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Subacromial impingement is not free of criticism. First, the identification of acromion type shows poor intra- and inter-observer reliability. [26] [27] Second, a computerized three-dimensional study failed to support impingement by any portion of the acromion on the rotator cuff tendons in different shoulder positions. [28]
The coracoacromial ligament originates from the summit of the acromion of the scapula, just in front of the articular surface for the clavicle. [1] It inserts by its broad base along the whole length of the lateral border of the coracoid process of the scapula. [1] The clavicle and under surface of the deltoid muscle are above it.
The acromion is a bony process at the end of the scapula. The shoulder is a complex mechanism involving bones, ligaments, joints, muscles, and tendons. The two main causes are acute injury or chronic and cumulative degeneration of the shoulder joint. Mechanisms can be extrinsic, intrinsic or a combination of both. [27]
When performing the Neer impingement test, the elbow should be extended, humerus in internal rotation and the forearm pronated. When the examiner is passively flexing the arm forward, it is causing compression of the structures between the greater tuberosity, inferior acromion process and the acromioclavicular joint. [1]
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It is attached, by its apex, to the summit of the acromion just in front of the articular surface for the clavicle; and by its broad base to the whole length of the lateral border of the coracoid process. [2] This ligament, together with the coracoid process and the acromion, forms a vault for the protection of the head of the humerus.
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