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Home » Anatomy » Shoulder Impingement Diagnosis and Examination: A Comprehensive Guide

Shoulder Impingement Diagnosis and Examination: A Comprehensive Guide


In this article, we will discuss the Shoulder Impingement Diagnosis and Examination, enabling healthcare professionals to develop a targeted treatment plan for their patients. Shoulder impingement is a common cause of shoulder pain and functional limitations. Prompt and accurate diagnosis is essential for effective management and treatment.

Examination Process for Shoulder Impingement Diagnosis

Patient History for  examination

The examination begins with a detailed patient history, where the healthcare professional gathers information about the patient’s symptoms, including the location, duration, and onset of shoulder pain. They may inquire about any specific activities or movements that aggravate or relieve the symptoms. Understanding the patient’s medical history, previous shoulder injuries, and relevant lifestyle factors is also important.

Physical Examination

The physical examination involves a comprehensive assessment of the patient’s shoulder joint and surrounding structures. The healthcare professional may observe the patient’s posture, alignment, and shoulder symmetry. They will assess the range of motion of the shoulder joint, looking for any limitations, pain, or mechanical symptoms such as clicking or catching.

Strength Testing

Strength testing evaluates the integrity and function of the rotator cuff muscles and other shoulder girdle muscles. The healthcare professional may perform specific tests, such as resisted external and internal rotation, abduction, and scapular stabilization exercises. Weakness or pain during these tests may indicate rotator cuff involvement or muscle imbalances.

Provocative Tests

Provocative tests are designed to reproduce or exacerbate the symptoms associated with shoulder impingement. These tests help confirm the diagnosis and identify the specific structures involved. Common provocative tests include the Neer test, Hawkins-Kennedy test, painful arc test, and the empty can test. Positive findings on these tests suggest impingement of the rotator cuff tendons or bursa.

Diagnostic Procedures for Shoulder Impingement Examination

Imaging Studies

Imaging studies, such as X-rays, magnetic resonance imaging (MRI), or ultrasound, are often used to confirm the diagnosis of shoulder impingement and assess the extent of structural abnormalities. X-rays can help evaluate bony structures, rule out other conditions, and identify any bone spurs or acromial abnormalities. MRI or ultrasound can provide detailed images of soft tissues, including the rotator cuff tendons and bursa.

Injection Test

In some cases, a diagnostic injection can be performed to determine the source of shoulder pain. An anesthetic or a combination of anesthetic and corticosteroid is injected into the subacromial space. If the pain is significantly reduced or eliminated, it suggests that impingement is the primary cause of symptoms.

Arthroscopic Examination

Arthroscopy is a minimally invasive procedure that allows direct visualization of the inside of the shoulder joint. It is considered the gold standard for diagnosing and treating shoulder impingement. During arthroscopy, a small camera is inserted into the joint, providing detailed images of the rotator cuff tendons, bursa, and other structures. This procedure can also be used for therapeutic interventions, such as removing bone spurs or repairing torn tendons.


Examination and diagnosis are crucial steps in the management of shoulder impingement. A thorough patient history, physical examination, and the use of appropriate diagnostic procedures help healthcare professionals accurately identify the condition and its underlying causes. By understanding the specific structures involved and the extent of the impingement, healthcare professionals can develop targeted treatment plans, including physical therapy, medication, injections, or surgical interventions. Early and accurate diagnosis ensures timely intervention, leading to improved outcomes and a successful recovery for patients with shoulder impingement.

FAQS related to Shoulder Impingement Diagnosis and Examination

How do doctors diagnose shoulder impingement?

Shoulder impingement is typically diagnosed through a combination of patient history, physical examination, and imaging studies. The healthcare professional will evaluate the patient’s symptoms, assess shoulder range of motion and strength, perform specific provocative tests, and may order X-rays, MRI, or ultrasound to confirm the diagnosis.

What are provocative tests, and why are they important?

During the physical examination, healthcare professionals perform provocative tests to reproduce or aggravate the symptoms of shoulder impingement. They help identify the specific structures involved and provide additional evidence to support the diagnosis. Positive test results can indicate impingement of the rotator cuff tendons or bursa.

Are imaging studies necessary for diagnosing shoulder impingement?

While imaging studies such as X-rays, MRI, or ultrasound can provide valuable information about the structural abnormalities associated with shoulder impingement, clinicians do not always require them for diagnosis. Based on the patient’s symptoms, physical examination findings, and response to conservative treatment, healthcare professionals can often make the diagnosis.

Can doctors diagnose shoulder impingement without performing an arthroscopy?

Doctors consider arthroscopy as the gold standard for diagnosing shoulder impingement, as it enables them to directly visualize the joint structures. However, it is not always necessary for diagnosis, especially in cases where the symptoms and physical examination findings are consistent with impingement. Surgeons usually reserve arthroscopy for cases that do not respond to conservative treatment or when they are considering surgical intervention.

How long does the diagnostic process for shoulder impingement take?

The duration of the diagnostic process can vary depending on factors such as the availability of healthcare professionals, scheduling of imaging studies, and individual patient circumstances. During the initial evaluation, healthcare providers can make the diagnosis in most cases, and they can order additional tests or imaging as needed.

Can other shoulder conditions misdiagnose shoulder impingement?

Shoulder impingement can sometimes present with similar symptoms to other shoulder conditions, such as rotator cuff tears, bursitis, or labral tears. That is why a comprehensive evaluation, including a thorough patient history, physical examination, and imaging studies, is important to differentiate between these conditions and make an accurate diagnosis.

What are the benefits of early diagnosis of shoulder impingement?

Early diagnosis of shoulder impingement allows for timely intervention and treatment, which can lead to better outcomes. Prompt identification of impingement can help prevent further damage to the rotator cuff tendons, minimize pain and functional limitations, and improve the chances of successful non-surgical treatment. Early intervention also reduces the risk of complications and may prevent the need for more invasive surgical procedures.

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