Diagnosis

Patients usually suffer from pain independent of movement, which – if the bursae also show inflammation – can also occur at rest and at night. If pressure is exerted on the anterior joint space in the area of the tubercle majus and other points of examination, so-called pressure pain occurs. Lifting the arm against resistance also hurts when lifting in the range between 60 and 120°.

This is known as a so-called “painful arc” or “painful arc”. In addition, there are other functional tests that specifically pinch the rotator cuff below the acromion. Pain can be reduced by injecting a local anesthetic under the acromion.

In the event that the arm still cannot be lifted despite being pain-free or with reduced pain, damage to the rotator cuff area must be considered. In order to be able to estimate the exact extent of the disease, the bony structure of the shoulder joint can be assessed by means of X-ray control. The shape of the acromion and the position of the head of humerus or possible calcification of the rotator cuff, which are particularly indicative of wear, must be assessed. There is also the possibility of an ultrasound examination or magnetic resonance imaging. It is possible to assess the condition of the rotator cuff and the size of the bursa without side effects by means of an ultrasound examination.

Studies

During the physical examination, the examiner can sometimes cause pain by applying pressure to the front joint space. Attempting to lift the arm over the side against resistance also causes pain. If the radius of movement of the lateral arm lift (abduction) is imagined as a semicircle, the pain is typically between 60-120°.Especially in this area, the supraspinatus tendon is located in the aforementioned constriction and this phenomenon is called the “painful arc”.

In order to verify the diagnosis of impingement syndrome, a so-called switch-off test can also be performed. This involves injecting a local anesthetic below shoulder height. If it is still not possible to lift the arm after this, the rotator cuff may have been injured.

Sonography, X-rays and magnetic resonance imaging (Marnet resonance imaging) are used as instrumental examinations if impingement syndrome is suspected. The tendon can be scanned for calcifications, the size of the bursa can be measured and the rotator cuff can be assessed. X-rays can be used to assess the position and configuration of the bony structures and to measure the distance between the acromion and the humeral head (acromio-humeral distance), which indicates the presence of an impingement syndrome if it is less than 10 mm long.

In addition, calcified areas in the tendon can be seen in the X-ray. Magnetic resonance imaging provides information about the anatomy and pathologies of the shoulder joint, especially in cases where the diagnosis is unclear. The impingement test according to Hawkins is an orthopedic test that can indicate or disprove an impingement syndrome.

The test is mainly used when an orthopedic disease is suspected in the shoulder joint or in the area of the upper arm. The Hawkins test is performed with the patient either standing or sitting in front of the examiner and the corresponding arm hanging relaxed next to the body. The examiner grasps the patient’s elbow with one hand and the wrist with the other.

First the arm is bent by 90 degrees at the shoulder joint, then the arm at the elbow joint. The patient then holds the arm in a stretched position in front of him. The examiner then moves a windshield wiper similar to the patient’s arm up and down, performing a passive rotation in the shoulder joint from 130-145 degrees.

This combination of movements results in an increasing constriction in the area of the shoulder joint. If this joint is already constricted by an impingement syndrome, the patient will report symptoms. Especially at the end of the pendulum movement, the pain indicated by Hawkins is positive and strongly indicates an impingement syndrome.

The Hawkins test is called negative if no movement pain occurs as a result of the movement sequences described above. If the Hawkins test is negative, an impingement syndrome is almost impossible. In very rare cases the test can be negative despite the presence of impingement syndrome.

Especially mild courses or very early stages often cause the Hawkins test to be negative, although a pathological narrowing of the shoulder joint has occurred. The Hawkins test is one of the most important measures in the diagnosis of impingement syndrome, along with imaging procedures such as ultrasound or x-rays. The test is quick to perform, costs nothing and gives a high diagnostic grade compared to the strain. If patients have anatomically large spaces in the area of the shoulder joint, the Hawkins test can also be negative if an impingement is in training. Conversely, in this case a positive Hawkins sign indicates an already advanced impingement syndrome.