Rotator Cuff Impingement
What is it?
Pain referral pattern:
Diagnostic tool to rule in/out:
- In 1972 Neer introduced the topic of impingement causing pain in the anterior portion of the shoulder usually. Neer defined it as an external source of mechanical injury to the rotator cuff. It has since been defined as an overuse syndrome.
- Primary impingement is believed to be caused by the narrowing of the supraspinatus outlet as a result of acromioclavicular joint spurring, greater tuberosity malunion, thickened coracoacromial ligament thickening, and or lesion.
- Secondary impingement occurs in athletes who use their shoulders repetitively at the extremes of motion, a situation that leads to gradual attenuation of static stabilizers and may result in instability. This microinstability causes the humeral head to sublux anteriorly and superiorly, thus creating secondary impingement as the cuff is compressed on the undersurface of the coracoacromial arch.
- Internal impingement occurs when anterior subluxation leads to contact and abrasion of the undersurface of the supraspinatus tendon against the posterosuperior glenoid labrum. Impingement occurs within the joint rather than in the subacromial space.
- Pain presents with pain in the anterior or lateral portion of the affected shoulder. Pain increases when the patient is asked to raise the arm above the head.
Pain referral pattern:
- Pain generally refers to the anterior or lateral aspect of the shoulder.
Diagnostic tool to rule in/out:
- Positive Neer's - the scapula is stabilized and the arm is elevated in the plane of the scapula. As the arm reaches the limit of forward elevation, the greater tuberosity is jammed underneath the acromion and thus produces pain indicating a pathology of impingement.
- Positive Hawkins Kennedy - is performed with the arm at 90 degrees of forward elevation, in slight adduction; with the elbow flexed at 90 degrees, the shoulder is internally rotated, a maneuver then impales the greater tuberosity under the acromion indicating impingement.
- Patient will present with pain in the anterior and or lateral aspect of the shoulder with trouble lifting the arm over head.