Shoulder impingement syndrome occurs when the tendons of the rotator cuff are compressed during shoulder movement.
Shoulder impingement syndrome describes pinching of the rotator cuff tendons, and often the bursa alongside them, between the head of the upper arm bone and the bony arch above it, the acromion, during overhead movement. It is a common and often early stage in a spectrum of shoulder conditions that, if not addressed, can progress over time to more established rotator cuff tendinopathy or, in some cases, a tear.
Repetitive overhead activity, whether in sport such as swimming and throwing, or in occupations involving frequent reaching above shoulder height, is a common contributor to impingement. Weakness or imbalance in the rotator cuff and the muscles that control the shoulder blade can allow the space beneath the acromion to narrow during movement, increasing the likelihood of impingement.
Some people also have a naturally shaped acromion that provides less clearance for the rotator cuff tendons, making impingement more likely regardless of activity level.
Typical symptoms of shoulder impingement include:
Symptoms often build gradually with a specific repetitive activity before becoming more persistent.
Assessment includes specific movement tests that reproduce impingement symptoms, and imaging such as ultrasound or MRI can help assess the rotator cuff and bursa if symptoms are persistent or the diagnosis is unclear.
Physiotherapy is the cornerstone of treatment, focused on strengthening the rotator cuff and the muscles controlling the shoulder blade, along with correcting posture and movement patterns that contribute to impingement. Activity modification and anti-inflammatory medication support this process.
A corticosteroid injection into the subacromial space can help settle pain and allow more effective participation in physiotherapy where symptoms are limiting progress.
Surgery, arthroscopic subacromial decompression, is considered for the minority of patients whose symptoms persist despite a genuine course of physiotherapy, creating more space for the rotator cuff tendons to move without pinching.
The majority of people with shoulder impingement improve significantly with a structured physiotherapy programme, though this can take several weeks to months of consistent effort. Surgery, when needed, generally provides good outcomes for the minority who do not respond to non-surgical treatment.
Shoulder impingement is a common cause of pain with overhead activity, sitting on the same spectrum as rotator cuff and bursa problems in the shoulder. The majority of people improve well with a structured physiotherapy programme, and surgery is reserved for the minority who do not. Persistent pain with overhead reaching or a painful arc of motion is worth having assessed.
