By: Dr. Cherif Tadros, Orthopaedic surgeon, Kinatex
One of the most common pathologies in orthopaedics is shoulder pain. Although
the differential diagnose of shoulder pain may be extensive, in this article,
only the condition commonly called impingement syndrome will be discussed.
Impingement can be defined as an “irritation” of the rotator cuff muscles
under the arch created by the acromion, the coracoacromial ligament, the
coracoid process and the acromioclavicular joint. This pathology is also called
shoulder tendonitis and bursitis.
One must also consider that a tear of the cuff may also cause impingement
syndrome. The same can also be said for a poorly healed fracture of the humeral
head or even a tumour in the shoulder area.
Signs and Symptoms
The main symptom in the shoulder is pain that can be felt both internally and
externally. The pain may extend to the lateral side of the arm and extend to the
elbow. The pain will increase when the arm is elevated and diminish while at
For instance, women will have difficulty to do up their bra and men will have
a hard time reaching for their wallet in the back pocket. A painter will have a
hard time lifting the arm above the level of the shoulder and a tennis player
will have difficulty with the serve.
The impingement syndrome can be chronic and dull or acute and very intense
(as in the case of acute bursitis). Patients suffering from a rotator cuff tear
may feel weakness and nocturnal pain.
Examination of the shoulder may be negative or, in cases of chronic tear of
the cuff, show muscle wasting. Examination of the rotator cuff muscles may
create pain and discomfort.
Active range of motion may be limited due to pain, while passive
movement remains normal as opposed to a shoulder capsulitis in which case both
passive movements are limited.
There exists specific tests used to diagnose a possible
impingement problem, they include the
It is possible that muscular strength will remain normal except in cases of massive tear of the rotator cuff.
A simple X-Ray of the shoulder is essential for every patient feeling pain. Although the X-Ray may often be normal, it will allow an assessment of the acromion shape, detect calcifications, or even diagnose a bone tumour or a soft
An ultrasound may eliminate a tear in the rotator cuff, and if necessary a
MRI may be suggested.