Diagnosing Shoulder Impingement

A pinching sensation in the shoulder when reaching the arm up may indicate impingement. However, the only way to know for sure is with a diagnosis, which requires a visit to a health care provider.

A health care provider will take the patient’s medical history, conduct a physical examination, and order any necessary medical imaging tests

Patient History

The person should be prepared to provide an accurate description of symptoms, including the nature, duration, and location of the pain. A person will want to inform his or her physician of any trauma (even minor) to the shoulder area.

Physical Examination

During a physical exam, a doctor will check the shoulder’s range of motion and look for symptoms, such as tenderness or swelling. Orthopedic tests may be used to trigger the pain a person experiences in day-to-day activities. Examples include:

• Neer sign test. During this test:
  1. The patient will be in a relaxed, standing position with arms at his or her side.
  2. The doctor will move the arm of the affected shoulder through a full range of motion above the head.
  3. The test is positive if the patient reports pain in the front or top of the shoulder.
• Hawkins-Kennedy Test. During this test:
  1. The patient will sit or stand in a relaxed position.
  2. The doctor will raise the arm to shoulder height and adduct the arm (towards the body).
  3. The doctor will then internally rotate the shoulder by firmly moving the arm in a downward motion.

  Pain with this maneuver can be a sign of subacromial or subcoracoid impingement.

After a thorough physical examination, a doctor may be able to rule out certain other potential causes of the shoulder pain, such as a rotator cuff tear or shoulder osteoarthritis. To make a definitive diagnosis, the doctor will order diagnostic testing.

Medical Imaging

Medical imaging that may be ordered to confirm or rule out a shoulder impingement diagnosis include:

• X-rays. X-rays do not show soft tissue and cannot be used to definitively diagnose shoulder impingement. However, they may be used to identify bone spurs or other bone abnormalities that can lead to shoulder impingement.
• Magnetic resonance imaging (MRI). An MRI will show a detailed view of the soft tissue around the shoulder. MRIs can show inflammation and/or tearing of the rotator cuff and bursa. An MRI of the shoulder can sometimes be preceded by another medical imaging procedure called an arthrogram. During the arthrogram, contrast dye that is visible on MRI images is injected into the joint. The dye can sometimes help tissue damage stand out on MRI results.

Once a diagnosis is made, a doctor will recommend a treatment plan.