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Shoulder Impingement Syndrome Cheat Sheet (DRAFT) by

Description of diagnostic criteria for shoulder impingement.

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Not entirely clear
Thought to be syndrome that begins as overuse injury with tendin­opathy of supras­pinatus (under­surface near bicep)

Age at presen­tation

Primary (External)
Secondary (External)
Internal (Glenoid)


Repetitive overhead activities (handball, volley­ball, swimming, carpen­ters, painters, hairdr­essers)
Risk factors: heavy loads, infection, smoking, and fluoro­qui­nolone antibi­otics.


Primary (External)
Narrowing of subacr­omial space. Abnormal acromion anatomy (hooked class III acromion) or swelling of soft tissues
Secondary (External)
Normal anatomy at rest and onset of imping­ement during shoulder motion, secondary to RC weakness (uncon­trolled cranial transl­ation of humeral head), or weak traps and SA muscles (limiting ER and rise of scapula w abd).
Internal (Glenoid)
Imping­ement of the articular surface of the RC against the glenoid labrum.


Altered biomec­hanics and atrophy
Rotator cuff/b­ici­pital tendonitis or tear
Adhesive capsulitis


~2 years w physio, NSAIDs, cortic­ost­eroid injections and other conser­vative interv­entions

Clinical Presen­tation

Pain lifting arm or lying on affected side
Functional restri­ctions, specif­ically overhead
Pain during night
Weakness and stiffness secondary to pain

Subjective Markers

Onset is usually gradual or insidious, typically developing over weeks to months
Patients unable to describe direct trauma or inciting event
Pain described as being located over the lateral acromion, frequently with radiation to the lateral mid-hu­merus
Inquire about overhead and repetitive activities
Relief may be noted with rest, anti-i­nfl­amm­atory meds, and ice, but symptoms often recur upon return to activity
Describe "Dead Arm": weakness after throwing, slipping of shoulder
Popping, clicking, catching, sliding
Creech and Silver, 2021

Objective Assessment

Observe neck and shoulder height. Muscular asymmetry.
Tenderness when palpating over coracoid process
Loss w abd. and ER. Scapular dyskinesis seen with forward elevation. GIRD loss of IR & loss of total rotational motion. May have increased laxity.
Weakness with abduction and ER.
Throwing, reaching overhead


Equal effect­iveness of physio­therapy led sessions and surgery in long term (Kromer, 2009)
Conser­vative, NSAIDs, subacr­omial cortisol inject­ions, treatment of choice for first 3-6 months
Focus on rotator cuff streng­thening (supra­spi­natus and infras­pin­atus), trap and SA streng­thening
Retraining exercises to minimize scapular dyskinesia
Correct strength imbalances
Hypert­hermia (short­-term relief) moderate evidence

Special Tests (Positive Sign Combined)

Empty Can (Jobe's)
Painful Arc (btwn 70-120 degree)
Negative sulcus sign, anterior appreh­ension, and reloca­tion: shoulder instab­ility