External Impingement of the Shoulder

Campbell, Robert S.; Dunn, Andrew

doi:10.1055/s-2008-1078699

Cited by 15 publications

(4 citation statements)

References 77 publications

(133 reference statements)

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“…Tendon thickening with mucoid degeneration as a result of eccentric forces while in the overhead position leads to subsequent impingement on the coracoacromial arch due to the increased size of the tendon. 4 Clinical examination and tests have been shown to be sensitive but nonspecific in their ability to differentiate between shoulder impingement and other pathology. 10 Imaging is performed to identify pathology associated with impingement such as rotator cuff tears and to identify abnormalities that may be contributing to impingement.…”

Section: Etiology Of Impingementmentioning

confidence: 99%

Shoulder Impingement

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Campbell

McNally

2013

Semin Musculoskelet Radiol

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Impingement is a clinical scenario of painful functional limitation of the shoulder, 1 thought to be secondary to compression or altered dynamics that irritate and ultimately damage the tissues around the shoulder joint. Shoulder impingement is currently subdivided into external (subacromial) and internal impingement. External impingement is further subdivided into primary and secondary, and internal impingement into posterosuperior and anterosuperior (►Fig. 1). 2-8 External ImpingementThe theory of external impingement syndrome was first proposed by Neer in 1972 to describe shoulder pain associated with varying degrees of chronic bursitis and partial-or full-thickness tears of the rotator cuff. 7 However, this was before the advent of modern imaging, primarily ultrasound (US) and MR imaging. External/subacromial impingement occurs when the supraspinatus tendon and subacromialsubdeltoid (SASD) bursa are impinged between the humeral head, the acromion, and coracoacromial ligament. Early theories on etiology focused on anatomical abnormalities of the coracoacromial arch (►Fig. 2). However, there is growing evidence that scapular dysfunction may be more significant, especially in the patient <40 years of age. Etiology of ImpingementAnatomical abnormalities of the arch have highlighted morphological variation in the acromion and acromioclavicular (AC) joint. The morphology of the acromion has been categorized into three types (type I flat, type II concave, and type III hooked). It has been suggested that the hooked type III configuration may predispose to external impingement. 9 However, it is more likely that (unless the anatomical changes are gross) acromial changes are secondary rather than primary. Anterior and lateral downsloping of the acromion is also implicated in external impingement, particularly in tears of the supraspinatus tendon at its attachment. Acromioclavicular joint arthrosis, with osteophytes on the undersurface of the acromium, 1 and os acromiale are both believed to be causative in external impingement but are not accurately assessed with US and require subacromial outlet radiographs or MR imaging for optimal visualization.Functional abnormalities lead to external impingement by causing a relative decrease in the subacromial space due to glenohumeral instability or abnormal scapulothoracic movement. In other words, it is proximal displacement of the humeral head that causes impingement of the subacromial space against the coracoacromial arch rather than the reverse. These are encompassed within the term the SICK scapula syndrome (scapular malposition, inferomedial prominence, coracoid pain, scapular dyskinesis). 9a The disturbed balance of forces between the rotator cuff muscles and the deltoid muscle leads to elevation of the humeral head and secondary impingement of the contents of the subacromial space on the coracoacromial arch. Abnormal shoulder biomechanics also contribute to glenohumeral instability, particularly the AbstractThis update examines recent articles and evidence for the role ...

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Section: Etiology Of Impingementmentioning

confidence: 99%

Shoulder Impingement

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Campbell

McNally

2013

Semin Musculoskelet Radiol

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“…Medial evaluation of a thrower begins with a good thorough history of the problem. In eliciting the history of the injury, determining if the resulting symptoms are of vague character and of gradual onset or occurred as the result of an acute incident is important [23,[40][41][42]. Most patients present with a progressive decrease in throwing velocity or a loss of control and performance [43][44][45].…”

Section: Clinical Evaluationmentioning

confidence: 99%

Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes—evolving concepts

Kirchhoff

Imhoff

2010

International Orthopaedics (SICOT)

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During throwing motion the athlete puts enormous stress on both the dynamic and the static stabilisers of the shoulder. Repetitive forces cause adaptive soft tissue and bone changes that initially improve performance but ultimately may lead to shoulder pathologies. Although a broad range of theories have been suggested for the pathophysiology of internal impingement, the reasons are obviously multifactorial. This review aims to critically analyse the current literature and to summarise clinically important information. The cardinal lesions of internal impingement, articular-sided rotator cuff tears and posterosuperior labral lesions, have been shown to occur in association with a number of other findings, most importantly glenohumeral internal rotation deficit and SICK scapula syndrome, but also with posterior humeral head lesions, posterior glenoid bony injury and, rarely, with Bankart and inferior glenohumeral ligament lesions. Extensive biomechanical and clinical research is necessary before a complete understanding and reconciliation of the varying theories of the pathomechanisms of injury can be developed.

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“…Dabei stellt das Impingement-Syndrom der Schulter die wahrscheinlich häufigste Ursache für persistierende Schulterschmerzen bei Erwachsenen dar [73]. Es wird zwischen einem internen und externen Impingement unterschieden [7,47,51,61,71,85].…”

Section: Introductionunclassified

Diagnosegenauigkeit klinischer Tests bei einem Impingement-Syndrom der Schulter

Pfäffle

2014

manuelletherapie

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ZusammenfassungIn der Literatur findet sich eine Vielzahl klinischer Tests zur Diagnose eines Impingement-Syndroms der Schulter. Die vorliegende Arbeit stellt diese Testverfahren systematisch dar und vergleicht ihre Validität zur Diagnosestellung und Identifizierung auslösen-der Strukturen.Die gefundenen Studien beschreiben vergleichbare Daten zur Identifizierung eines Schulter-Impingement-Syndroms und zur Strukturverifizierung. Insgesamt erreichten 12 der eingeschlossenen Studien eine ausreichend gute bis hohe Bewertung der methodischen Qualität. Bei 18 Tests ergaben sich ausreichend hohe Wahrscheinlichkeiten zur Diagnosesicherung und Weichteilidentifizierung. SchlüsselwörterSchulter-Impingement-Syndrom | diagnostische Tests | AbstractThe literature reports a variety of clinical tests for the diagnosis of shoulder impingement. This article systematically describes these tests and compares their validity for diagnosis and for the identification of symptom inducing structures.The identified studies describe comparable data for the identification of shoulder impingement and for structural verification. In summary, 12 of the included studies attained a satisfactory "good" to "high" rating for methodological quality. 18 tests produced an adequately high likelihood for diagnosis and soft tissue identification.

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External Impingement of the Shoulder

Cited by 15 publications

References 77 publications

Shoulder Impingement

Shoulder Impingement

Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes—evolving concepts

Diagnosegenauigkeit klinischer Tests bei einem Impingement-Syndrom der Schulter

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