tay.generalcomments@nhs.scot

Impingement

Symptoms and signs

  • True impingement rarely found in younger than 40 years old OR older than 70 years. Pain felt in anterior shoulder in C5 distribution/radiating to the arm
  • Pain on overhead activities and/or abduction.
  • Pain is more likely anterior shoulder and may radiate to the side of the arm.
  • A painful arc of movement- less pain on passive movement
  • Weakness due to pain usually in abduction and/or lateral rotation
  • Non-capsular loss of movement at the affected shoulder
  • Shoulder pain at night
  • Positive impingement tests (Hawkins Kennedy)

Initial management

  • Pain control - analgesia and NSAIDs as appropriate
  • Refer to MSK Physiotherapy
  • Subacromial steroid injection by appropriately trained healthcare professional
  • Minimum of 6 months conservative treatment

Useful Resources

Primary Care Diagnostics

  • XR to assess for acromial impingement, calcific tendinopathy

Who to Refer

  • Symptoms for 6-12 months.
  • Failure of conservative treatment (at least 2 steroid injections) and protracted course of physiotherapy.
  • Those who wish to consider sub-acromial decompression surgery and are aware of the benefits and risks (off work for up to 3 months depending on employment)
  • X-Ray prior to referral +/- USS if appropriate (can be requested by MSK Physiotherapist)

Information to include when referring:
  • Duration and any cause of symptoms, dominance, effect on ADL, work, hobbies
  • Indicate site/ spread of pain and if pain constant or intermittent, and/or waking at night
  • Indicate active and passive ROM (+/- painful arc)
  • Include treatment to date
  • XR results

How to refer

  • If under the care of the TNHS MSK physiotherapy team, investigations and onward referral to UL service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention
  • SCI gateway: Orthopaedic/Elbow and shoulder . Please note first point of contact may be advanced practice Physiotherapist
Information to include when referring:
  • Duration and any cause of symptoms, dominance, effect on ADL, work, hobbies
  • Indicate site/ spread of pain and if pain constant or intermittent, and/or waking at night
  • Indicate active and passive ROM (+/- painful arc)
  • Include treatment to date
  • XR/USS results