Subacromial Impingement classifications

1. Stages of subacromial impingement: Neer’s classification
2. Stages of subacromial impingement in athletes: Jobe’s classification
3. Grading of impingement changes: Milgrom’s ultrasound classification
4. Impingement lesions: Copeland Levy classification

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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

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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

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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

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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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