Distinguishing Shoulder Impingement Symptoms from Labral Tears: An Evidence-Based Review

Introduction

Accurately diagnosing shoulder injuries is essential for effective treatment and a smooth recovery. Two of the most common shoulder issues — shoulder impingement and labral tears—often present with similar symptoms, making it challenging to tell them apart. In this article, we’ll break down the key differences between these conditions, exploring their symptoms, diagnostic approaches, and implications for treatment. Our goal is to provide clear, straightforward information and guidance so you can better understand these common shoulder complaints .

What Is Shoulder Impingement?

Shoulder impingement occurs when the tendons of the rotator cuff—a group of muscles that stabilize the shoulder —become pinched as they pass beneath the shoulder blade. This compression leads to irritation, inflammation, and pain. Most people with shoulder impingement notice a gradual onset of discomfort, especially when lifting their arm overhead. Other common signs include tenderness and reduced shoulder mobility.

Research shows that rotator cuff problems, including impingement, tendonitis, and bursitis, are a leading cause of shoulder pain seen by physicians (Ludewig & Cook, 2002). Clinicians often use physical tests like the Neer and Hawkins-Kennedy maneuvers, where specific arm movements help reproduce the pain, to assess for impingement . These exams, combined with imaging tools like ultrasound or MRI, help confirm the diagnosis and rule out other causes.

Shoulder impingement can be triggered by abnormal shoulder movement, muscle imbalances , or tightness in the joint capsule. Addressing these underlying issues—such as improving shoulder mobility and correcting muscle dysfunction through physical therapy —can be crucial to recovery (Tyler et al., 2009). Selecting the right combination of clinical tests during the examination also helps clinicians efficiently get to the root of the problem.

Understanding Labral Tears

The labrum is a ring of cartilage that lines the shoulder socket and keeps the joint stable. A labral tear means this cartilage has been damaged, often from a sudden injury like a fall or from repetitive overhead motions. Unlike shoulder impingement , labral tears frequently cause sharp, catching pain, a clicking sensation, or the feeling that the shoulder might slip out of place.

Since labral tear symptoms can overlap with those of impingement, making a diagnosis is sometimes difficult. Doctors use specialized tests, such as O’Brien’s test or the crank test, to help identify labral pathology. These tests are often combined with advanced imaging—especially MRI arthrography, which uses contrast dye to highlight injuries —to get the most accurate picture. Because so many different shoulder tests exist, choosing the most reliable ones for each patient is especially important (Cools et al., 2008).

Diagnostic Challenges: Clinical Assessment Versus Imaging

Distinguishing between shoulder impingement and labral tears can be challenging, as their symptoms often overlap and physical exams are not always clear-cut. This is where imaging becomes extremely valuable. MRI scans , in particular, provide detailed images of the shoulder’s soft tissues, allowing doctors to spot inflammation, tendon damage, or labral tears. CT arthrography is another option when MRI results aren’t definitive.

However, imaging may sometimes reveal abnormalities that aren’t actually causing symptoms, making interpretation more complex. That’s why combining a thorough clinical exam with relevant imaging findings is the most effective strategy. Addressing problems like joint tightness through targeted physical therapy has been shown to help resolve symptoms in some cases (Tyler et al., 2009). Ultimately, the clinician’s experience and careful selection of appropriate tests are crucial for getting the diagnosis right (Cools et al., 2008).

Conclusion and Future Perspectives

While shoulder impingement and labral tears can present with similar complaints, they are unique conditions that require careful assessment. A detailed clinical examination, supported by thoughtful use of imaging, is key to distinguishing between them. As diagnostic technology continues to advance, we can look forward to even greater accuracy in the future—making it easier for patients to receive the right treatment and quickly return to their normal activities.