Clinical assessment of factors associated with subacromial shoulder impingement: a systematic review

Background: Physiotherapists commonly use orthopaedic special tests to reproduce subacromial shoulder impingement (SIS) pain by increasing compression or tension within the subacromial space. However, these tests do not differentiate between purported extrinsic and intrinsic mechanisms associated with SIS. Objective: To identify, and determine the reliability and validity of clinical tests used to assess extrinsic factors associated with SIS. Method: A scoping review identified tests for extrinsic SIS. A systematic approach was then used to search six electronic databases in July 2016 to identify clinical tests used to measure (1) posterior shoulder range, (2) cervical and/or thoracic posture, (3) 2D scapula movement, (4) rotator cuff strength. The 14 articles included in the review were assessed using a modified Downs and Black quality assessment tool. Results: Moderate quality studies investigated 2D scapula measurements (N = 2), resting pectoralis minor length (N = 2) and rotator cuff strength (N = 5). High quality studies measured forward head position and/or thoracic posture (N = 2) and rotator cuff strength (N = 1). Conclusion: A good level of assessment reliability and significantly less range and strength was identified in those with SIS for: posterior shoulder range (passive shoulder adduction and internal rotation and passive internal rotation in supine); isokinetic peak torque values for internal and external shoulder rotation (isokinetic testing); forward head position (lateral photograph) and thoracic range of motion (tape measure or ultrasound tomography). Good to excellent reliability was reported for lateral scapular slide test positions and resting pectoralis minor muscle length. These clinical tests should be considered for use in SIS assessment.