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. 2025 Oct;54(10):2087-2096.
doi: 10.1007/s00256-025-04916-3. Epub 2025 Apr 23.

Radiographic findings in patients suspected of subacromial impingement syndrome in relation to shoulder pain and disability

Linda Christie Andrea  1   2 , Susanne Wulff Svendsen  3 , Poul Frost  4 , Kate Smidt  5 , John Gelineck  6 , David Høyrup Christiansen  7   8   9 , Søren Rasmussen Deutch  10 , Torben Bæk Hansen  11 , Annett Dalbøge  4
Affiliations

Radiographic findings in patients suspected of subacromial impingement syndrome in relation to shoulder pain and disability

Linda Christie Andrea et al. Skeletal Radiol. 2025 Oct.

Abstract

Objective: The aim was to study the association between specific radiographic findings and patient reported shoulder pain and disability in patients suspected of subacromial impingement syndrome (SIS).

Materials and methods: This cross-sectional study used baseline data from a prospective study. Study population included patients age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Radiographic findings before first visit to a department of orthopaedic surgery comprised subacromial calcifications, acromial morphological characteristics (i.e. acromial type and spur), acromioclavicular osteoarthritis, signs of previous glenohumeral dislocation (Bankart/Hill-Sachs lesions), and architectural measures (i.e. acromial tilt, acromion index, and lateral acromial angle). Shoulder pain and disability were evaluated using the Oxford Shoulder Score (OSS) from patient's response to a questionnaire at first visit to the public department of orthopaedic surgery or before surgery for SIS. A low OSS was defined as having a score < 25. Associations between the radiographic findings and low OSS were analysed using logistic regression.

Results: The population comprised 825 patients. Median time between radiographic examination and completion of the questionnaire was 9 days (SD = 27.1). In adjusted analysis, we found a statistically significant association for lateral spur especially birdbeak type (OR = 2.24 (95% CI 1.36-3.71)), Bankart/Hill-Sachs lesion (OR = 2.49 (95% CI 1.38-4.48)), and acromial tilt > 35° (OR = 0.62 (95% CI 0.41-0.94)). Female sex (OR = 2.25 (95% CI 1.59-3.18)) was also associated with low OSS.

Conclusion: In terms of associations with patient-reported shoulder pain and disability, lateral spurs, with emphasis on birdbeak type, Bankart/Hill-Sachs lesions, and acromial tilt > 35°, seemed clinically important.

Keywords: Impingement; Oxford shoulder score; Radiograph; Shoulder; Subacromial pain.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Standard projections. Anterior–posterior projections with humerus in external rotation (A), internal rotation (B), and outlet view (C)
Fig. 2
Fig. 2
Subacromial calcification
Fig. 3
Fig. 3
Acromion types: type I, flat (A); type II, curved (B); type III, hooked (C)
Fig. 4
Fig. 4
Lateral spurs in three different patients: bird beak type (A + B) and heel type (C)
Fig. 5
Fig. 5
Medial acromion spurs
Fig. 6
Fig. 6
Osteoarthritis of the acromioclavicular joint with narrowing of joint and spurring of medial acromion
Fig. 7
Fig. 7
Acromial tilt (A). Lateral acromial angle (B). Acromion index (C)
See this image and copyright information in PMC

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