Shoulder Impingement Syndrome

Farin PU, Jaroma H, Harju A et al (1990) Shoulder impingement syndrome sonographic evaluation. Radiology 176 845-849... 

Adhesive capsulitis, also referred to as frozen shoulder, refers to an insidious syndrome of shoulder pain and restricted movement in the absence of shoulder impingement and rotator cuff injury. The patient generally complains of loss of the normal... 

Rasmussen OS (2004) Anterior shoulder instability sonographic evaluation. J Clin Ultrasound 32 430-437 Read JW, Perko M (1998) Shoulder ultrasound diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg 7 264-271... 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

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