Redefine Shoulder Impingement Syndrome for Enhanced Diagnosis?

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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