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The results of the first 2 rounds were used to develop a Likert\u2010style questionnaire for round 3. If agreement at round 3 was \u226460% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (&gt;60%, &lt;80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti\u2010inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no\u2010operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V, expert opinion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2021.09.031","type":"journal-article","created":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T03:07:10Z","timestamp":1634267230000},"page":"1051-1065","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":14,"title":["Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons"],"prefix":"10.1002","volume":"38","author":[{"given":"Erik","family":"Hohmann","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Sportsmedicine Valiant Clinic\/Houston Methodist Dubai United Arab Emirates"},{"name":"University of Texas Health Science Centre San Antonio Texas U.S.A."},{"name":"Department of Orthopaedic Surgery Royal Brisbane Hospital Herston Australia"},{"name":"Orthopaedic Research Centre of Australia Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaida","family":"Glatt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sportsmedicine Valiant Clinic\/Houston Methodist Dubai United Arab Emirates"},{"name":"University of Texas Health Science Centre San Antonio Texas U.S.A."},{"name":"Department of Orthopaedic Surgery Royal Brisbane Hospital Herston Australia"},{"name":"Orthopaedic Research Centre of Australia Sydney 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