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Traumatic Versus Atraumatic Causes of Shoulder Impingement Syndrome: A Systematic Review of Pathophysiology and
Muhammad Irfan Akram1, Kunjan Yogesh Barot2, Rao Junaid Saleem3
1Trauma and Orthopedics, Ipswich Hospital, Ispwich, GBR.
Abstract:
Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder caused by traumatic or atraumatic factors, resulting in pain, functional limitation, and reduced quality of life. This systematic review aimed to summarize the pathophysiology, anatomical changes, and functional outcomes of traumatic versus atraumatic SIS. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library up to 2025 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, including studies reporting clinical outcomes and pathophysiological findings in humans. Five studies comprising 467 participants were included. Traumatic SIS, often following acute injuries or post-acromioclavicular (AC) joint fixation, was associated with rotator cuff tears, labral lesions, and anatomical changes, leading to pain, limited range of motion, and delayed recovery. Atraumatic SIS, common in overhead athletes, resulted from repetitive microtrauma, causing tendon degeneration, subacromial narrowing, and deficits in strength, motion, and dynamic balance. Both etiologies shared rotator cuff and bursal inflammation. Traumatic SIS frequently requires surgical intervention, whereas atraumatic SIS is managed conservatively with structured rehabilitation. Differentiating etiologies is essential to optimize outcomes, prevent recurrence, and guide treatment strategies, and further long-term studies are warranted to evaluate functional recovery and intervention effectiveness.
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