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What is shoulder impingement?

Impingement syndrome is an increasingly common cause of shoulder pain. The rotator cuff is a sling of muscles which support the glenohumeral joint. Over time, with movement, the tendons and bursae within this complex become trapped and compressed, developing tears or inflammation causing an acute flare up in pain.

What can cause it?

  • Trauma
  • Repetitive overhead movements

Within the shoulder girdle, the muscles of the rotator cuff should glide smoothly beneath acromion. With overhead arm movement, this subacromial space narrows and when this happens repetitively, the friction between the structures can become inflamed causing pain.

Types of shoulder impingement

  • Primary impingement – this is caused by structural changes within the joints such as bony spurs which can narrow the subacromial space.
  • Secondary impingement – this is affected by a person’s posture and movement patterns such as increased joint mobility or muscle imbalance within the girdle.

People with who participate in physical activity or have occupations which involve repetitive overhead movement are most at risk.

Symptoms include:

  • Pain when bringing your arm into an arc above head, cross body or hand behind back movements.
  • Soreness when lying on the affected side.
  • Weakness and loss of function of the affected shoulder.

If you have any of these symptoms, it can have huge impacts on your quality of life and occupational ability.


  • Physical examination using specific shoulder tests.
  • Ultrasound is often used to assess the extent of the impingement along with associated tendinopathies, bursitis or muscle tear.
  • X-rays are sometimes used to rule out and bony deformities such as arthritis or spurs.

Types of treatment:

  • Corticosteroid Injection – Not a long term solution. The relief provided is transient, it is helped in cases where the pain is very severe.
  • Subacromial Decompression Surgery – There is high quality research which reveals that there is no differences in outcomes.
  • Physiotherapy – a 12- week program of graded exercises has proven to reduce pain and to improve strength and function.

When treating shoulder impingement, it’s important to determine which type of impingement you are having and to consider the cause of the impingement as opposed to the specific structures involved. Our posture, muscle strength and muscle length in our upper trunk play an important role. Through strengthening, stretching and postural re-education with the guidance of your physiotherapist, we aim to regain your full range of motion, restore the shoulder strength and scapular stability and return you to a healthy and pain free movement pattern.

Written By: Mary Wrixon, Physiotherapist


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