Shoulder Impingement Explained | Shoulder Impingement Assessment
Shoulder impingement is an outdated term (when it comes to the subacromial space) that used to be described as being a diagnosis but the view on the condition has shifted towards considering it to be a cluster of symptoms rather than a pathology itself. If you are interested in an updated take on “shoulder impingement”, check out our video on Shoulder Impingement Myth Busting.
But let’s further explain the underlying theory behind the term. shoulder impingement. Various studies have identified underlying pathological mechanisms like rotator cuff pathology, scapular dyskinesis, shoulder instability, biceps pathology, SLAP lesions, and glenohumeral internal rotation deficit, which is abbreviated as GIRD. These conditions are suggested to cause impingement symptoms. The literature describes two types of impingement:t subacromial or external impingement and internal impingement. Subacromial impingement is the mechanical encroachment of soft tissue structures like bursa or rotator cuff tendons in the subacromial space between the humeral head and the acromial arch. Patients often present pain in the mid-range of motion during active abduction causing a so-called painful arc.
Internal impingement describes an encroachment of the rotator cuff tendons between the humeral head and the glenoid rim. Based on the location of this encroachment there are two types anterosuperior and posterosuperior glenoid impingement. Anterosuperior glenoid impingement occurs after deep surface tears of the subscapularis retract which subsequently becomes trapped between the anterosuperior glenoid rim and the humeral head. Pain is typically provoked in shoulder flexion with internal rotation. Posterosuperior glenoid impingement consists mostly of the encroachment of the supra- and infraspinatus tendons between the greater tubercle of the humerus and the posterosuperior rim of the glenoid. Pain is typically provoked in maximal external rotation, horizontal abduction, and a certain amount of abduction. Just imagine an overhead throwing position.
Apart from the distinction based on the site of encroachment, shoulder impingement is further classified based on the cause of the problem dividing it into primary and secondary impingement. In primary impingement, the source of pain and dysfunction is a structural narrowing of the subacromial space occurring due to acromioclavicular arthropathy, due to a type I or III acromion, which is a flat acromion lagging the natural curvature or a hooked acromion respectively or due to swelling of soft tissue within the subacromial space. In secondary impingement, there are no structural abnormalities causing the dysfunction, but rather functional problems occurring in specific positions. It may occur in the subacromial space, as well as internally in the glenohumeral joint.
So with all this information, you might ask yourself how to correctly identify the underlying pathological mechanism in a patient who presents with impingement symptoms. Cools et al.(2008) have developed an algorithm for clinicians that should assist you in the assessment of impingement patients. Based on the outcomes of different clinical tests you can narrow it down to one of the aforementioned pathological mechanisms: rotator cuff pathology, scapular dyskinesias, shoulder instability, biceps pathology, SLAP lesions, and glenohumeral internal rotation deficit.
Cools AM, Cambier D, Witvrouw EE. Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British journal of sports medicine. 2008 Aug 1;42(8):628-35.
- Barbara Fasol05/09/23Rotator Cuff Related Shoulder Pain THE BEST COURSE SO FAR
I really enjoyed this course, so much it felt like a pleasure instead of a work. The explanations are very clear and the content is well documented and complete. Thank you!Alvin Chi24/06/23Rotator Cuff Related Shoulder Pain OVERALL A QUALITY COURSE THAT SUMMARIZES THE EVIDENCE WELL.
Overall a good course. I found the scapula dyskinesis section the most helpful, as it taught helpful physical exam findings that I could not find elsewhere. I also found the discussion on various tissue irritability helpful. I removed one star because this course has large sections of text, and relatively little videos and helpful diagrams. In comparison to the PFPS course by Claire Robertson, there was too much text and too little videos. I do appreciate how evidence based the course was, but summary diagrams and additional videos would have been helpful. Despite this, I would still recommend this course.Lynn Tastenhoye21/06/23Rotator Cuff Related Shoulder Pain REVIEW RC RELATED SHOULDER PAIN
Naar mijn gevoel werd het theoretische te weinig gekoppeld aan de praktische toepassing ervan
- Tristan Bard05/02/23Rotator Cuff Related Shoulder Pain REVIEW
Very interesting course, which allows you to improve your knowledge and your care with the patient, I highly recommend!Maud Silvertand12/01/23Rotator Cuff Related Shoulder Pain RCRSP COURSE REVIEW
A great course guided by up to date knowledge. It provides a good overview of rotator cuff related shoulder pain and the best research and treatment options following the latest evidence. In addition there is a lot of exercise and practice material to test your knowledge.Joscha Kaspar26/11/22Rotator Cuff Related Shoulder Pain AMAZING COURSE
Can highly recommend this course. Step by step you will be guided towards up to date knowledge about rotator cuff related shoulder pain. The Information is very well presented, not to long not to short. It helped me allready to make better treatment descisions in practice with patients. They often come with “impingement” diagnosis and ideas of their subacromial space being to small. Thanks to this course not only my communication is better towards those patients but also my clinical reasoning goes better and I am able to make better treatment plans within a realistic time frame. Thank you!
- Ivo Nieuwenhuis25/11/22Rotator Cuff Related Shoulder Pain GOOD COURSE TO LEARN AND UNDERSTAND MORE ABOUT THE SHOULDER
I liked this course because it is connecting evidence based with the practical understanding of cuff related problems. The way the course is given suits me because mr Struyf is not dictating he is explaining with an open mind.Janneke de Groot03/11/22Rotator Cuff Related Shoulder Pain ERG FIJNE PRAKTIJK GERICHTE CURSUS
Goede state of the art schouder cursus met fijne focus op het praktische aspect van het vak! Goede duidelijke instructie filmpjes en mooi voorbeeld materiaal wat meteen in de praktijk te gebruiken is!Jelter Wahlen05/10/22Rotator Cuff Related Shoulder Pain RCRSP COURSE!
Excellent course with the latest EB information! Higly recommend it!
- Lieselot Longé02/10/22Rotator Cuff Related Shoulder Pain ERG INTERESSANTE EN PRAKTIJKGERICHTE CURSUS!
Een heel praktisch gerichte cursus om rotatorcuff gerelateerde schouderklachten aan te pakken. Heeft mij echt nieuwe inzichten en motivatie gegeven om met schouderklachten aan de slag te gaan! Je kan de cursus op je eigen tempo thuis volbrengen met regelmatig een quiz en leuke praktische video’s.Pavel Samsonov13/07/22Rotator Cuff Related Shoulder Pain Perfect course with uptodate knowledge and fine quizes.
I liked the way corse structured: from epidemiology and screening to assessment, exercise ideas and prognostic factors.
Test in the end of the course is great idea to check your knowledge.Remy03/06/22Rotator Cuff Related Shoulder Pain Very good course, up to date background information, skilled instructor. Highly recommended
- Khaled Mohi03/09/21Rotator Cuff Related Shoulder Pain His course is excellent one . here you will find true understanding to this very common misunderstanded syndrome . how to treat without causig injury to the patient . i said it is truly excellent courseJanneke de Groot01/01/70Rotator Cuff Related Shoulder Pain ERG FIJNE PRAKTIJK GERICHTE CURSUS
Goede state of the art schouder cursus met fijne focus op het praktische aspect van het vak! Goede duidelijke instructie filmpjes en mooi voorbeeld materiaal wat meteen in de praktijk te gebruiken is!