Shoulder impingement is a common condition. The problem that arises is mainly pain when moving overhead above the shoulder. Often reaching up high, getting dressed, putting the shirt in the back of the pants, etc. are actions that are characteristic of this condition. As a physiotherapist you have various tests to distinguish between different conditions (bursa, tendonitis, tendon tear, etc.).

Shoulder Impingement

A shoulder impingement is a condition that is divided into 2 categories. A primary impingement and a secondary impingement. In a primary impingement the cause comes from changes in anatomical structures. This is usually due to a change in the bone structure of the shoulder roof (acromion), but thickening of the bursa or a thickening of tendons can also cause a primary impingement.With secondary impingement, the cause comes from structures that are not directly related to the shoulder. These are usually structures that indirectly control the shoulder head in the shoulder socket. If abnormalities arise (as a result of instability, reduced control or shortening of muscles, incorrect posture, insufficient movement of the shoulder blade, etc.), an impingement can also occur, but indirectly (secondary).As a physiotherapist, there are different types of tests to demonstrate which structures are affected. Over the years, dozens of tests have been developed to demonstrate impingement complaints, but not every test has proven its worth. To give you a clear picture of which tests are the most valid, below are the most valid tests when it comes to diagnosing impingement complaints.

To test

There are 3 tests that are most valid for diagnosing bursitis in the shoulder:

• Down sign
• Hawkins-Kennedy sign
• Painful arc sign

To diagnose partial thickening/damage (tear) of the tendons that run under the shoulder roof, there are 2 tests that are the most valid:

• Down sign
• Hawkins-Kennedy sign

To diagnose a complete thickening/damage (tear) of the tendons that run under the shoulder roof, there are 3 tests that are the most valid:

• Painfui arc sign
• Drop arm sign
• Infraspinatus muscle test

For diagnosing shoulder impingement in general, there are 3 tests that are the most valid:

• Hawkins-Kennedy impingement sign
• Painful arc sign
• Infraspinatus muscle test

Combination of different tests

Research has shown that when the Hawkins-Kennedy impingement sign, Painful arc sign and the Infraspinatus muscle test are used as a test battery, the predictive value (for having an impingement) is considerably higher:

• 3 tests are positive, then the chance that the patient has an impingement is 10.56 (the higher the value the better)
• 2 tests positive, then the chance that the patient has an impingement is 5.03
• If 1 tests positive, the chance that the patient has an impingement is 0.90
• 0 tests positive, then the chance that the patient has an impingement is 0.17