Does a positive neer impingement sign reflect rotator cuff contact with the acromion?

Standing Tall on Their Shoulders: Essential Eponyms in Shoulder Surgery

There has been enormous advancement in the field of shoulder surgery since its initial establishment as a subspecialty. This is due in large part to the numerous contributions made by clinicians who came before us. This review of eponyms in shoulder surgery provides the opportunity to honor our predecessors and their contributions as well as promote the correct use of eponyms going forward.

Predictive value of preoperative clinical examination for subacromial decompression in impingement syndrome

PURPOSE

Subacromial decompression is the standard surgical treatment of subacromial impingement syndrome. Unsatisfactory results have been reported for concomitant lesions as well as inadequate diagnosis. We sought to determine the predictive value of the preoperative examination for the results of arthroscopic subacromial decompression in impingement syndrome.

METHODS

Forty-nine shoulder joints in 47 patients receiving arthroscopic subacromial decompression were prospectively followed for a mean 3.7 ± 0.4 years. Prior to surgery, the impingement tests according to Neer, Hawkins-Kennedy (in the neutral as well as abducted position), and the Jobe test (empty can position) were evaluated as well as the presence of a painful arc. The association between the presence of these sings, success of the operation, and improvement in Constant scores as well as WORC indices was analysed.

RESULTS

Pre- to postoperative improvement in Constant scores as well as WORC indices was greater in case of a positive test result for every test studied. With the numbers available, significant greater improvements in Constant scores were observed only for patients with a positive Hawkins-Kennedy sign in the neutral position, Neer and Jobe tests, compared to patients with negative signs, respectively. No significant differences were observed for the improvement in WORC indices. Patients with at least four positive tests out of the five studied had greater improvement in Constant scores than patients with three or less positive test results. Five patients went on to receive subsequent shoulder surgery. There was no association between the necessity for revision surgery and the presence or absence of impingement signs.

CONCLUSION

The impingement tests according to Hawkins-Kennedy, Neer, and Jobe are valid predictors of outcome after subacromial decompression, as is the presence of multiple impingement tests. This study may aid in improving patient outcome and especially patient selection for subacromial decompression.

LEVEL OF EVIDENCE

Prognostic, Level I.

Impingement is not impingement: the case for calling it "Rotator Cuff Disease"

Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease.

Magnetic resonance imaging of rotator cuff disease and external impingement

Magnetic resonance (MR) imaging plays a major role in helping to identify rotator cuff disease and in demonstrating the pathology associated with external impingement. Many surgeons rely on MR imaging to assist in decision making and presurgical planning for patients with rotator cuff pain. This article reviews the etiology of external impingement and rotator cuff tears, and describes the MR imaging appearance of the normal and the pathologic rotator cuffs. It focuses on the supraspinatus tendon because this is the tendon involved in 95% of rotator cuff tears.