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The Journal of Bone and Joint Surgery 80:1851-2 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Jonathan Cohen, M.D., Louis U. Bigliani, M.D. and William N. Levine, M.D.

TO THE EDITOR:

I take issue with several parts of "Current Concepts Review. Subacromial Impingement Syndrome" (79-A: 1854–1868, Dec. 1997), by Bigliani and Levine. The first problem has to do with the concept of impingement. I agree with the designation of impingement as a syndrome, meaning a concurrence of symptoms or signs (I do not believe that it should be designated as a diagnosis, which the authors did not do), but problems arise in the discussion of the pathological findings. The authors' exemplary historical account ends with Neer's idea of three stages of impingement1. My concern is particularly with stage I, which is described as "edema and hemorrhage of the bursa and cuff and is typically found in patients who are less than twenty-five years old." Since the syndrome most frequently occurs in older individuals, in whom it is a chronic rather than an acute process, it is logical . . . [Full Text of this Article]


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