Patients present with painful arc, pain at night and pain over deltoid
Due to loss of space under 'coracoacromial arch'
Clinical tests are not always clear cut - see Jobe test video
Imaging goal is to differentiate patients with bursitis/tendinopathy from tears
Clinical examination is not always accurate despite the numerous clinical tests that are available.
Not all cuff tears are painful and not all require surgery.
The SASD bursa is a large bursa that separates deltoid from the rotator cuff tendons.
Impingement synptoms occur when there is inflammation of the bursa usually due to loss of subacromial space.
This can occur for complex reasons including:
• Genetic predisposition
• Scapular re-orientation due to muscle imbalance (Sick Scapula)
• Bony impingement related to AC shape and osteophytes
• Enlarged tendon due to tendinopathy
Clinical relevance of different acromial shapes in some doubt
Hooked acromium probably not arelevant finding
Acromial slope more important, especialy if less than 70 degrees (image opposite)
Report Os acromiale if present
Look for tendon calcification
