Shoulder impingement revisited: Evolution of diagnostic understanding in orthopedic surgery and physical therapy

Jonathan P. Braman, Kristin D. Zhao, Rebekah L. Lawrence, Alicia K. Harrison, Paula M. Ludewig

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

"Impingement syndrome" is a common diagnostic label for patients presenting with shoulder pain. Historically, it was believed to be due to compression of the rotator cuff tendons beneath the acromion. It has become evident that "impingement syndrome" is not likely an isolated condition that can be easily diagnosed with clinical tests or most successfully treated surgically. Rather, it is likely a complex of conditions involving a combination of intrinsic and extrinsic factors. A mechanical impingement phenomenon as an etiologic mechanism of rotator cuff disease may be distinct from the broad diagnostic label of "impingement syndrome". Acknowledging the concepts of mechanical impingement and movement-related impairments may better suit the diagnostic and interventional continuum as they support the existence of potentially modifiable impairments within the conservative treatment paradigm. Therefore, it is advocated that the clinical diagnosis of "impingement syndrome" be eliminated as it is no more informative than the diagnosis of "anterior shoulder pain". While both terms are ambiguous, the latter is less likely to presume an anatomical tissue pathology that may be difficult to isolate either with a clinical examination or with diagnostic imaging and may prevent potentially inappropriate surgical interventions. We further recommend investigation of mechanical impingement and movement patterns as potential mechanisms for the development of shoulder pain, but clearly distinguished from a clinical diagnostic label of "impingement syndrome". For shoulder researchers, we recommend investigations of homogenous patient groups with accurately defined specific pathologies, or with subgrouping or classification based on specific movement deviations. Diagnostic labels based on the movement system may allow more effective subgrouping of patients to guide treatment strategies.

Original languageEnglish (US)
Pages (from-to)211-219
Number of pages9
JournalMedical and Biological Engineering and Computing
Volume52
Issue number3
DOIs
StatePublished - Mar 2014

Keywords

  • Biomechanics
  • Diagnostic classification
  • Physical examination

ASJC Scopus subject areas

  • Biomedical Engineering
  • Computer Science Applications

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