For years my shoulder problems have been blamed on a condition called shoulder impingement. What would you, as an orthopedic doctor, do to prove or disprove my impingement?

Shoulder impingement is a term used to describe pain that occurs with overhead movements. As the arm is brought overhead, the rotator cuff and overlying bursal tissue is squeezed between the shoulder blade and the ball of the socket. There are many factors that contribute. Some people are born with bony shoulders that create a tight space for the rotator cuff tendon and bursal tissue to maneuver. Some older individuals develop bony spurs over time. The spurs encroach upon the rotator cuff and bursa creating pain. As an orthopedic physician, I would look for a history of pain with overhead activities and pain at night that wakes you. Your response to overhead maneuvers, instability, loss of range of motion and strength would be assessed by a physical exam. Your response to a local anesthetic injected into the shoulder can help localize the problem area and assist in the diagnosis of impingement. Special X-ray views are helpful to detail bony anatomy to identify tight spaces or bone spurs. A magnetic resonance image study (MRI) can show the amount of impingement and whether a rotator cuff tendon tear has developed from the impingement. Arthroscopic surgery is a valuable tool, not only for confirming the diagnosis, but also with treatment when conservative measures fail.