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MRI showing subacromial impingement with partial rupture of the supraspinatus tendon, but no retraction or fatty degeneration of the supraspinatus muscle. Impingement syndrome can be diagnosed by a targeted medical history and physical examination , [ 11 ] [ 12 ] but it has also been argued that at least medical imaging [ 13 ] (generally X-ray ...
Localized pain on the anterior shoulder suggests subacromial impingement, whereas posterior shoulder pain suggests internal impingement. [45] For the diagnosis of full-thickness rotator cuff tear, the best combination appears to include once more the painful arc and weakness in external rotation, and in addition, the drop arm sign . [ 42 ]
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle. [1]
The coracoacromial ligament may impinge and compress rotator cuff muscle or tendon. [3] It may be damaged during a shoulder injury. [4]The attachment of the coracoacromial ligament may be moved from acromion to the end of the clavicle when reconstructing the acromioclavicular joint.
Diagram of normal bursae surrounding the shoulder joint: (1) subacromial-subdeltoid bursa, (2) subscapular recess, (3) subcoracoid bursa, (4) coracoclavicular bursa, (5) supra-acromial bursa and (6) medial extension of subacromial-subdeltoid bursa.
Radiographs will often be normal, but imaging features of adhesive capsulitis can be seen on ultrasound or non-contrast MRI. Ultrasound and MRI can help in diagnosis by assessing the coracohumeral ligament , with a width of greater than 3 mm being 60% sensitive and 95% specific for the diagnosis.
The Hawkins-Kennedy test [11] [12] has a sensitivity of approximately 80% to 90% for detecting impingement. The infraspinatus and supraspinatus [13] tests have a specificity of 80% to 90%. [10] A common cause of shoulder pain in rotator cuff impingement syndrome is tendinosis, which is an age-related and most often self-limiting condition. [14]
Although historically regarded as an incidental finding, the os acromiale may occasionally produce symptoms from subacromial impingement or instability at the site of non-union. [9] In people with symptoms of os acromiale , dynamic ultrasound sometimes shows hypermobility in the area during shoulder movement, or graded compression with the ...