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40 years n Differential diagnosis: cervical radiculitis

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2.1 Stages of outlet impingement according to Neer [97] *

Stage I: edema and hemorrhage

n Characteristically caused by overuse with the arm above the horizontal

n Typical age: <25 years

n Differential diagnosis: subluxation, AC-arthritis

n Clinical course: reversible

n Treatment: conservative

Stage II: fibrosis and tendinitis

n Typical age: 25±40 years

n Differential diagnosis: frozen shoulder, calcifying tendinitis

n Clinical course: recurrent pain with activity

n Treatment: consider bursectomy; CA ligament division

Stage III: bone spurs and tendon rupture

n Typical age: > 40 years

n Differential diagnosis: cervical radiculitis; neoplasm

n Clinical course: progressive disability

n Treatment: anterior acromioplasty, rotator cuff repair

Subacromial space 2

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2.2 Stages of impingement in athletes according to Jobe [65]

n Stage 1:

Tendinitis, usually of the supraspinatus or the long head of the biceps

n Stage 2:

Fibre dissociation in the tendon

n Stage 3:

Rotatorcuff tearless than 1 cm

n Stage 4:

Rotatorcuff tear1 cm and more 8 2 Subacromial space

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