Shoulder impingement tests

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The vast majority of shoulder pain is temporary and not due to anything serious. However, sometimesimpingement could be the result of an underlying condition.
How is shoulder impingement diagnosed?

Healthcare professionals should begin by taking a detailed history of the problem before carrying out some physical examination tests.It’s important to ascertain if the problem is muscular or orthopaedic in nature, or something else.

Firstly, clinicians should establish what is known as a“capsular pattern of stiffness” to the joint. This test means keeping the elbow at ninety degrees while rotating the hand away from the side to externally rotate the shoulder. Ifsignificant discomfort occurs, then a problem with the shoulder joint (glenohumeral joint) itself is likely to be the problem. So something like a frozen shoulder or osteoarthritis.

Secondly, tests to isolate the rotator cuff tendons should be carried out by asking the patient to resist certain movements. These tests put pressure on particular tendons and muscles. Any pain could indicate a tear or inflammationin the rotator cuff.


Which scans and tests may be required?

For musculoskeletal and orthopaedic diagnosis, X-rays, MRI scans and ultrasound scans may be required. Each one has its own use in diagnosing shoulder impingement.

X-rays are the main way of confirming suspected shoulder fractures, as well as age related osteoarthritis in the shoulder joint. Osteoarthritis of the AC joint as well as the glenohumeral joint should show up in an X-ray. Additionally, if symptoms of subacromial impingement are present, an X-ray can help to determine the degree of the osteoarthritis and any bony spurs from the AC joint that might be adding to the problem.

Ultrasound scans are ideal for detecting any possible inflammation, calcium deposits or tears to the tendons around the rotator cuff. Ultrasounds can also assess the shoulder during movement, which is helpful in spotting any signs of mechanical subacromial impingement whilst the shoulder is elevated.

Finally, MRI scans show extremely detailed images of the soft tissues, muscles, bones, tendons, cartilage, and other structures that make up the shoulder itself.Orthopaedic surgeons may refer a patient for an MRI scan before they take on surgery for subacromial or rotator cuff related shoulder pain. MRI scans are also much more likely than ultrasound and X-rays to pick up areas of inflammation and tears to the labrum of the shoulder.


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