Communication breakdown: clinicians disagree on subacromial impingement

“Subacromial impingement syndrome (SIS)” is frequently used as a diagnostic label, but has become more controversial as such in the literature. This study assesses views on SIS in clinical practice using a survey with 63 0-10 VAS items among orthopedic surgeons and physical therapists from the United States and the Netherlands. Multivariate regression and cluster analyses were applied to identify consensus items and to study profession and/or nationality effects on item ratings. Most items received neutral or highly variable ratings. Twenty-nine were considered associated with SIS, including worsening of pain with overhead activities, painful arc and a positive Neer’s test. Seven items were regarded pleading against SIS, including loss of passive motion. Activity modifications and physical therapy are the most significant treatments according to therapists, who placed great value on motion-related etiologic mechanisms. Surgeons, with higher ratings for intrinsic and anatomic etiologies, appreciated the use of subacromial corticosteroids and surgery. Clinicians from different professional backgrounds have different views on what SIS is, and even within professional groups, variations are substantial. This has to be taken into account when communicating about SIS symptoms, for instance, in intercollegial consultation or scientific research. The authors suggested cautious application of (subacromial) impingement syndrome as a diagnostic label.