Shoulder impingement
Dr Yuranga Weerakkody and Dr Frank Gaillard et al.
Shoulder impingement is implicated in a large proportion of rotator cuff tears. It is due to impingement on the rotator cuff (usually supraspinatus ) by a decrease in the subacromial space.
Causes include:
- os acromiale
- type III and type IV acromions
- acromioclavicular degenerative disease
- thickening of the coracoacromial ligament
- coracoacromial ligament ossification
- shoulder instability
- post traumatic deformity
- supraspinatus over development
- low lying acromion
Although impingement appears to be from above the majority of tears are on the humeral surface.
Ultrasound of the shoulder is a useful technique as it allows dynamic examination of the joint.
Less common types of impingement include:
- subcoracoid impingement - which affects subscapularis
- posterosuperior impingement - which involves infraspinatus
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