Impingement syndrome

1. What is impingement syndrome?
2. What are the three different acromion shapes? Which kinds are associated with higher risk of rotator cuff tears?
3. What are symptoms of rotator cuff tear?
4. What is the range of the painful arc?
5. What is the supraspinatus test?
6. What physical exam test indicates a complete tear of the rotator cuff?

Answers:
1. Narrowing of subacromial space causing compresion and inflammation of the subacromial bursa, biceps tendon, and rotator cuff tendons. These tendons then get inpinged upon under the acromion and greater tuberosity with arm abduction and internal rotation.
2. Type I is flat, type II is curved, type III is hooked. Curved and hooked have higher risk of tear.
3. Pain with repetitive overhead activities or sports (throwing ball, swimming), crepitus, clicking, weakness, nocturnal pain (sleeping on affected side), tenderness over greater tuberosity or inferior to acromion, atrophy (with tears).
4. 60-120 degrees.
5. Pain and weakness with arm in flexion, abduction, and internal rotation.
6. Drop arm test: passively abduct arm to 90 degrees and internally rotated --> positive is if patient is unable to maintain arm in abduction.