A Nonoperative Approach to Shoulder Impingement Syndrome

Because the presentation of chronic shoulder pain from overuse injuries can be confusing, determining the underlying cause of the pain requires taking a complete history and conducting an appropriate physical examination. One of the more frequent causes of this pain is impingement of the rotator cuff tendons, also known as impingement syndrome. This article reviews the functional anatomy of the shoulder and provides illustrations of the maneuvers used in the physical examination, as well as concise definitions and descriptions of the subtypes of impingement syndrome. Successful treatment depends not only on an accurate diagnosis, but also on appropriate utilization of rehabilitation exercises, anti-inflammatory medications, corticosteroid injections, and, when appropriate, referral to a specialist. The authors provide a comprehensive approach to the prevention, diagnosis, and nonoperative treatment of the various stages of impingement syndrome, since a nonoperative approach is successful in the majority of individuals.