Impingement Syndrome: Diagnosis and Management

Chapter 7

Impingement Syndrome

Diagnosis and Management

Chunyan Jiang, and Fenglong Li


Shoulder impingement syndromes are caused by external or internal impingement. External impingement includes subacromial and subcoracoid impingement, and is caused by the abnormalities of the anterolateral acromion and coracoacromial arch, leading to disorders of the outlet structures. Internal impingement is caused by pinching of the posterosuperior labrum on the glenoid rim and the undersurface of the rotator cuff with the arm in abduction and external rotation. This nonoutlet impingement usually occurs in overhead athletes.


Subacromial or subcoracoid decompression can be used to treat the outlet impingement syndromes. Debridement or repair of the rotator cuff tear and posterosuperior labral lesion may be needed for symptomatic nonoutlet (internal) impingement.

Patient History

Patient Examination


Treatment Options: Nonoperative and Operative

Surgical Anatomy

Surgical Indications

  1. • Outlet impingement.
  2. • Patients with persistent pain affecting the activities of daily living and symptoms irresponsive to conservative treatment (including subacromial cortisone injection and physiotherapy) for 3 to 6 months.
  3. • Acromioplasty is indicated for patients with hooked acromion or huge acromial spur with a healthy cuff or reparable rotator cuff tear.
  4. • Coracoplasty is indicated for the patients with both clinical and radiologic evidences of coracoid impingement (coracoid spur or close contact between coracoid and subscapularis).
  5. • Internal impingement.
  6. • Failure to respond to conservative treatment for 3 to 6 months (including intraarticular cortisone injection and physiotherapy).
  7. • Inability to return to sports despite at least 3 months of structured rehabilitation.

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Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Impingement Syndrome: Diagnosis and Management

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