressive exercise program that included resistive strengthening, stretching, and postural exercises that were done daily at home. Subjects also were given shoulder education related to anatomy, the basic mechanics of impingement, and strategies for reducing load on the shoulder. Each subject attended one physical therapy session per week for a 6-week period, primarily for monitoring and upgrading the exercise program. Pretest and posttest scores were compared using paired t tests and repeated-measures analysis of variance. RESULTS: Passive range of motion increased for both external and internal rotation but not for elevation. Abduction external and internal rotation force all increased. There were no differences in scapular kinematics. Improvements were found for pain, satisfaction, and shoulder function and for Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores related to physical function. At 6-month follow-up, improvements made in pain, satisfaction, and function were maintained. DISCUSSION AND CONCLUSION: The use of this exercise protocol in the management of shoulder impingement syndrome may have a positive impact on patients' impairments and functional limitations. Our findings suggest a relatively simple exercise program combined with patient education may be effective and, therefore, merits study in a larger trial using a control group. Changes in scapular kinematics did not appear to be a primary mechanism underlying improvement in symptoms and function.

Adult↗
PubMed2000

Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome.

STUDY DESIGN: A prospective randomized clinical trial. OBJECTIVE: To compare the effectiveness of 2 physical therapy treatment approaches for impingement syndrome of the shoulder. BACKGROUND: Manual physical therapy combined with exercise is a commonly applied but currently unproven clinical treatment for impingement syndrome of the shoulder. METHODS AND MEASURES: Thirty men and 22 women (age 43 years +/- 9.1) diagnosed with shoulder impingement syndrome were randomly assigned to 1 of 2 treatment groups. The exercise group performed supervised flexibility and strengthening exercises. The manual therapy group performed the same program and received manual physical therapy treatment. Both groups received the selected intervention 6 times over a 3-week period. The testers, who were blinded to group assignment, measured strength, pain, and function before treatment and after 6 physical therapy visits. Strength was a composite score of isometric strength tests for internal rotation, external rotation, and abduction. Pain was a composite score of visual analog scale measures during resisted break tests, active abduction, and functional activities. Function was measured with a functional assessment questionnaire. The visual analog scale used to measure pain with functional activities and the functional assessment questionnaire were also measured 2 months after the initiation of treatment. RESULTS: Subjects in both groups experienced significant decreases in pain and increases in function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pretreatment mean (+/- SD) of 575.8 (+/- 220.0) to a posttreatment mean of 174.4 (+/- 183.1). In contrast, pain in the exercise group was reduced from a pretreatment mean of 557.1 (+/- 237.2) to a posttreatment mean of 360.6 (+/- 272.3). Strength in the manual therapy group improved significantly while strength in the exercise group did not. CONCLUSION: Manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial is better than exercise alone for increasing strength, decreasing pain, and improving function in patients with shoulder impingement syndrome.

Adult↗
PubMed1998

Shoulder impingement syndromes.

OBJECTIVE: Not all shoulder pain conditions are a consequence of rotator cuff injuries secondary to anterior subacromial impingement. Additional causative forms have been identified and classified as posterosuperior glenoid rim, subcoracoid and suprascapular nerve (at spinoglenoid notch) impingement syndromes. MATERIAL AND METHODS: We reviewed 206 consecutive magnetic resonance examinations carried out with conventional T1- and T2-weighted spin-echo and gradient-echo sequences in patients complaining of shoulder pain. Adjunctive sequences were acquired with the involved arm positioned in abduction and external rotation. RESULTS: Anterior subacromial impingement is only one of the possible causes of shoulder disorders. Posterosuperior glenoid rim impingement is the most frequent cause of shoulder pain in young throwers. Subcoracoid and spinoglenoid notch suprascapular nerve impingement are additional forms that must be considered in the differential diagnosis because of their frequent occurrence in routine clinical practice. CONCLUSION: Magnetic resonance imaging is the most useful diagnostic modality for shoulder disorders.

Disease Progression↗
PubMed2001

Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome.

This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on antero-posterior (AP) radiographs of the shoulder as the referential line. Twenty-seven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the study. Scapular upward and axial rotational tilts were compared between the affected and contralateral shoulders. AP radiographs were obtained at shoulder abduction angles of 0 degrees, 45 degrees, and 90 degrees, and the X-ray films were digitized by computer. The upward and axial rotational tilts of the scapula were then evaluated on the digital images. In shoulder impingement syndrome, both upward and axial external rotations of the scapula were impaired at the painful arc angle of abduction. This tended to be more apparent for the axial rotation of the scapula than for the upward rotation. These reductions in scapular rotations reduce available clearance for the rotator cuff and humeral greater tuberosity as the shoulder is abducted.

Adult↗
PubMed2006

Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings.

OBJECTIVE: Although there has been much research about imaging methods for shoulder impingement syndrome, the clinical information and upper limb level of disability have been generally ignored. The purpose of this study was to detect the relationships between clinical, functional, and radiologic variables in patients with shoulder impingement syndrome. DESIGN: A cross-sectional, clinical, and radiologic study was planned and 59 shoulders of 58 consecutive patients waiting for physical therapy because of a clinically suspected shoulder impingement syndrome were included into this study. Comprehensive clinical examination, radiography, shoulder ultrasonography, and magnetic resonance imaging were performed in the same month. RESULTS: Despite the high sensitivities of ultrasonography for diagnosing rotator cuff tears (98.1%) and biceps pathologies (100%), magnetic resonance imaging was superior to ultrasonography in many important shoulder structures such as a glenoid labral tear and subacromial bursal effusion/hypertrophy (P < 0.01). These structures were the determinants of the shoulder's disability measured by disabilities of the arm, shoulder, and hand questionnaire. CONCLUSION: Ultrasonography and magnetic resonance imaging had comparable high accuracy for identifying the biceps pathologies and rotator cuff tears. The basic clinical tests had modest accuracy in both disorders. The choice of which imaging test to perform should be based on the patient's clinical information (regarding lesion of glenoid labrum, joint capsule, muscle, and bone), cost, and imaging experience of the radiology department.

Adult↗