X-ray of shoulder impingement

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Author: Mikael Häggström [notes 1]

Planning

Indication

Impingement syndrome can be diagnosed by a targeted medical history and physical examination,[1][2] but it has also been argued that medical imaging, primarily projectional radiography ("X-ray") is a necessary part of the workup.[3]

Method

X-ray of the shoulder that should include:

  • Frontal with and without external rotation of the shoulder
  • Scapular outlet view

Evaluation

Supraspinatus outlet view X-ray, showing subacromial space measurement, and an acromial spur (above the arrow).
  • Measurement of the subacromial space. This is normally 9–10 mm in shoulder radiographs.[4] It is significantly greater in men, with a slight reduction with age.[4] In middle age, a subacromial space less than 6 mm is pathological.[4]
In case of decreased subacromial space, also measure the position of the humerus as described at X-ray of rotator cuff tear
  • Shape of the acromion, at least for the presence of any acromial spur

Also look for common differential diagnoses or worsening factors of shoulder impingement:

  • Osteoarthritis. For severity grading, see X-ray of osteoarthritis of the shoulder
  • Presence of any calcifications in the supraspinatus tendon, which indicates a differential diagnosis of calcific tendonitis.

  • Calcifications in the supraspinatus tendon.

Report

  • Either normal subacromial space, or a decrease thereof, with measurement of the space in the latter case.
  • Presence or absence of an acromial spur.

A more comprehensive report also mentions:

  • The acromial shape regardless[notes 2]
  • Even the absence of osteoarthritis.
See also: General notes on reporting

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
  2. ↑ 2.0 2.1 2.2 2.3 Generally, report the shape of the acromion in the form of type 1, 2 or 3 only if responding to an orthopedic clinic where this is the customary classification.

References

  1. ↑ Craig Hacking and Frank Gaillard (2019-03-06). Subacromial impingement. Radiopaedia.
  2. ↑ . Shoulder Impingement Syndrome. Stanford University Medical Center (2019-03-06).
  3. ↑ Garving, Christina; Jakob, Sascha; Bauer, Isabel; Nadjar, Rudolph; Brunner, Ulrich H. (2017). "Impingement Syndrome of the Shoulder ". Deutsches Aerzteblatt Online. doi:10.3238/arztebl.2017.0765. ISSN 1866-0452. 
  4. ↑ 4.0 4.1 4.2 Claes J. Petersson & lnga Redlund- Johnell (1984). "The subacromial space in normal shoulder radiographs ". Acta Orthop Scanda 55 (1): 57–8. PMID 6702430. 
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