Utilization of the Transcapular Y-View Radiograph in the Diagnosis of Shoulder Impingement Syndrome

Shoulder impingement syndrome is commonly evaluated with the Neer and Hawkins-Kennedy tests, although there is debate in the literature about their diagnostic value. A 48-year-old male presented with a 3-month history of insidious-onset right shoulder pain, worst when lifting the arm overhead and when lying on the affected side. Examination found right shoulder abduction and flexion limited to 90 degrees by pain, positive Neer and Hawkins-Kennedy tests on the right, normal neurological findings, and dysrhythmic cervical motion. An anteroposterior radiograph showed widening of the distal clavicle and arthritic changes on the acromion but could not establish whether these changes affected the supraspinatus tendon. A transcapular Y-view radiograph showed a large subacromial osteophyte extending inferiorly into the supraspinatus tendon, causing extrinsic impingement. Management consisted of cervical adjustment and orthopedic referral. A month of conservative rotator cuff strengthening exercises did not meet the functional goal, and arthroscopic subacromial decompression was performed. At 6 weeks post-op, the patient reported a good outcome and was performing his usual activities of daily living without pain. This case illustrates the transcapular Y-view as a cost-effective radiograph that can add pertinent clinical information to a shoulder impingement evaluation before advanced imaging such as MRI.