Clinical Evaluation of Impingement

McFarland, Edward G.; Selhi, Harpal Singh; Keyurapan, Ekavit

doi:10.2106/00004623-200602000-00026

Cited by 52 publications

(41 citation statements)

References 45 publications

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“…[8][9][10][11]17,18 Although these reports all largely agree on the patient symptoms and physical examination findings present in coracoid impingement, none has been able to identify a definitive preoperative imaging reference standard for diagnosis, and none of the signs and symptoms described in the literature has demonstrable sensitivity, specificity, or accuracy. 19 Masala et al 5 compared the use of plain radiography, sonography, CT, and MRI to evaluate the CHI in 15 patients with coracoid impingement. They found that signs of classic impingement and degenerative changes, but not coracoid impingement, could be seen on plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

Sonography of the Coracohumeral Interval

Tracy

Trella

Nazarian

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Coracoid impingement has been recognized as an etiology for anterior shoulder pain; however, no imaging reference standard exists. We used sonography to compare the coracohumeral interval (CHI) in asymptomatic volunteers with the CHI in patients with coracoid impingement. Methods. Bilateral shoulder sonography was performed in 19 asymptomatic volunteers (10 men and 9 women) and in 8 shoulders in 7 patients (6 men and 1 woman) with a clinical diagnosis of coracoid impingement. With the arm adducted across the chest, the interval between the coracoid process and the lesser tuberosity of the humerus was measured using a linear array ultrasound transducer with a peak frequency of 13 MHz. Results. In the asymptomatic volunteers, the mean ± SD for the CHI was 12.2 ± 2.5 mm (range, 7.8-17.5 mm). In the symptomatic shoulders, the mean ± SD for the CHI was 7.9 ± 1.4 mm (range, 5.9-9.6 mm). Repeated measures analysis of variance revealed the CHI to be significantly narrower in symptomatic shoulders than in asymptomatic volunteers (P < .0001). Conclusions. These data suggest a role for sonography in diagnosing coracoid impingement. Key words: coracohumeral interval; coracoid impingement; shoulder. Most commonly, impingement of the supraspinatus tendon occurs deep to the coracoacromial arch. Less commonly, the space between the coracoid and the lesser tuberosity (ie, the coracohumeral interval [CHI]) is too narrow to allow unencumbered passage of the subscapularis tendon.2 This results in the entity known as coracoid impingement, which can be difficult to identify on both physical examination and imaging studies.Cadaveric studies have revealed tremendous variability in the bony anatomy of the coracoid process and subcoracoid recess.3 Plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) all have been used to evaluate the CHI. [4][5][6] Unfortunately, although plain radiography can provide evidence of classic impingement and degenerative changes, it does not show any specific signs predictive of coracoid impingement.5 Standard CT and MRI allow only static evaluation

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Section: Discussionmentioning

confidence: 99%

Sonography of the Coracohumeral Interval

Tracy

Trella

Nazarian

et al. 2010

Journal of Ultrasound in Medicine

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“…The examination included active and passive ROM, manual muscle strength testing, an upper extremity neurologic evaluation, and determination of other physical examination signs, including the Neer impingement sign [13,18,27,31,32], Kennedy-Hawkins impingement sign [17,18,27,29,31,32], and Gagey sign [12] (suggested as a measure of inferior capsular contracture). Weakness in abduction or external rotation with the arm at the side had been recorded.…”

Section: Methodsmentioning

confidence: 99%

“…We defined rotator cuff disease as symptomatic tendinosis, partial rotator cuff tear, or fullthickness rotator cuff tear [29].…”

Section: Methodsmentioning

confidence: 99%

“…Examining patients with shoulder problems can be challenging because (1) shoulder motion involves a complex interaction of movement of the scapula on the thorax, the humeral head on the glenoid, and the clavicle at the acromioclavicular and sternoclavicular joints [6,13,24]; and (2) physical examination tests for the shoulder are sensitive but not specific for one particular shoulder condition [4,5,10,20,23,26,[29][30][31]. It is important clinicians understand the limitations of physical examination tests when evaluating patients with shoulder pain.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Evaluation of the Shoulder Shrug Sign

Jia

Petersen

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The ''shrug sign'' (inability to lift the arm to 90°abduction without elevating the whole scapula or shoulder girdle) has been associated with a diagnosis of rotator cuff disease. Based on our clinical experience, we hypothesized the shrug sign is not a specific diagnostic sign for this condition, but rather is associated with various shoulder conditions and shoulder weakness and loss of range of motion. We retrospectively reviewed 982 consecutive patients who had been examined preoperatively for the shrug sign. A positive shrug sign was present in 51.3% of the patients, and the average distance lost from the horizontal was 20.5°± 2.2°(standard error of mean). Increasing age was associated with the presence of a shrug sign. The highest incidence was in patients with adhesive capsulitis (94.7%). The shrug sign was not sensitive for tendinosis, partial rotator cuff tears, or full-thickness or massive rotator cuff tears. The shrug sign was associated with weakness in abduction, night pain, and loss of range of motion, especially passive abduction. Although the shrug sign is useful as a general sign of shoulder abnormality, particularly when associated with stiffness, it was not specific or sensitive for rotator cuff problems.

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“…Thus, Cummins et al [2] reported pain at the antero-lateral aspect of the shoulder that was exacerbated by activities requiring arm elevation above the head. McFarland et al [3] reported pain in the deltoid region exacerbated by resisted abduction. Henkus et al [4] also reported that patients experienced pain in the deltoid region but were able to lie down on the involved side.…”

Section: Introductionmentioning

confidence: 99%