Med Biol Eng Comput - Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy.


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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.

Resumo Limpo

imping syndrom common diagnost label patient present shoulder pain histor believ due compress rotat cuff tendon beneath acromion becom evid imping syndrom like isol condit can easili diagnos clinic test success treat surgic rather like complex condit involv combin intrins extrins factor mechan imping phenomenon etiolog mechan rotat cuff diseas may distinct broad diagnost label imping syndrom acknowledg concept mechan imping movementrel impair may better suit diagnost intervent continuum support exist potenti modifi impair within conserv treatment paradigm therefor advoc clinic diagnosi imping syndrom elimin inform diagnosi anterior shoulder pain term ambigu latter less like presum anatom tissu patholog may difficult isol either clinic examin diagnost imag may prevent potenti inappropri surgic intervent recommend investig mechan imping movement pattern potenti mechan develop shoulder pain clear distinguish clinic diagnost label imping syndrom shoulder research recommend investig homogen patient group accur defin specif patholog subgroup classif base specif movement deviat diagnost label base movement system may allow effect subgroup patient guid treatment strategi

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