Rotator Cuff Impingement — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyRotator Cuff ImpingementSCE Rheumatology

A 38-year-old woman presents with atraumatic lateral shoulder pain that is worse at night and during overhead activity. Active abduction produces a painful arc between 60° and 120°, but passive glenohumeral movement is full, including external rotation. Neer and Hawkins-Kennedy tests reproduce her pain. Neurological examination of the upper limbs is normal. What is the most likely diagnosis?

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Correct answer: C — Subacromial impingement syndrome

The diagnosis is subacromial impingement syndrome (rotator cuff impingement, now often termed subacromial pain syndrome). Night pain, pain on overhead activity, a mid-range painful arc (60–120° of abduction) and pain reproduced by the Neer and Hawkins-Kennedy manoeuvres form the classic clinical pattern; individual impingement tests have limited specificity, so the combination of findings with preserved passive glenohumeral movement is decisive. Adhesive capsulitis restricts both active and passive movement, particularly external rotation, which is explicitly full here. Glenohumeral osteoarthritis also causes stiffness with restricted passive range and is uncommon at 38 without prior trauma. Acromioclavicular osteoarthritis typically produces focal superior shoulder pain reproduced at end-range (high) abduction and by cross-body adduction, not a mid-range arc. Cervical radiculopathy would produce neck pain with dermatomal sensory change, reflex loss or myotomal weakness, excluded by the normal neurological examination.

Reference: NHS Greater Glasgow and Clyde MSK pathway (Right Decision Service). Shoulder impingement syndrome (SIS) — clinical presentation and examination. https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/shoulder/shoulder-impingement-syndrome-sis/