Subacromial Impingement classifications
- Stages of subacromial impingement: Neer’s classification
- Stages of subacromial impingement in athletes: Jobe’s classification
- Grading of impingement changes: Milgrom’s ultrasound classification
- Impingement lesions: Copeland Levy classification
Stages of subacromial impingement: Neer’s classification
Historical interest, stages do not necessarily follow one another
Stage 1: oedema and haemorrhage , age <25, reversible
Stage 2: fibrosis and tendinitis, age 25-40, recurrent pain with activity
Stage 3: bone spurs and tendon rupture, age >40, progressive disability
Stages of subacromial impingement in athletes: Jobe’s classification (1989)
1. Pure impingement with no instability
2. Primary instability with capsular and labral injury with secondary impingement which can be internal impingement or subacromial
3. Primary instability because of generalised ligamentous laxity with secondary impingement
4. Pure instability and no impingement
Grading of impingement changes: Milgrom’s ultrasound classification
Stage 1 - Bursal thickness 1.5 to 2.0mm
Stage 2 - Bursal thickness over 2.0mm
Stage 3 - Partial or full thickness tear of the rotator cuff
Impingement lesions: Copeland Levy classification
for more detail click here
Acromial Side |
Bursal Side |
A0 Normal - smooth surface A1 Minor scuffing, haemorrhage or local injection and inflammation A2 Marked scuffing / damage of the undersurface of the acromion & CA ligament A3 Bare bone areas |
B0 Normal - smooth surface B1 Minor scuffing, haemorrhage or local injection and inflammation B2 Major scuffing of cuff, partial thickness tear B3 Full thickness tear B4 Massive cuff tear |
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