Pathology
Impingement may result from:
- subacromial spurs
- osteoarthritic thickening of the acromioclavicular joint
- swelling of the cuff or subacromial bursa from systemic inflammatory disease such as rheumatoid arthritis or gout
- prolonged, excessive or unaccustomed use of the shoulder in the impingement position
The effect of such impingement ranges from localised, self-limiting tendinitis, to the development of minute tears (which may be followed by scarring and calcification of the tendon), to partial or even full-thickness tearing of the cuff. Small tears of the cuff are almost universal after the age of 60.
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