Shoulder Impingement Syndrome
- Ajinkya Achalare
- Oct 15
- 6 min read
Shoulder pain is one of the most common reasons people visit an orthopaedic clinic, and shoulder impingement syndrome is among the leading causes. As an orthopaedic doctor specialising in sports and shoulder injuries, I often see athletes, office goers and even senior citizens troubled by this condition. Understanding its causes, symptoms, and treatment can help patients find relief and return to an active life.
What is Shoulder Impingement?
The shoulder is a complex joint made up of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff, a group of four muscles, surrounds the shoulder joint, keeping it stable and allowing smooth movements.
Above the rotator cuff lies a bony structure called the acromion, which is a part of the scapula (shoulder blade). A small, fluid-filled sac called the subacromial bursa sits between the rotator cuff and acromion, acting as a cushion.
The rotator cuff tendons get compressed or “impinged” when the arm is lifted overhead due to various reasons. Repeated pinching causes inflammation in the tendons and the bursa (known as ‘bursitis’), swelling and eventually pain.
Why does it happen?
Shoulder impingement often develops from a combination of anatomical and lifestyle factors:
Overuse and repetitive overhead activity can cause significant stress on the shoulder, as seen in sports like swimming, tennis, and cricket, or occupations involving tasks such as lifting, painting, or carpentry.
Age-Related Degeneration - As we age, rotator cuff tendons lose elasticity, and the acromion may develop bony spurs, narrowing the space through which the tendons glide.
Postural Issues - Rounded shoulders from poor posture or prolonged desk work alter the shoulder mechanics and encourage impingement.
Previous Shoulder Injuries - Old fractures, instability, or rotator cuff tears can disturb normal movement patterns.
What symptoms can point towards a probable impingement?
Patients typically complain of pain on the side of the shoulder, especially while lifting the arm, reaching overhead, back or lying on the affected side. Early on, pain may be mild and activity-related, but over time, it can occur at rest and even disturb sleep.
Other symptoms include:
Weakness while raising or rotating the arm
Limited movements
A catching or clicking sensation
Pain radiating down the outer arm
If left untreated, persistent impingement may eventually lead to partial or full-thickness tears in the rotator cuff muscle tendon.
How is it diagnosed?
A thorough clinical examination is essential. It includes:
Specific history: Onset, activities, and aggravating positions
Physical tests: Neer’s and Hawkins-Kennedy tests, which reproduce the impingement position and hence pain
Range of motion and strength: To gauge tendon function.
‘Painful arc test’, in which patients feel the pain typically in 60 to 120 degrees of shoulder abduction, is a classical finding
Imaging helps to confirm the diagnosis and rule out other causes:
X-rays reveal bony spurs or an abnormal acromion shape.
MRI shows bursitis, inflammation and/or tears in the rotator cuff tendon
What are the treatment options?
Management depends on the severity of pain, lifestyle and the patient’s expectations. Most people improve without surgery if the condition is diagnosed early.
Conservative (Non-Surgical) Treatment
Activity Modification: Avoiding repetitive overhead actions and lifting heavy weights.
Physiotherapy: The cornerstone of treatment aimed at improving the space
beneath the acromion bone, focuses on:
Stretching the posterior shoulder capsule
Strengthening the rotator cuff and scapular stabilising muscles
Correcting posture
Anti-inflammatory Medications: Short-term use of NSAIDs reduces pain, internal swelling and allows the patient to start with physiotherapy
Cryotherapy: Applying ice packs after activity helps calm down inflammation.
Corticosteroid Injections: In cases of persistent severe pain, a targeted subacromial injection reduces local inflammation, provides temporary relief and facilitates physiotherapy.
Surgical Treatment
If symptoms persist beyond 3–6 months of structured therapy or if there is a significant rotator cuff tear, surgery may be recommended.
Arthroscopic Subacromial Decompression: Using a minimally invasive camera and instruments, the surgeon removes inflamed bursal tissue and may shave down bony spurs to create more space.
Rotator Cuff Repair: If a tear is present, it can be repaired arthroscopically during the same procedure.
Surgical outcomes are generally excellent when combined with proper rehabilitation.
Rehabilitation and Prevention
Recovery doesn’t end with surgery or medication. Physiotherapy remains key for restoring shoulder strength and motion. A typical rehab program includes:
Gentle stretching to regain full motion
Progressive rotator cuff and scapular muscle strengthening
Postural correction and ergonomic guidance
Preventing recurrence is equally important:
Warm up before sports and include regular shoulder stretches.
Strengthen the rotator cuff and upper back muscles.
Maintain good posture—especially if you work long hours at a desk.
Avoid repetitive overhead movements when possible.
Prognosis
With early diagnosis and dedicated therapy, most patients experience significant improvement within 6–12 weeks. Even athletes and physically active individuals can typically return to their sport after completing a structured rehabilitation program. Delayed treatment, however, increases the risk of chronic pain and rotator cuff damage.
When to See a Doctor
Seek professional evaluation if you notice: Shoulder Impingement Syndrome: A Doctor’s Detailed Guide
Shoulder pain is one of the most common reasons people visit an orthopedic clinic, and shoulder impingement syndrome is among the leading causes. As an orthopedic doctor specializing in sports and shoulder injuries, I often see athletes, office workers, and even seniors troubled by this condition. Understanding its causes, symptoms, and treatment can help patients find relief and return to an active life.
Understanding the Shoulder and the Impingement Mechanism
The shoulder is a complex joint made up of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff—a group of four muscles and their tendons—surrounds the shoulder joint, keeping it stable and allowing smooth movement.
Above the rotator cuff lies a bony structure called the acromion, part of the scapula. A small, fluid-filled sac called the subacromial bursa sits between the rotator cuff and acromion, acting as a cushion. In shoulder impingement syndrome, these soft tissues—primarily the rotator cuff tendons and the bursa—become compressed or “impinged” when the arm is lifted overhead. Repeated pinching causes inflammation, swelling, and pain.
Causes and Risk Factors
Shoulder impingement often develops from a combination of anatomical and lifestyle factors:
Overuse and Repetitive Overhead Activity: Sports like swimming, tennis, and cricket, as well as occupations involving lifting, painting, or carpentry, place constant stress on the shoulders.
Age-Related Degeneration: As we age, rotator cuff tendons lose elasticity, and the acromion may develop bony spurs, narrowing the space through which the tendons glide.
Postural Issues: Rounded shoulders from poor posture or prolonged desk work alter the shoulder mechanics and encourage impingement.
Previous Shoulder Injuries : Old fractures, instability, or rotator cuff tears can disturb normal movement patterns.
Symptoms to Watch For
Patients typically complain of pain in the front or side of the shoulder, especially when lifting the arm, reaching overhead, or lying on the affected side. Early on, pain may be mild and activity-related, but over time, it can occur at rest and even disturb sleep. Other signs include:
Weakness when raising or rotating the arm
Limited range of motion
A catching or popping sensation
Pain radiating down the outer arm
Left untreated, persistent impingement may lead to partial or full-thickness rotator cuff tears.
Diagnosis: How a Doctor Evaluates Shoulder Impingement
A thorough clinical examination is essential. As an orthopedic doctor, I assess:
Patient history: Onset, activities, and aggravating positions
Physical tests: Neer’s and Hawkins-Kennedy tests, which reproduce impingement pain
Range of motion and strength: To gauge tendon function
Imaging helps confirm the diagnosis and rule out other causes:
X-rays reveal bony spurs or an abnormal shape of the acromion.
Ultrasound or MRI scans show rotator cuff inflammation or tears, as well as
bursa swelling.
Key Takeaway from a Doctor’s Perspective
Shoulder impingement syndrome is both common and treatable. The earlier you address shoulder pain, the better your chance of avoiding surgery. A combination of accurate diagnosis, individualised physiotherapy, and lifestyle modification is usually all that’s needed for a full recovery.
If you experience shoulder discomfort that interferes with daily life or sports, don’t ignore it. Consult an orthopedic specialist to identify the cause and create a tailored treatment plan. With proper care, you can regain pain-free motion and return to the activities you love.
Dr. Ajinkya Achalare, Orthopedic & Sports Medicine Specialist
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