Shoulder Impingement Syndrome
Topic at a Glance
- Shoulder impingement (often called shoulder impingement syndrome) occurs when soft tissues in the shoulder get pinched between the upper arm bone (humeral head) and the shoulder blade (scapula)/acromion.
- Risk factors & complications include overhead athletes, manual workers, and age-related changes. These can lead to rotator cuff disease, rotator cuff tendinopathy, biceps tendon injury, and possibly the need for shoulder impingement surgery.
- Symptoms include shoulder pain (especially with overhead movement), reduced range of motion, weakness, and nighttime pain.
- Treatments range from rest, NSAIDs, physical therapy, steroid injections, to surgical options like subacromial decompression when conservative care fails.
Shoulder impingement can turn simple arm movements into painful ordeals. The sensation of your shoulder hurting when you lift your arm or reach behind you might be a sign that something more is going on with your shoulder joint.
If you’re looking for expert care, consider visiting Paspa Physical Therapy. Sessions are carried out in our private treatment rooms and full gym, offering the kind of tailored care that can help relieve pain and restore function. Reach out to our Manhattan clinic today to schedule a consultation.
What is Shoulder Impingement?
Shoulder impingement refers to the condition where the soft tissues, such as the rotator cuff tendons, subacromial bursa, or the biceps tendon, inside the shoulder joint become compressed or “impinged” during arm motion. Subacromial impingement syndrome is the most common form.
Understanding the anatomy helps explain this. The shoulder joint’s ball, found at the top of the upper arm bone (the humeral head), moves inside the socket of the scapula (shoulder blade). This is called the glenohumeral joint. Above this joint is the acromion, which is part of the scapula.
The space between the acromion and the humeral head is called the subacromial space. When that space narrows, the rotator cuff tendons and the subacromial bursa (a fluid-filled sac) may get compressed or impinged.
What Causes Shoulder Impingement?
Several factors can cause or contribute to shoulder impingement:
- Structural or anatomical narrowing: A hooked acromion or bone spurs growing on the acromion (or along the acromioclavicular joint) reduce the space under the acromion and above the humeral head, leading to compression of soft tissue.
- Overuse of the rotator cuff and shoulder muscles: Repeated overhead arm movements (as in swimming, tennis, baseball, painting, construction work) irritate the rotator cuff tendons or the subacromial bursa.
- Degenerative changes and soft-tissue swelling: With age, rotator cuff tendons may suffer wear, and thicken, or bursitis may occur. This causes impingement as the swollen soft tissues take up more space.
- Muscle imbalance or scapular dysfunction (scapular dyskinesis): Weakness of the shoulder blade stabilizers, or improper motion of the scapula, can allow the humeral head to ride up (superior migration) and reduce the subacromial space during motion.
- Trauma or injury: A fall or blunt impact can lead to swelling or structural change in the shoulder that leads to impingement.
What Are Shoulder Impingement Risk Factors and Complications?
Risk factors include the following:
- Participation in sports with repetitive overhead motions (swimming, volleyball, tennis).
- Jobs involving overhead work or repetitive shoulder usage (painters, carpenters, window washers).
- Older adults are at higher risk for degenerative changes and bone spur formation.
- Anatomical factors such as a hooked acromion or a narrowed subacromial space.
Complications, if left untreated, may include the following:
- Progression into more severe rotator cuff disease, including partial or full tears of the rotator cuff tendon.
- Development of frozen shoulder or persistent shoulder pain and loss of range of motion.
- Need for surgical treatment (such as subacromial decompression) when conservative management fails.
What Are the Signs and Symptoms of Shoulder Impingement?
Typical signs and symptoms include the following:
- Shoulder pain (especially in the front or side of the shoulder) during overhead movement, lifting, or reaching.
- Pain when lying on the affected side, and possibly disturbed sleep due to discomfort.
- Weakness or inability to lift or rotate the upper arm properly.
- Catching, grinding, or feeling like you have a pinched nerve when moving the shoulder.
How Do You Diagnose Shoulder Impingement?
Diagnosis typically involves the following:
- Physical examination: Your clinician will assess shoulder anatomy, look for pain with certain movements, check your range of motion, strength of the rotator cuff, and observe shoulder blade mechanics (scapular motion).
- Specific tests for impingement: For example, the Neer test or Hawkins-Kennedy test can provoke symptoms by narrowing the subacromial space.
- Imaging tests: These can rule out other shoulder pathologies such as a rotator cuff tear, biceps tendon injury, or arthritis. X-rays can show bone spurs or the acromion shape. MRI or ultrasound can show soft-tissue changes in the rotator cuff tendons or subacromial bursa.
How Do You Treat Shoulder Impingement?
Treatment has tiers, starting conservatively and escalating if needed:
- Rest and activity modification: Avoid overhead or aggravating movements until the shoulder settles.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These relieve pain and reduce inflammation of tendons and bursae.
- Physical therapy: A physical therapist will work to relieve pain, restore range of motion, strengthen the rotator cuff tendons and shoulder muscles, correct scapular dyskinesis, and gradually restore function. At Paspa Physical Therapy, you’ll get one-on-one care from experienced therapists in a full gym and private rooms.
- Steroid injections: For some cases, a corticosteroid injection into the shoulder joint or subacromial space may help when pain is significant or therapy progress is limited.
- Surgical treatment: If the above fail, or if there is significant structural damage (e.g., rotator cuff tear, large bone spur), surgery may be recommended. The most common is arthroscopic subacromial decompression, where the acromion or bony spur is reshaped or removed to enlarge the subacromial space.
How Can I Prevent Shoulder Impingement?
Prevention strategies are vital, especially if you’re in a higher-risk group. Consider:
- Strengthening the rotator cuff tendons and the surrounding shoulder muscles to maintain a balance of forces, and keeping the upper arm bone (humeral head) centered in the socket.
- Maintaining good posture and shoulder-blade (scapular) mechanics. Avoid a forward-rounded shoulder blade position that reduces the subacromial space.
- Minimizing overhead repetitive work or incorporating breaks and varying movements.
- Stretching and warm-up of the shoulder muscles before activity, and gradually building up overhead motion rather than jumping into it.
- If you feel pain starting, seek treatment early. Intervention may prevent progression to rotator cuff tendinopathy or tear.
Physical Therapy for Shoulder Impingement in Manhattan, NY
If you are struggling with shoulder pain, limited shoulder motion, or the kind of discomfort that wakes you at night, you don’t have to wait until the pain becomes worse. With tailored care, you can relieve pain, regain function, and avoid more invasive treatments down the line.
At Paspa Physical Therapy in Manhattan, you’ll receive one-on-one sessions with experienced physical therapists. We don’t use aides or trainees. Our physical therapists offer private rooms and a full gym to help address shoulder impingement and other shoulder conditions using individualized plans. Contact us today to schedule a consultation and get on the path to recovery.
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FAQs About Shoulder Impingement
What is the difference between internal impingement and external impingement?
External impingement (often called subacromial impingement) occurs when soft tissues (rotator cuff tendon, subacromial bursa) get pinched between the acromion and the humeral head. Internal impingement occurs inside the glenohumeral joint and often affects overhead throwing athletes.
Will shoulder impingement go away on its own?
In some mild cases, yes. With rest and activity modification, the pain may settle. However, if untreated, it can progress into more serious rotator cuff tendinopathy or tears, so early-stage care is advised.
How long does treatment for shoulder impingement usually take?
It depends on severity. Many people see improvement within weeks of physical therapy and activity modifications. Full recovery, restoring the full range of motion and strength, may take months, and surgical recovery may take longer.
Do I always need surgery for shoulder impingement syndrome?
No. Most cases are managed non-surgically with therapy, strengthening, and inflammation control. Surgery is reserved for cases where conservative care fails or there is underlying structural damage, such as large bone spurs or a rotator cuff tear.
What should I look for in a physical therapist for shoulder impingement treatment?
Look for a physical therapist with experience treating shoulder conditions in a one-on-one session rather than in a group class. You should have access to a full gym where you can do strengthening, flexibility, and functional retraining. At Paspa Physical Therapy, we provide these elements in our Manhattan practice.