Rotator Cuff
Recurrent Dislocation
Internal Impingement
ACJ SCJ
Neural Compression
Misc
Shoulder
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Clinical Aspects of Impingement
Clinical examination and clinical history allow patients with shoulder problems to be correctly categorised into a particular diagnostic category. Common presentations include painful arc syndrome, recurrent dislocation, patients with frozen shoulder and osteoarthritis and patients with chronic shoulder pain related to sport/misuse. This group is frequently described as internal impingement. Patients with impingement syndrome usually present with the clinical picture of a painful arc. This classical clinical presentation describes pain that occurs on abduction between 30 and 90°. Pain is thought to be due to impingement of the subacromial subdeltoid bursa and the supra spinatus tendon beneath the coracoacromial arch which is made up of the coracoid, the coracoacromial ligament and the acromium.
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The principle imaging goal in patients with impingement is to differentiate those with tendinopathy and bursitis from patients with rotator cuff tears as this will have the most significant management implication. Clinical examination is not always accurate despite the numerous clinical tests that are available. Not all cuff tears are painful and not all require surgery. In many cases subacromial decompression is sufficient to alleviate symptoms and has a quicker recovery rate than cuff repair
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