What went wrong and what to do about it: pitfalls in the treatment of shoulder impingement.

Shoulder impingement is a commonly treated disorder; however, the absence of a clear understanding of pathophysiology and causation can create variability in treatment. Pitfalls that can impede optimal patient outcomes can occur in the areas of diagnosis, treatment, and rehabilitation. Diagnostic pitfalls include failing to identify some of the multiple extrinsic diagnoses as well as the intrinsic subacromial pathology in patients with symptoms of impingement. Surgical pitfalls include not addressing the entire pathology and doing an incomplete or excessive decompression. Rehabilitation pitfalls include prescribing the wrong exercises at the wrong time and omitting steps in the rehabilitation process. Every patient who presents for primary treatment of impingement or secondary treatment following failed treatment should have a thorough evaluation of all intrinsic and extrinsic factors that can contribute to the symptoms of shoulder impingement.