| History: The hallmark symptom of impingement syndrome is shoulder pain that is most often gradual and progressive. In the early stages, individuals will experience pain only when the arm is held out from the side or in front of the body with the elbow at or above shoulder level, and the pain will be relieved with rest. There may be a "catching" sensation when the arm is lowered. As the impingement syndrome becomes more chronic, pain is felt most with shoulder activity but will not be relieved with positional change or rest. Shoulder pain may be so severe that it prevents the individual from moving his or her shoulder, which can lead to adhesive capsulitis. Pain is also frequently felt at night and may be severe enough to interfere with sleep, particularly when the individual rolls onto the affected shoulder. There may be a clicking or popping sensation felt with arm motion. The individual may have an occupation that requires repetitive arm motions. Complaints of weakness or the inability to raise the arm may indicate that the rotator cuff tendons are actually torn. Physical exam: Pain will be evident in individuals as the physician elevates the arm and positions the shoulder in a 90-degree forward-flexed and then internally rotated position (Hawkins impingement sign) or in maximal forward flexion (Neer impingement sign). Pain may occur at a particular point in the arc of motion but disappear as motion proceeds (called “painful arc”). Pain may also be elicited by resisted arm elevation during muscle strength testing. Range of motion testing will reveal limitations, most commonly in abduction and internal rotation. Individuals may exhibit total relief of symptoms after injection of a local anesthetic into the subacromial space (injection test). Pressure on the subacromial region produces pain. Tests: Routine shoulder x-rays, including special views of the acromial arch, are used to evaluate the shape of the arch and rule out other diagnoses. For most individuals, MRI is the imaging study of choice for shoulder pathology (DeBerardino). It is noninvasive and can be used to measure the amount of room for the rotator cuff, determine whether tendinitis is present in the cuff tendons (increased signal), determine whether osteophytes or acromioclavicular joint hypertrophy are producing impingement, detect rotator cuff tears, and detect other pathology (biceps tendinitis or rupture, labrum tear, etc.). Diagnostic ultrasound or shoulder joint arthrography (x-rays obtained after injecting a contrast medium, such as iodine solution) are alternatives that examine the integrity of the rotator cuff. |
Source: Medical Disability Advisor