Shoulder impingement
Shoulder impingement after a motor accident
Impingement describes painful compression during shoulder elevation, but it does not identify the whole diagnosis. A useful claim distinguishes bursitis, cuff pathology, AC joint change, altered mechanics and pain-limited movement before selecting a WPI method.
Motor accident injury
How can this injury happen?
Car or passenger collision
Seat-belt loading or bracing may inflame the bursa, strain the cuff or alter shoulder mechanics.
Motorcycle accident
A fall can cause cuff, AC or bursal injury followed by painful elevation.
Pedestrian or cyclist impact
Direct impact can produce swelling, bruising and secondary impingement during recovery.
Injuries that can occur
- subacromial bursitis
- rotator cuff tendinopathy or partial tear
- AC joint injury or post-traumatic change
- scapular movement dysfunction and painful elevation
Symptoms and functional problems
- painful arc during lifting
- pain reaching overhead or across the body
- night pain and reduced endurance
- difficulty lifting at work or placing the hand behind the back
Clinical evidence
What findings matter?
Provocation tests may support the clinical diagnosis but do not determine WPI. The assessor needs reliable active ROM and evidence explaining the accident-related pathology.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Clinical impingement and cuff tests | Identify a reproducible pain pattern and possible tendon involvement. | A positive provocation test is not a WPI table value. |
| Ultrasound or MRI | May show bursitis, cuff pathology or AC change. | Degenerative findings require causation analysis. |
| Active shoulder ROM | Shows permanent functional loss in relevant planes. | Pain behaviour without consistent angles is insufficient. |
Movement in daily life
How movement affects real activities
Elevation through flexion and abduction often reproduces impingement, while rotation affects dressing and grooming. Real-world difficulty should correspond with reliable active movement.
Flexion
Lifting the arm forward and overhead, including reaching a shelf or putting on a shirt.
Active flexion and extension are rated through AMA4 shoulder Figures 36 to 38 when reliable.
Abduction
Lifting the arm sideways, including reaching away from the body or fastening a seat belt.
Active abduction and adduction are addressed by Figures 39 to 41.
External rotation
Washing hair, reaching behind the head and positioning the arm to put on a jacket.
Active external rotation is read with the shoulder rotation figures, not estimated from pain severity.
Internal rotation
Reaching behind the back for dressing, hygiene or fastening clothing.
Active internal rotation is addressed with Figures 42 to 44 and must be measured consistently.
Threshold injury is a separate question: bursitis, tendinopathy and impingement without a verified rupture are usually soft tissue conditions. A separate partial or complete tendon rupture may alter classification.
Part 6 permanent impairment
How is CTP WPI assessed?
Active shoulder ROM is the clearest verified method. Clause 6.57 permits another upper-extremity disorder method by analogy only where justified and non-duplicative.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Active shoulder ROM | Clauses 6.50-6.52; Figures 36-44 | Permanent measurable loss caused by the impingement condition. | Painful arc alone is not a movement percentage. |
| Analogous disorder method | Clauses 6.24 and 6.57 | A diagnosed residual disorder not fairly represented by ROM. | A readable AMA4 row and rationale are required before assigning a value. |
| Table 3 conversion | Clause 6.56 | Converts UEI to WPI. | Do not add pain separately. |
- Confirm that the condition has stabilised.
- Address cuff rupture separately where present.
- Do not use strength Table 34.
What cannot be combined?
- ROM and analogy for the same painful elevation
- pain as a separate impairment
- prohibited strength evaluation
What does not establish WPI by itself?
- positive impingement sign
- bursitis on ultrasound
- pain with lifting
- an injection response alone
Motor accident examples
Seat-belt injury with persistent painful elevation
The diagnosis and treatment history support causation, but WPI still depends on reliable permanent active movement or another justified method.
Impingement with a partial cuff rupture
Threshold classification must address the rupture separately; WPI must avoid rating the same shoulder loss twice.
Claim file preparation
Evidence checklist
Assessment source
Shoulder impingement WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.24, 6.47-6.57 and 6.67; AMA4 shoulder Figures 36-44 and Table 3.
Threshold injury: Impingement without verified rupture is commonly a threshold soft tissue injury; classification remains separate from WPI.
What the assessor checks
- active ROM method
- analogy rule
- Table 3 conversion
- strength prohibition
What does not establish the result by itself
- painful arc
- scan label
- injection
- weakness
Official sources
Related NSW CTP guides
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Frequently asked questions
- Does impingement have a fixed WPI?
- No. The assessor applies a permitted method to permanent residual impairment.
- Is a painful arc enough?
- No. It supports diagnosis but does not replace reliable active ROM or a justified analogous method.
- Can an ultrasound prove the crash caused impingement?
- Not alone. Timing, prior history, examination and specialist reasoning matter.
- Can strength loss be rated?
- Not through upper-extremity Table 34, which clause 6.67 prohibits.
- What if a cuff tear is also present?
- The rupture must be assessed for threshold classification and WPI without double counting the same shoulder consequence.