Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging

Background: Subacromial impingement is a common cause of shoulder pain and one cause of rotator cuff disease. We aimed to identify which shoulder motions cause subacromial impingement by measuring the vertical displacement and peak strain of the coracoacromial ligament using ultrasound speckle tracking imaging. Methods: Sixteen shoulders without shoulder disability were enrolled. All subjects were men, and the average age was 28.6 years. The vertical displacement and peak strain of the coracoacromial ligament were analyzed by the motion tracing program during the following active assisted motions (active motion controlled by the examiner): (1) forward flexion in the scapular plane, (2) horizontal abduction in the axial plane, (3) external rotation with the arm at 0 degrees abduction (ER0), (4) internal rotation with the arm at 0 degrees abduction (IR0), (5) internal rotation with the arm at 90 degrees abduction (IR90), and (6) internal rotation at the back (IRB). Results: The mean vertical displacement of the coracoacromial ligament during forward flexion (2.2 mm), horizontal abduction (2.2 mm), and IR90 (2.4 mm) was significantly greater than that during the other motions (ER0, -0.7 mm; IR0, 0.5 mm; IRB, 1.0 mm; P < .003). The mean peak strain was significantly higher in forward flexion (6.88%), horizontal abduction (6.58%), and IR90 (4.88%) than with the other motions (ER0, 1.42%; IR0, 1.78%; IRB, 2.61%; P < .003). Conclusions: Forward flexion, horizontal abduction, and IR90 showed higher vertical displacement and peak strain of the coracoacromial ligament, causing subacromial impingement. It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.