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The acromioclavicular joint and glenohumeral joints are well aligned; there are moderate osteoarthritic changes involving the glenohumeral joint and the acromioclavicular joint. There is a loss of the subacromial space, suggesting subacromial impingement.
Subacromial impingement should not be diagnosed solely off a plain radiograph and should be considered clinically 1; this particular case was clinically correlated and diagnosed.
Physical examination includes the investigation of three signs firstly, the Neer sign (pain on forced flexion) secondly, the Hawkings sign (pain on internal rotation with arm elevated to 90 degrees) and thirdly, the Neer injection test (less pain during the Neer sign after a local injection). However, the sensitivity of these physical examinations is disputed in the literature 3.
It is one of the most common forms of shoulder impingement; it accounts for 44-65% of shoulder complaints 2.
- 1. van der Windt DA, Koes BW, de Jong BA et-al. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann. Rheum. Dis. 1996;54 (12): 959-64. Free text at pubmed - Pubmed citation
- 2. Cone RO, Resnick D, Danzig L. Shoulder impingement syndrome: radiographic evaluation. Radiology. 1984;150 (1): 29-33. doi:10.1148/radiology.150.1.6689783 - Pubmed citation
- 3. Hegedus EJ, Goode A, Campbell S et-al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2007;42 (2): 80-92. doi:10.1136/bjsm.2007.038406 - Pubmed citation
- 1. Van der Windt DA, Koes BW, de Jong BA et-al. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann. Rheum. Dis. 1996;54 (12): 959-64. Free text at pubmed - Pubmed citation