Impingement Syndrome of the Shoulder

Dtsch Arztebl Int. 2017 Nov 10;114(45):765-776. doi: 10.3238/arztebl.2017.0765.


Background: Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice. It is usually due to a defect of the rotator cuff and/or an impingement syndrome.

Methods: This review is based on pertinent literature retrieved by a selective search of the Medline database.

Results: Patients with shoulder impingement syndrome suffer from painful entrapment of soft tissue whenever they elevate the arm. The pathological mechanism is a structural narrowing in the subacromial space. A multiplicity of potential etiologies makes the diagnosis more difficult; it is established by the history and physical examination and can be confirmed with x-ray, ultra - sonography, and magnetic resonance imaging. The initial treatment is conservative, e.g., with nonsteroidal antiinflammatory drugs, infiltrations, and patient exercises. Conservative treatment yields satisfactory results within 2 years in 60% of cases. If symptoms persist, decompressive surgery is performed as long as the continuity of the rotator cuff is preserved and there is a pathological abnormality of the bursa. The correct etiologic diagnosis and choice of treatment are essential for a good outcome. The formal evidence level regarding the best treatment strategy is low, and it has not yet been determined whether surgical or conservative treatment is better.

Conclusion: Randomized controlled therapeutic trials are needed so that a standardized treatment regimen can be established.

Publication types

  • Review

MeSH terms

  • Cross-Sectional Studies
  • Humans
  • Rotator Cuff
  • Shoulder
  • Shoulder Impingement Syndrome* / complications
  • Shoulder Impingement Syndrome* / diagnosis
  • Shoulder Impingement Syndrome* / therapy
  • Shoulder Pain / etiology