MOJ Header

Current Issue - November 2019, Volume 13, Issue No. 3

Official Journal of Malaysian Orthopaedic Association and ASEAN Orthopaedic Association

Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth?


  1. Codman EA. The Shoulder; Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston: Thomas Todd Co; 1934.
  2. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972; 54(1): 41-50.
  3. Van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995; 54: 959-64.
  4. Vitale MA, Arons RR, Hurwitz S, Ahmad CS, Levine WN. The rising incidence of acromioplasty. J Bone Joint Surg Am. 2010; 92(9): 1842-50.
  5. Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome. Am J Med. 2005; 118(5): 452-5.
  6. Uhthoff HK, Sarkar K. Classification and definition of tendinopathies. Clin Sports Med. 1991; 10(4): 707-20.
  7. Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990; (254): 35-38.
  8. McFarland EG, Maffulli N, Del Buono A, Murrell GA, Garzon-Muvdi J, Petersen SA. Impingement is not impingement: the case for calling it “Rotator Cuff Disease”. Muscles Ligaments Tendons J. 2013; 3(3): 196-200.
  9. Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S. Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera. J Bone Joint Surg Am. 1988; 70(8): 1224-30.
  10. Ling SC, Chen CF, Wan RX. A study on the vascular supply of the supraspinatus tendon. Surg Radiol Anat. 1990; 12(3): 161-5.
  11. Del Buono A, Battery L, Denaro V, Maccauro G, Maffulli N. Tendinopathy and inflammation: some truths. Int J Immunopathol Pharmacol. 2011; 24(1 Suppl 2): 45-50.
  12. Seitz AL, McClure PW, Finucane S, Boardman ND, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?. Clin Biomech (Bristol, Avon). 2011; 26(1): 1-12.
  13. Danielson P, Andersson G, Alfredson H, Forsgren S. Marked sympathetic component in the perivascular innervation of the dorsal paratendinous tissue of the patellar tendon in arthroscopically treated tendinosis patients. Knee Surg Sports Traumatol Arthrosc. 2008; 16(6): 621-6.
  14. Lewis JS. Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?. Physical Therapy Reviews. 2011; 16:5: 388-98.
  15. Papadonikolakis A, McKenna M, Warme W, Martin BI, Matsen FA. Published evidence relevant to the diagnosis of impingement syndrome of the shoulder. J Bone Joint Surg Am. 2011; 93: 1827-32.
  16. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008; 42: 80-92.
  17. Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am. 1997; 79: 1854-68.
  18. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994, 308: 90-7.
  19. Butters KP, Rockwood CA. Office evaluation and management of the shoulder impingement syndrome. Orthop Clin North Am. 1998; 19: 755-65.
  20. Kamkar A, Irrgang JJ, Whitney SL. Nonoperative management of secondary shoulder impingement syndrome. J Orthop Sports Phys Ther. 1993; 17: 212-24.
  21. Neer CS. Impingement lesions. Clin Orthop Relat Res. 1983; (173): 70-7.
  22. Morrison DS, Frogameni AD, Woodworth P. Non-operative treatment of subacromial impingement syndrome. J Bone Joint Surg Am. 1997; 79(5): 732 7.
  23. Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, et al. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012; 42(3): 297-316.
  24. Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015; 38(2): 95-106.
  25.  Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010; 44(5): 319-27.
  26. Beaudreuil J, Lasbleiz S, Richette P, Seguin G, Rastel C, Aout M, et al. Assessment of dynamic humeral centering in shoulder pain with impingement syndrome: a randomised clinical trial. Ann Rheum Dis. 2011; 70(9): 1613-8.
  27. Holmgren T, Hallgren HB, Oberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012; 344: e787.
  28. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000; 80(3): 276-91.
  29. Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013; 47(14): 877-85. doi:10.1136/bjsports-2013-092425
  30. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010; 44(5): 300-5.
  31. Kibler BW, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003; 11(2): 142-51.
  32. Ellman H. Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy. 1987; 3: 173-81.
  33. Bjorkenheim JM, Paavolainen P, Ahovuo J, and Slatis P. Subacromial impingement decompressed with anterior acromioplasty. Clin Orthop Relat Res. 1990; 252: 150-5.
  34. Sahlstrand T. Operations for impingement of the shoulder. Early results in 52 patients. Acta Orthop Scand. 1989; 60: 45-8.
  35. Thorling J, Bjerneld H, Hallin G, Hovelius L, Hagg O. Acromioplasty for impingement syndrome. Acta Orthop Scand. 1985; 56(2): 147-8.
  36. Tibone JE, Jobe FW, Kerlan RK, Carter VS, Shields CL, Lombardo SJ, et al. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop Relat Res. 1985; 198: 134-40.
  37. Gartsman GM. Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg Am. 1990; 72(2): 169-80.
  38. Esch JC, Ozerkis LR, Helgager JA, Kane N, Lilliott N. Arthroscopic subacromial decompression: results according to the degree of rotator cuff tear. Arthroscopy. 1988; 4: 241-9.
  39. Paulos LE, Franklin JL. Arthroscopic shoulder decompression development and application. A five year experience. Am J Sports Med. 1990; 18: 235-44.
  40. Altchek DW, Warren RF, Wickiewicz TL, Skyhar MJ, Ortiz G, Schwartz E. Arthroscopic acromioplasty. Technique and results. J Bone Joint Surg Am. 1990; 72(8): 1198-207.
  41. Ryu RK. Arthroscopic subacromial decompression: a clinical review. Arthroscopy. 1992; 8: 141-7.
  42.  Olsewski JM, Depew AD. Arthroscopic subacromial decompression and rotator cuff debridement for stage II and stage III impingement. Arthroscopy. 1994; 10(1): 61-8.
  43. Roye RP, Grana WA, Yates CK. Arthroscopic subacromial decompression: two to seven-year follow-up. Arthroscopy. 1995; 11: 301-6.
  44. Hawkins RJ, Saddemi SR, Moor JT, Hawkins A. Arthroscopic subacromial decompression: a 2-year follow-up study. Arthroscopy. 1992; 8(3): 409. doi:
  45. Small NC. Complications in arthroscopy: the knee and other joints. Committee on Complications of the Arthroscopy Association of North America. Arthroscopy. 1986; 2(4): 253-8.
  46. Rupp S, Seil R, Muller B. Complications after subacromial decompression. Arthroscopy. 1998; 14: 445.
  47. Matthews LS, Burkhead WZ, Gordon S, Racanelli J, Ruland L. Acromial fracture: A complication of arthroscopic subacromial decompression. J Shoulder Elbow Surg. 1994; 3(4): 256-61.
  48. Bigliani LU, Flatow EL, Deliz ED. Complications of shoulder arthroscopy. Orthop Rev. 1991; 20(9): 743-51.
  49.  Pitman MI, Nainzadeh N, Ergas E, Springer S. The use of somatosensory evoked potentials for detection of neuropraxia during shoulder arthroscopy. Arthroscopy. 1988; 4(4): 250-5.
  50. Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth. 2005; 17(6): 463-9.
  51. Gale T, Leslie K. Anaesthesia for neurosurgery in the sitting position. J Clin Neurosci. 2004; 11(7): 693-6.
  52. Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg. 2003; 96(3): 899-902.
  53. Noud PH, Esch J. Complications of Arthroscopic Shoulder Surgery. Sports Med Arthrosc Rev. 2013; 21(2): 89-96.
  54. Muller D, Landsiedl F. Arthroscopy of the shoulder joint: a minimal invasive and harmless procedure? Arthroscopy. 2000; 16: 425.
  55. Gomoll AH, Kang RW, Williams JM, Bach BR, Cole BJ. Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotoxicity in the rabbit shoulder. Arthroscopy. 2006; 22(8): 813-9.
  56. Good CR, Shindle MK, Griffith MH, Wanich T, Warren RF. Effect of radiofrequency energy on glenohumeral fluid temperature during shoulder arthroscopy. J Bone Joint Surg Am. 2009; 91: 429-34.
  57. Beauthier V, Sanghavi S, Roulot E, Hardy P. Humeral head osteonecrosis following arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2010; 18(10): 1432-4.
  58. Goto M, Gotoh M, Mitsui Y, Okawa T, Higuchi F, Nagata K. Rapid collapse of the humeral head after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2015; 23(2): 514-6.
  59. Kim JK, Jeong HJ, Shin SJ, Yoo JC, Rhie TY, Park KJ, et al. Rapid Progressive Osteonecrosis of the Humeral Head After Arthroscopic Rotator Cuff Surgery. Arthroscopy. 2018; 34(1): 41-7.
  60. Vangsness CTJ, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995; 11(2): 180-4.
  61. Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. J Orthop Res. 1998; 16(5): 618-21.
  62. Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018; 391(10118): 329-38.
  63. Ketola S, Lehtinen JT, Arnala I. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J. 2017; 99-B(6): 799-805.
  64. Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. 2009; 91(10): 1326-34.
  65. Ketola S, Lehtinen J, Rousi T, Nissinen M, Huhtala H, Konttinen YT, et al. No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome: Five-year results of a randomised controlled trial. Bone Joint Res. 2013; 2(7): 132-9.
  66. Haahr JP, Østergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis. 2005; 64(5): 760-4.
  67. Karjalainen TV, Jain NB, Page CM, Lähdeoja TA, Johnston RV, Salamh P, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev. 2019; 17: CD005619. doi: 10.1002/14651858.CD005619.pub3.

Abstract   |   Reference

MOJ footer

About Us

The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing.

Keep in Touch

creative-commons License