![]() 5 In stage 1, a reversible edema and hemorrhage is present in a patient that is typically younger than 25 years. Neer described three stages of the impingement syndrome. 3, 4 The focus of this article is the subacromial impingement and the optimal treatment of this pathology. In the presence of anterior capsular laxity, the humeral head tends to excessively glide anterior, causing impingement of the supraspinatus and infraspinatus on the posterosuperior edge of the glenoid rim, which leads to undersurface rotator cuff tears and fraying of the posterosuperior glenoid labrum. In contrast, internal impingement, which involves impingement between the posterosuperior labrum and undersurface of the supraspinatus and infraspinatus tendons, typically occurs in overhead athletes when the arm is abducted and externally rotated. ![]() ![]() Since this original description of subacromial impingement, Matsen and Artnz 2 have further defined impingement as the encroachment of the acromion, coracoacromial ligament, coracoid process, or acromioclavicular joint on the rotator cuff mechanism and bursa that passes beneath them as the glenohumeral joint is moved, particularly in flexion and internal rotation (IR). 1 Neer described this as a progressive syndrome with three stages, beginning with chronic bursitis and proceeding to partial and complete tears of the supraspinatus tendon, which may extend to rupture of other parts of the rotator cuff and may also involve the long biceps tendon. 1 The supraspinatus tendon, via its insertion onto the greater tuberosity, the subacromial bursa, and the long biceps tendon as it passes through the bicipital groove, is positioned anterior to the coracoacromial arch (lateral acromion and coracoacromial ligament), and with shoulder flexion in the neutral position, these structures must pass under this arch and are susceptible to impingement. Impingement syndrome, used to describe subacromial impingement, was coined by Charles Neer in 1972. ![]() Shoulder impingement has two distinct pathological conditions: subacromial and internal impingement. ![]()
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