Shoulder impingement syndrome occurs as the result of chronic and repetitive compression or “impingement” of the rotator-cuff tendons in the shoulder, causing pain and movement problems. It can also be caused by an injury to the shoulder. People who perform repetitive or overhead arm movements, such as manual laborers or athletes who raise their arms repeatedly overhead (ie, weightlifters and baseball pitchers), are most at risk for developing a shoulder impingement. Poor posture can also contribute to its development. If left untreated, a shoulder impingement can lead to more serious conditions, such as a rotator cuff tear. Physical therapists can help decrease pain, and improve shoulder motion and strength in people with shoulder impingements.
The rotator cuff tendon and the bursa sit beneath the acromion. The bursa is a fluid-filled sac that provides a cushion between the bony acromion and the rotator cuff tendon, and it can become compressed underneath the acromion. Impingement symptoms can occur when compression and microtrauma harm the tendons. There are several causes to shoulder impingement syndrome including:
- Repetitive overhead movements, such as golfing, throwing, racquet sports, and swimming, or frequent overhead reaching or lifting.
- Injury, such as a fall, where the shoulder gets compressed.
- Bony abnormalities of the acromion, which narrow the subacromial space.
- Osteoarthritis in the shoulder region.
- Poor rotator cuff and shoulder blade muscle strength, causing the humeral head to move abnormally.
- Thickening of the bursa.
- Thickening of the ligaments in the area.
- Tightness of the soft tissue around the shoulder joint called the joint capsule.
How Does it Feel?
Individuals with shoulder impingement may experience:
- Restriction in shoulder motion with associated weakness in movement patterns, such as reaching overhead, behind the body, or out to the side.
- Pain in the shoulder when moving the arm overhead, out to the side, and beside the body.
- Pain and discomfort when attempting to sleep on the involved side.
- Pain with throwing motions and other dynamic movement patterns.
How Is It Diagnosed?
Special tests involving gentle movements of your arm and shoulder may be performed to determine exactly which tendons are involved. X-rays may also be taken to identify other conditions that could be contributing to your discomfort, such as bony spurs or abnormalities, or arthritis.
How Can a Physical Therapist Help?
Physical therapy can be very successful in treating shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:
Pain Management. Your physical therapist will help you identify and avoid painful movements, as well as correct abnormal postures to reduce impingement compression. Therapeutic modalities, like iontophoresis (medication delivered through an electrically charged patch) and ultrasound may be applied. Ice may also be helpful to reduce pain.
Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving properly, so that the tendons and bursa avoid impingement.
Range-of-Motion Exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. Often with shoulder impingement syndrome, the head of the humerus tends to drift forward and upward due to the rotator-cuff muscles becoming weak. Strengthening the rotator-cuff and scapular muscles helps position the head of the humerus bone down and back to ease the impingement. You may also perform resistance training exercises to strengthen your weaker muscles. You will receive a home-exercise program to continue your strengthening long after you have completed your formal physical therapy.
Patient Education. Learning proper posture is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become impinged. Your physical therapist will work with you to help improve your posture, and may suggest adjustments to your work station and work habits.
Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform a range of functions using proper shoulder mechanics, such as lifting an object onto a shelf or throwing a ball. This training will help you return to pain-free function on the job, at home, and when playing sports
Can this Injury or Condition be Prevented?
- Maintaining proper strength in the shoulder and shoulder-blade muscles.
- Regularly stretching the shoulders, neck, and middle-back region.
- Maintaining proper posture and shoulder alignment when performing reaching and throwing motions.
- Avoiding forward-head and rounded-shoulder postures (being hunched over) when spending long periods of time sitting at a desk or computer.
Recently, Bob began feeling pain in his right shoulder when he reached overhead to serve a tennis ball. He felt the same kind of pain when he tried to throw a softball during his daughter’s softball practice.
After a few weeks, the shoulder pain worsened and Bob began to have difficulty just reaching into a cupboard to get a glass at home. Last night, the pain in his shoulder woke him up every time he rolled onto it. He decided to call his physical therapist.
Bob’s physical therapist performed a full evaluation of his shoulder. She noted he felt pain with certain shoulder movements, and had difficulty performing them due to weakness in the rotator-cuff and scapular muscles. She also saw that he had a rounded posture when sitting. She performed range-of-motion and other special tests on his shoulder. Based on her findings, she diagnosed shoulder impingement syndrome.
Bob and his physical therapist worked together to establish short- and long-term goals for his treatment. She prescribed ice to help decrease his pain, and taught him some gentle movement and strengthening exercises. She performed manual (hands-on) therapy on his shoulder to gently mobilize the joints and tissues.
Bob’s physical therapist showed him how to improve his posture when sitting at his desk at work, and taught him a home-exercise program of stretching, strengthening, and postural exercises, which she modified throughout the course of his therapy as his condition improved.
After a few weeks of diligent physical therapy sessions and performing his home-exercise program, Bob reported he was able to raise his shoulder completely overhead without pain or limitation, and sleep on his side comfortably at night.
Today, Bob is back playing tennis pain-free, and is able to “throw long” for his daughter during softball practice.
- A physical therapist who is experienced in treating people with shoulder impingement syndrome. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
The following articles provide some of the best scientific evidence for the treatment of shoulder impingement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Khan Y, Nagy MT, Malal J, Waseem M. The painful shoulder: shoulder impingement syndrome. Open Orthop J. 2013;7:347–351. Free Article.
Wilk KE, Hooks TR, Macrina LC. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J orthop Sports Phys Ther. 2013;43(12):891–894. Free Article.
De Mey K, Danneels LA, Cagnie B, Huyghe L, Seyns E, Cools AM. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther. 2013;43(1):3–10. Free Article.
Struyf F, Nijs J, Baeyens JP, Mottram S, Meeusen R. Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports. 2011;21(3):352–358. Article Summary on PubMed.
Castagna A, Garofalo R, Cesari E, Markopoulos N, Borroni M, Conti M. Posterior superior internal impingement: an evidence-based review [erratum in: Br J Sports Med. 2010;44(8):604.]. Br J Sports Med. 2010;44(5):382–388. Article Summary on PubMed.
Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil. 2006;16(1):7–25. Article Summary on PubMed.