The patient had a positive exam consistent with impingement syndrome.  Palpation over the greater tuberosity and subacromial bursa was painful.  There was crepitus with shoulder motion.  Hawkins was positive.  Neer test was positive.  Supraspinous tendon weakness was demonstrated (90 degree elevation with thumb down).  No muscle atrophy over the top or back of the shoulder that would indicate rotator cuff tear.