This 2011 AAOS review by Harrison and Flatow examines subacromial impingement syndrome — its historical context, competing etiologic theories (extrinsic compression vs. intrinsic degeneration), diagnostic workup, and the evidence base for nonsurgical and surgical management options.
When a patient fails 6 months of PT and subacromial injections, surgery is indicated — but the evidence supports bursectomy alone or with acromioplasty equally, so intraoperative findings and surgeon judgment should guide the extent of decompression.
On physical exam, the Neer and Hawkins tests are highly sensitive but not specific, so combine them with imaging and history rather than relying on either test alone.
This 2011 AAOS review by Harrison and Flatow examines subacromial impingement syndrome — its historical context, competing etiologic theories (extrinsic compression vs. intrinsic degeneration), diagnostic workup, and the evidence base for nonsurgical and surgical management options.
When a patient fails 6 months of PT and subacromial injections, surgery is indicated — but the evidence supports bursectomy alone or with acromioplasty equally, so intraoperative findings and surgeon judgment should guide the extent of decompression.
On physical exam, the Neer and Hawkins tests are highly sensitive but not specific, so combine them with imaging and history rather than relying on either test alone.