Shoulder Impingement (Subacromial Pain Syndrome)

Overview

Shoulder impingement — now more often called subacromial pain syndrome — describes pain that comes on when you raise your arm, because the rotator cuff tendons and a fluid-filled cushion called the bursa become irritated in the narrow space beneath the bony roof of the shoulder (the acromion).

The old idea was that bone physically "pinches" the tendon. We now understand it is usually a problem of how the shoulder moves: if the shoulder blade does not rotate well, or the cuff muscles are not keeping the ball of the joint centred, the space narrows during movement and the tissues in it get sore. That is good news, because movement patterns can be retrained.

It typically affects people who do a lot of overhead work — swimmers, climbers, racket sport players, painters — and desk workers whose rounded, forward posture leaves the shoulder sitting in a cramped position all day. It overlaps heavily with rotator cuff tendinopathy and the two are often treated together.

Causes and risk factors

• Poor shoulder blade control or a rounded, forward-shoulder posture
• Repetitive overhead activity in sport or work
• Rotator cuff weakness or tendinopathy
• Tight chest muscles and stiff upper back
• A sudden increase in training, especially pressing and pull-ups
• Bursa inflammation (subacromial bursitis)
• Natural variation in the shape of the acromion

How we may be able to help

We start with a full assessment of how your shoulder, shoulder blade, neck and upper back move together. Special tests help us identify which structures are irritated, and our 3D posture scan can show rounded shoulders or an increased upper back curve that may be contributing. If needed, an online GP consultation can arrange an ultrasound scan to look at the bursa and tendons.

Physiotherapy then focuses on restoring space in the joint by retraining shoulder blade movement and strengthening the rotator cuff and the muscles that control the blade. This is combined with hands-on treatment: joint mobilisation of the shoulder and upper back, IASTM and cupping for tight chest and upper trapezius muscles, and kinesiology taping to encourage better blade position between sessions.

Our chiropractor can treat the stiff upper back (thoracic spine), which many people find makes it easier to lift the arm. For pain relief in the early phase, interferential therapy or therapeutic ultrasound may be used over the sore area. Where a tendon has become chronically irritated, focused shockwave may be considered.

What you can do at home

• Sit and stand taller: gently draw your shoulder blades back and down several times an hour
• Stretch your chest in a doorway for 30 seconds, a few times a day
• Temporarily reduce overhead lifting and pressing volume
• Keep moving the arm through pain-free ranges — avoid resting it completely
• Raise your monitor to eye level and bring your keyboard closer so your shoulders are not reaching forward
• Ice the front of the shoulder for 10–15 minutes after aggravating activity if it helps