American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a key symptom of subacromial impingement?

1. Pain during shoulder adduction

2. Pain with overhead activity

3. Pain while resting

4. Pain with external rotation

The correct answer is: Pain with overhead activity

Pain with overhead activity is a key symptom of subacromial impingement because this condition typically involves the compression of the rotator cuff tendons and the subacromial bursa against the acromion during arm elevation. When a person engages in overhead movements, such as reaching or lifting, this compression becomes evident, often resulting in sharp or aching pain. Understanding the mechanics of shoulder movement helps clarify why this symptom is so significant. During overhead activities, the humeral head moves upward, and if there is any narrowing in the subacromial space due to inflammation or structural anomalies, pain will be elicited. This symptom is particularly pertinent in athletes and individuals who perform repetitive overhead activities. In contrast, pain during shoulder adduction, while it may occur in various shoulder pathologies, is not specific to subacromial impingement. Similarly, pain while resting is typically associated with inflammatory conditions or other shoulder issues that are not directly related to impingement. Pain with external rotation is more commonly associated with rotator cuff tears or lesions rather than specifically with the impingement syndrome. Thus, recognizing pain during overhead activity as a hallmark symptom is essential for accurate diagnosis and treatment of subacromial impingement.