This 1980 review by Hawkins and Kennedy describes the pathophysiology, diagnosis, and staged management of shoulder impingement in overhead athletes. It asks how repetitive overhead motion leads to progressive rotator cuff pathology and what examination findings confirm the diagnosis. The paper synthesizes Neer's three-stage classification with practical clinical guidance for team physicians.
Before Neer and Hawkins framed impingement as a staged, progressive disease, shoulder pain in athletes was fragmented into isolated diagnoses — bursitis, biceps tendinitis, or cuff tear. Without a unifying pathologic model. This paper gave clinicians a roadmap: the stage predicts both reversibility and what treatment will work.
When you see a young overhead athlete (under 25) with anterior shoulder pain and a positive impingement sign, you are looking at Stage I. This lesion is usually reversible with activity modification, ice, anti-inflammatories, and technique correction before considering anything else. When a 35-year-old club tennis player can no longer serve despite months of conservative care, that is Stage II: the fibrosis is established, and a coracoacromial ligament release or anterior acromioplasty enters the conversation after at least one year of failed conservative management.
Avoid steroid injections in tendons you expect the athlete to load again within two weeks. The authors' own lab data showed collagen necrosis and reduced tensile strength persisting for at least that long.
In any athlete over 40 with a first-time shoulder dislocation who is not recovering as expected, think rotator cuff tear. The incidence rises with age and the arthrogram can be falsely negative if the tear is sealed by the subdeltoid bursa.
This 1980 review by Hawkins and Kennedy describes the pathophysiology, diagnosis, and staged management of shoulder impingement in overhead athletes. It asks how repetitive overhead motion leads to progressive rotator cuff pathology and what examination findings confirm the diagnosis. The paper synthesizes Neer's three-stage classification with practical clinical guidance for team physicians.
Before Neer and Hawkins framed impingement as a staged, progressive disease, shoulder pain in athletes was fragmented into isolated diagnoses — bursitis, biceps tendinitis, or cuff tear. Without a unifying pathologic model. This paper gave clinicians a roadmap: the stage predicts both reversibility and what treatment will work.
When you see a young overhead athlete (under 25) with anterior shoulder pain and a positive impingement sign, you are looking at Stage I. This lesion is usually reversible with activity modification, ice, anti-inflammatories, and technique correction before considering anything else. When a 35-year-old club tennis player can no longer serve despite months of conservative care, that is Stage II: the fibrosis is established, and a coracoacromial ligament release or anterior acromioplasty enters the conversation after at least one year of failed conservative management.
Avoid steroid injections in tendons you expect the athlete to load again within two weeks. The authors' own lab data showed collagen necrosis and reduced tensile strength persisting for at least that long.
In any athlete over 40 with a first-time shoulder dislocation who is not recovering as expected, think rotator cuff tear. The incidence rises with age and the arthrogram can be falsely negative if the tear is sealed by the subdeltoid bursa.