International Orthopaedics

, Volume 42, Issue 2, pp 359–366 | Cite as

Redefining anterior shoulder impingement: a literature review

  • Gregory CunninghamEmail author
  • Alexandre Lädermann
Review Article


Many different types of impingements have been described in the shoulder. Inasmuch as the term ‘shoulder impingement’ usually refers to subacromial impingement, anterior impingement usually refers to subcoracoid impingement. However, there are many different subtypes of anterior impingements in the shoulder, and awareness of their existence is critical as they vary in their nature and treatment. Recent advances in biomechanical research and arthroscopic exploration of the anterior structures of the shoulder have brought new insights on the various potential impingements, warranting a revision and update of the current definitions of anterior shoulder impingement. The purpose of this article is to propose a comprehensive review and classification of all different subtypes of anterior impingement in the shoulder, including newly described entities.


Shoulder Impingement Anterior Anterosuperior Subcoracoid FUSSI lesion Chondral print 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

Arthroscopic management of an infra-coracoid impingement of the subsapularis tendon between the lesser tuberosity and undersurface of the conjoined tendon. (MP4 34,141 kb)

Movie illustrating the arthroscopic management of a FUSSI lesion (MP4 51,327 kb)


  1. 1.
    de Witte P, Nagels J, van Arkel ER et al (2011) Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM). BMC Musculoskelet Disord 12:282CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Seitz AL, McClure PW, Finucane S et al (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech 26:1–12CrossRefGoogle Scholar
  3. 3.
    Voisin J-L, Ropars M, Thomazeau H (2014) The human acromion viewed from an evolutionary perspective. Orthop Traumatol Surg Res 100:S355–S360CrossRefPubMedGoogle Scholar
  4. 4.
    Lo IKY, Parten PM, Burkhart SS (2003) Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: an arthroscopic approach. Arthroscopy 19:1068–1078CrossRefPubMedGoogle Scholar
  5. 5.
    Goldthwait J (1909) An anatomic and mechanical study of the shoulder joint, explaining many of the cases of painful shoul- der, many of the recurrent dislocations and many of the cas- es of brachial neuralgias or neuritis. Am J Orthop Surg 6:579–606Google Scholar
  6. 6.
    Gerber C, Terrier F, Ganz R (1985) The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg (Br) 67:703–708CrossRefGoogle Scholar
  7. 7.
    Arrigoni P, Brady PC, Burkhart SS (2006) Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Arthroscopy 22:1139.e1–1139.e3CrossRefGoogle Scholar
  8. 8.
    Peidro L, Serra A, Suso S (1999) Subcoracoid impingement after ossification of the subscapularis tendon. J Shoulder Elb Surg 8:170–171CrossRefGoogle Scholar
  9. 9.
    Drakes S, Thomas S, Kim S et al (2015) Ultrasonography of subcoracoid bursal impingement syndrome. PM R 7:329–333Google Scholar
  10. 10.
    Ko JY, Shih CH, Chen WJ, Yamamoto R (1994) Coracoid impingement caused by a ganglion from the subscapularis tendon. A case report. J Bone Joint Surg Am 76:1709–1711CrossRefPubMedGoogle Scholar
  11. 11.
    Cuéllar A, Cuéllar R, Sánchez A et al (2015) Soft tissue tumour causing coracoid impingement syndrome. Knee Surg Sports Traumatol Arthrosc 23:2635–2638CrossRefPubMedGoogle Scholar
  12. 12.
    Suenaga N, Minami A, Kaneda K (2000) Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear. J Shoulder Elb Surg 9:275–278CrossRefGoogle Scholar
  13. 13.
    Lo IK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and tuff lesions of the subscapularis. Arthroscopy 19:1142–1150CrossRefPubMedGoogle Scholar
  14. 14.
    Gumina S, Postacchini F, Orsina L, Cinotti G (1999) The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome. Int Orthop 23:198–201CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shah SH, Small KM, Sinz NJ, Higgins LD (2016) Morphology of the lesser tuberosity and Intertubercular groove in patients with arthroscopically confirmed Subscapularis and biceps tendon pathology. Arthroscopy 32:968–975CrossRefPubMedGoogle Scholar
  16. 16.
    Kowalsky MS, Bell J-E, Ahmad CS (2007) Arthroscopic treatment of subcoracoid impingement caused by lesser tuberosity malunion: a case report and review of the literature. J Shoulder Elb Surg 16:e10–e14CrossRefGoogle Scholar
  17. 17.
    Mavrogenis AF, Valencia JD, Romagnoli C et al (2012) Tumors of the coracoid process: clinical evaluation of twenty-one patients. J Shoulder Elb Surg 21:1508–1515CrossRefGoogle Scholar
  18. 18.
    Park J-Y, Lhee S-H, Oh K-S et al (2012) Is arthroscopic coracoplasty necessary in Subcoracoid impingement syndrome? Arthroscopy 28:1766–1775Google Scholar
  19. 19.
    Richards DP, Burkhart SS, Campbell SE (2005) Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy 21:1223–1228CrossRefPubMedGoogle Scholar
  20. 20.
    Bauones S, Moraux A (2015) The accessory coracobrachialis muscle: ultrasound and MR features. Skelet Radiol 44:1273–1278CrossRefGoogle Scholar
  21. 21.
    Ogawa K, Takahashi M, Yoshida A (1999) Aberrant muscle anterior to the shoulder joint: its clinical relevance. J Shoulder Elb Surg 8:46–48CrossRefGoogle Scholar
  22. 22.
    Garofalo R, Conti M, Massazza G et al (2011) Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors. Musculoskelet Surg 95:25–29CrossRefGoogle Scholar
  23. 23.
    Dines DM, Warren RF, Inglis AE, Pavlov H (1990) The coracoid impingement syndrome. J Bone Joint Surg (Br) 72:314–316Google Scholar
  24. 24.
    Finnoff JT, Thompson JM, Collins M, Dahm D (2010) Subcoracoid bursitis as an unusual cause of painful anterior shoulder snapping in a weight lifter. Am J Sports Med 38:1687–1692CrossRefPubMedGoogle Scholar
  25. 25.
    Tracy MR, Trella TA, Nazarian LN et al (2010) Sonography of the coracohumeral interval: a potential technique for diagnosing coracoid impingement. J Ultrasound Med 29:337–341CrossRefPubMedGoogle Scholar
  26. 26.
    Russo R, Togo F (1991) The subcoracoid impingement syndrome: clinical, semeiologic and therapeutic considerations. Ital J Orthop Traumatol 17:351–358PubMedGoogle Scholar
  27. 27.
    Lo IKY, Burkhart SS, Parten PM (2004) Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 20:591–595CrossRefPubMedGoogle Scholar
  28. 28.
    Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg 54:41–50CrossRefPubMedGoogle Scholar
  29. 29.
    Gerber C, Sebesta A (2000) Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. J Shoulder Elb Surg 9:483–490CrossRefGoogle Scholar
  30. 30.
    Bath SS, Bath SS, Tehranzahdeh J (2012) Anterosuperior glenoid impingement syndrome. Clin Med Insights Arthritis Musculoskelet Disord 5:15–18CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Habermeyer P, Magosch P, Pritsch M et al (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg 13:5–12CrossRefGoogle Scholar
  32. 32.
    Valadie AL, Jobe CM, Pink MM et al (2000) Anatomy of provocative tests for impingement syndrome of the shoulder. J Shoulder Elb Surg 9:36–46CrossRefGoogle Scholar
  33. 33.
    Struhl S (2002) Anterior internal impingement: an arthroscopic observation. Arthroscopy 18:2–7CrossRefPubMedGoogle Scholar
  34. 34.
    Lädermann A, Chagué S, Kolo FC, Charbonnier C (2016) Kinematics of the shoulder joint in tennis players. J Sci Med Sport 19:56–63CrossRefPubMedGoogle Scholar
  35. 35.
    Habermeyer P, Walch G (1996) The biceps tendon and rotator cuff disease. In: Burkhead WZ Rotator Cuff Disord. Williams & Wilkins, Baltimore, p 142–159Google Scholar
  36. 36.
    Castagna A, Mouhsine E, Conti M et al (2007) Chondral print on humeral head: an indirect sign of long head biceps tendon instability. Knee Surg Sports Traumatol Arthrosc 15:645–648CrossRefPubMedGoogle Scholar
  37. 37.
    Zappia M, Carfora M, Romano AM et al (2016) Sonography of chondral print on humeral head. Skelet Radiol 45:35–40CrossRefGoogle Scholar
  38. 38.
    Lafosse L, Reiland Y, Baier GP et al (2007) Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 23:73–80CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Division of Orthopaedics and Trauma Surgery, Department of SurgeryGeneva University HospitalsGeneva 14Switzerland
  2. 2.Division of Orthopaedics and Trauma SurgeryLa Tour HospitalMeyrinSwitzerland
  3. 3.Faculty of MedicineUniversity of GenevaGeneva 4Switzerland

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