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
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