Subacromial Impingement — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologySubacromial ImpingementSCE Rheumatology

A 45-year-old woman presents with atraumatic lateral shoulder pain that is worse during overhead activity. Active abduction reproduces pain between 70° and 120°, but passive glenohumeral movement is full. The Hawkins test is positive. There is no focal acromioclavicular joint tenderness, and neck movement does not reproduce her symptoms. What is the most likely diagnosis?

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Correct answer: E — Subacromial impingement syndrome

The correct answer is E, subacromial impingement syndrome, also commonly described within the broader category of subacromial pain syndrome. The characteristic findings are pain during overhead activity, a mid-range painful arc of active abduction and a positive Hawkins test, with preserved passive movement. Adhesive capsulitis and glenohumeral osteoarthritis cause restriction of passive as well as active movement; adhesive capsulitis particularly limits external rotation. Acromioclavicular joint osteoarthritis usually causes focal superior shoulder tenderness and pain on cross-body adduction. Cervical radiculopathy is more likely to produce neck-provoked pain, neurological symptoms or objective sensory, reflex or motor abnormalities.

Reference: Hertfordshire and West Essex Clinical Guidance, Shoulder Pain Clinical Presentation: Assessment of a Painful Shoulder, examination section, date not stated. https://www.hweclinicalguidance.nhs.uk/all-clinical-areas-documents/download?checksum=711eb1daa7e94ff827f1c10ba4e24413&cid=1646&document=22&field=1