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BioMed Research International
Volume 2017, Article ID 2941238, 5 pages
Research Article

Internal Impingement of the Shoulder: A Risk of False Positive Test Outcomes in External Impingement Tests?

1Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
2Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
3Department of Radiology, University Hospital of Cologne, Cologne, Germany
4Center of Radiology Euskirchen, Euskirchen, Germany
5PAN Clinic Cologne, Cologne, Germany

Correspondence should be addressed to Tim Leschinger;

Received 28 February 2017; Revised 7 May 2017; Accepted 4 June 2017; Published 20 August 2017

Academic Editor: Sae H. Kim

Copyright © 2017 Tim Leschinger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. External impingement tests are considered as being particularly reliable for identifying subacromial and coracoid shoulder impingement mechanisms. The purpose of the present study was to evaluate if these tests are likely to provoke an internal shoulder impingement mechanism which, in cases of a pathologic condition, can lead to a positive test result. Method. In 37 subjects, the mechanical contact between the glenoid rim and the rotator cuff (RC) was measured quantitatively and qualitatively in external impingement test positions using an open MRI system. Results. Mechanical contact of the supraspinatus with the posterosuperior glenoid was present in 30 subjects in the Neer test. In the Hawkins test, the subscapularis was in contact with the anterosuperior glenoid in 33 subjects and the supraspinatus in 18. In the horizontal impingement test, anterosuperior contact of the supraspinatus with the glenoid was identified in 35 subjects. Conclusion. The Neer, Hawkins, and horizontal impingement tests are likely to provoke the mechanism of an internal shoulder impingement. A posterosuperior internal impingement mechanism is being provoked predominately in the Neer test. The Hawkins test narrows the distance between the insertions of the subscapularis and supraspinatus and the anterosuperior labrum, which leads to an anterosuperior impingement mechanism.