 Often in the case of Shoulder Impingement Syndrome, the scapula may be anteverted such that the shoulder on the affected side appears protracted.The ribs that may cause such an anteversion of the scapula include ribs 2–8.Impingement syndrome can be diagnosed by a targeted medical history and physical examination, but it has also been argued that at least medical imaging (generally X-ray initially) and/or response to local anesthetic injection is necessary for workup.