Houston Methodist. Leading Medicine

Shoulder FAQ


I just got a second opinion about my shoulder problem from orthopedic surgeon number two. The first one said I have an "impingement" problem. The second one said, impingement is a nonspecific term and I really have rotator cuff tendinosis. Can you please explain this to me? Are we talking about the same thing or are these two different problems? Who's right?


Shoulder problems labeled shoulder impingement syndrome often make it difficult to raise the arm overhead. Patients are able to raise the arm forward or out to the side to a certain point. But then the arm won't go any further without help from the other hand lifting it up. Another sign of shoulder impingement is pain that occurs when raising the arm from about 90 degrees until the person gets the arm up to around 120 degrees of motion. Then the arm continues on its merry way to the top, no problem. Pain often occurs when bringing the arm back down -- and usually in the same place: when the arm is about 120 degrees away from the body moving back down to around 90 degrees. From 90 degrees down to the side is usually painfree. This type of clinical presentation has been referred to as an impingement syndrome since the early 1970s when the term was first used. But better diagnostic tests such as MRIs, ultrasound, and arthroscopic exam are making it possible to clearly define the problem. And that may mean the term 'impingement syndrome' is being replaced by a more specific term such as rotator cuff tendinosis. Tendinosis means the tendon is damaged from a previous injury but there's no current active inflammation. The body's attempt to heal the torn tendon failed to fully restore the natural, anatomic soft tissue structure known as the rotator cuff. The most likely causes of impingement are rotator cuff tendinosis, partial-thickness tear, full-thickness tear, bursitis, or tight posterior capsule. Any of these conditions can cause the clinical presentation of pain and limited motion we still refer to as impingement. In time, billing codes from the nonspecific terminology associated with 'impingement' may be changed to allow for more accurate categories. Once that step has been taken, then it will be possible for everyone to call each condition by its proper name and not lump them all into the broad, nonspecific category of 'impingement.' Impingement describes the functional limitation (can't lift the arm over head smoothly) but not the underlying cause, which in your case is tendinosis. So, in a way, both physicians are correct. Anastasio Papadonikolakis, MD, et al. Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder. In The Journal of Bone and Joint Surgery. October 5, 2011. Vol. 93-A. No. 19. Pp. 1827-1832.

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