Determining Dominant Mechanism in Shoulder Impingment

Shoulder impingement represents a clincal challenge because patients present with similar complaints which can be cause by a variety of pathologies.
Furthurmore, the mechanism of pathology is of prime importance for physiotherapists and rehabilitation professionals who provide care. Distinction between a tendonitis, a partial cuff tear or a mechanical impingment can be very challenging but has profound implications on the treatment strategy.
In addition mechanical impingement can be either primary or secondary with a multitude of different contributary factors.
Rotator cuff strengthening progressing through range ie into the impingment zone is highly unlikely to be beneficial in the presence of underlying capsular restriction. Failure to identify this component is a common reason for poor treatment outcomes.
It is therefore critical that therapists identify disturbance of the key accessory joint motion in the GH joint if they are attempting to progress loading in functional positions.
The above illustration highlights only one aspect of the clinical relevance of determining the mechanism of impingement