Elsevier

Physiotherapy

Volume 87, Issue 9, September 2001, Pages 458-469
Physiotherapy

Professional articles
The Aetiology of Subacromial Impingement Syndrome

https://doi.org/10.1016/S0031-9406(05)60693-1Get rights and content

Summary

Subacromial impingement syndrome has been described as the most common form of shoulder pathology (Jobe and Jobe, 1983; Kessel and Watson, 1977). Neer, et al., 1972, Neer, et al., 1983 argued that 100% of impingement lesions and 95% of rotator cuff pathology are caused by friction between the acromion and surrounding tissues within the subacromial space. This concept has been challenged and the literature suggests that the aetiology of subacromial impingement is multifactorial. These causes include anatomical and mechanical factors, rotator cuff pathology, glenohumeral instability, restrictive processes of the glenohumeral joint, imbalance of the muscles controlling the scapula, and postural considerations. The purpose of this paper is to explore the potential factors contributing to pathology.

Introduction

Subacromial impingement syndrome (SIS) is a general term used to describe a variety of conditions that may act independently or in combination, and manifest as anterior or anterior-lateral-superior shoulder pain. SIS occurs as a result of pathology of one or more of the structures located within the subacromial space. The pain is associated with a loss of shoulder function, especially during overhead activities, occurring during vocational, sporting or the normal activities associated with daily living.

The subacromial space has also been termed the acromio-humeral joint or the bursal joint (Wiles, 1955), the supraspinatus outlet (Neer and Poppen, 1987), and the suprahumeral space (Calliet, 1991). These names reflect the borders and contents of this region. The superior border is the coracoacromial arch, comprising the inferior surface of the acromion, the coracoacromial ligament and the coracoid process. The inferior border comprises the greater tuberosity and superior aspect of the head of the humerus. Petersson and Redlund-Johnell (1984) in a series of 175 radio-graphs reported that the mean distance between the inferior border of the acromion and the superior border of the humerus in an anteroposterior projection was between 9 to 10 millimetres (mm).

Located within the subacromial space are the tendons of the rotator cuff and the long head of biceps, the subacromial/subdeltoid bursa and the superior capsule of the glenohumeral joint. During elevation of the arm the greater tuberosity moves closer to the acromion, narrowing the space. SIS results from pathology of any of these structures. The inferior aspect of the acromioclavicular joint has also been implicated in the aetiology and pathogenesis of SIS (Petersson and Gentz, 1983).

Section snippets

Historical Background

Numerous early references to sub-acromial pathology have appeared in the literature (Adams, 1852; Bosworth, 1940; Codman, 1934; Diamond, 1964; McLaughlin and Asherman, 1951; Meyer, 1931). Neer (1972) argued that the anterior one-third of the acromion, the coracoacromial ligament and, at times, the acromioclavicular joint impinged upon the rotator cuff, primarily in the region of the insertion of the supraspinatus into the greater tuberosity. He stated that this impingement occurred mainly when

Primary Mechanical Impingement

SIS as described by Neer, et al., 1972, Neer, et al., 1983 has been termed primary mechanical impingement. Neer (1983) argued that the reason rotator cuff tears and SIS develop in some people and not in others is best explained by the shape of the acromion. In support, Bigliani et al (1986) examined the shape of the acromion of 140 shoulders in 71 cadavers and concluded that there were three distinct shapes, type 1 flat, 2 curved and 3 hooked, arguing that these differences were due to

Summary

Subacromial impingement syndrome is one of the most common causes of shoulder pathology (Jobe and Jobe, 1983; Kessel and Watson, 1977) with reference to the condition appearing in the literature approximately 150 years ago (Adams, 1852). The pain and dysfunction associated with SIS are generally considered to occur when the shoulder is placed in positions of elevation, an activity commonplace during many sporting and vocational pursuits, as well as during the activities involved in daily living.

Acknowledgements

The authors would like to thank Katie Money-Kyrle who contributed the diagrams for this paper.

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    1

    Jeremy S Lewis MSc MAPA MCSP MMPAA MMACP is a PhD candidate at Coventry University and research co-ordinator in the department of physiotherapy, Chelsea and Westminster Hospital

    2

    Ann Green MSc MCSP is principal lecturer, School of Health and Social Sciences, Coventry University.

    3

    Shmuel Dekel PhD MD is professor and head of the Department of Orthopaedic Surgery, Sourasky Medical Centre, Tel Aviv, Israel.

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