Redefine Shoulder Impingement Syndrome for Enhanced
Diagnosis?
October 26, 2011 | Imaging In Rheumatology
By RheumatologyNetwork Staff
More accurate differentiation of rotator cuff disorders is
now possible with advanced imaging. Greater diagnostic accuracy should help
replace nonspecific terminology (impingement syndrome) with more specific
terms—rotator cuff tendinosis, partial tears, and complete tears—to better
determine the indications for and effectiveness of various treatments.
Papadonikolakis and associates conducted a systematic review
of articles related to impingement syndrome and acromioplasty. Their 5
hypotheses were (1) clinical signs and tests can reliably differentiate
impingement syndrome from other conditions, (2) clinically common forms of
rotator cuff abnormality are caused by contact with the coracoacromial (CA)
arch, (3) contact between the CA arch and the rotator cuff does not occur in
normal shoulders, (4) spurs on the anterior aspect of the acromion extend
beyond the CA ligament and encroach on the underlying rotator cuff, and (5)
successful management of impingement requires surgical alteration of the
acromion or CA arch.
Evidence to support each of the hypotheses was lacking.
There was no support for ongoing use of the term "impingement
syndrome" or for the use of acromioplasty.
The authors noted that future clinical investigations can
now focus on the indications for and the outcome of treatments for the specific
rotator cuff diagnoses.
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