Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement--an anatomic study.

OBJECTIVE The purpose of the study was to investigate the relationship of the distal supraspinatus tendon to the coracoacromial arch on radiographs and MR imaging at various shoulder positions. MATERIALS AND METHODS Radiopaque and gadolinium-impregnated markers were sutured to the distal aspect of the supraspinatus tendon and along the coracoacromial ligament in three cadavers. While varying positions of the shoulder, we obtained gross anatomic visualization, radiographs, and MR images. RESULTS Impingement of the distal aspect of the supraspinatus tendon between the acromion and the greater tuberosity of the humerus was well visualized during forward flexion and abduction of more than 30 degrees. Shoulder impingement was best seen at 60 degrees forward flexion, 60 degrees abduction, and internal rotation. CONCLUSION MR imaging of different shoulder positions may help reveal the pathogenesis of shoulder impingement syndrome.

[1]  L. Bassett,et al.  Shoulder impingement syndrome: MR findings in 53 shoulders. , 1988, AJR. American journal of roentgenology.

[2]  Cs Neer,et al.  2nd. Impingement lesions. , 1983 .

[3]  D. Patte.  The subcoracoid impingement. , 1990, Clinical orthopaedics and related research.

[4]  R. J. Pawluk,et al.  Excursion of the Rotator Cuff Under the Acromion , 1994, The American journal of sports medicine.

[5]  P. Bonutti,et al.  Kinematic MRI of the Shoulder , 1993, Journal of computer assisted tomography.

[6]  D. Resnick,et al.  Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. , 1991, Radiology.

[7]  C. Gerber,et al.  The role of the coracoid process in the chronic impingement syndrome. , 1985, The Journal of bone and joint surgery. British volume.

[8]  D Resnick,et al.  Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. , 1992, Radiology.

[9]  D. Sartoris,et al.  MR findings in asymptomatic shoulders: a blind analysis using symptomatic shoulders as controls. , 1992, Clinical imaging.

[10]  P Boileau,et al.  Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: An arthroscopic study. , 1992, Journal of shoulder and elbow surgery.

[11]  M. Watson.  Rotator cuff function in the impingement syndrome. , 1989, The Journal of bone and joint surgery. British volume.

[12]  N. Pratt.  Anatomy and biomechanics of the shoulder. , 1994, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[13]  V. Mow,et al.  The relationship of acromial architecture to rotator cuff disease. , 1991, Clinics in sports medicine.

[14]  J. Lee,et al.  Os acromiale associated with rotator cuff impingement: MR imaging of the shoulder. , 1994, Radiology.

[15]  T. Whipple,et al.  Anatomic relationships in the shoulder impingement syndrome. , 1993, Clinical orthopaedics and related research.

[16]  H. Genant,et al.  MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. , 1994, Radiology.

[17]  Crues Jv rd,et al.  Magnetic resonance imaging of shoulder impingement. , 1991 .

[18]  J. H. Brown,et al.  Rotator cuff: evaluation with fat-suppressed MR arthrography. , 1993, Radiology.

[19]  L. Steinbach,et al.  MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers. , 1992, AJR. American journal of roentgenology.

[20]  H Ellman,et al.  Diagnosis and treatment of incomplete rotator cuff tears. , 1990, Clinical orthopaedics and related research.

[21]  J. Kennedy,et al.  Impingement syndrome in athletes , 1980, The American journal of sports medicine.