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

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

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

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

Impingement lesions: Copeland Levy classification

Acromial Side	Bursal Side
A0   Normal - smooth surface	B0   Normal - smooth surface
A1   Minor scuffing, haemorrhage or local injection and inflammation	B1   Minor scuffing, haemorrhage or local injection and inflammation
A2   Marked scuffing / damage of the undersurface of the acromion & CA ligament	B2   Major scuffing of cuff, partial thickness tear
A3   Bare bone areas	B3   Full thickness tear
	B4   Massive cuff tear