What is shoulder impingement?
Shoulder impingement, also known as subacromial impingement is the most frequent cause of shoulder pain1. This condition can result in pain in the front of the shoulder, often present with repetitive overhead motions of the arms. This pain occurs when an area known as the subacrominal space becomes narrow, as a result of this decreased space different structures (such as tendon and bursa) can rub against each other resulting in irritation and pain in the front of the shoulder.
Commonly, shoulder impingement will cause pain with daily activity such as reaching up, reaching behind the back during dressing, or reaching overhead during work or sporting activity. If this condition persists for a prolonged period it can lead to an inflammation of structures of the shoulder resulting in conditions known as rotator cuff tendinitis or bursitis2.
How is shoulder Impingement diagnosed and treated?
Shoulder impingement can be accurately identified by a thorough physical exam performed by a physical therapist or other healthcare provider. Generally the patient will report a background of overhead work or sporting activity, anterior shoulder pain (front of shoulder), pain at night (sleeping on affected side), or a recent change in job or lifestyle activites3. Patients with impingement also commonly have a rounded shoulder posture which can result form extended sitting, such as office or computer work. This condition can also be confirmed with imaging such as X-ray, or MRI.
Physical therapy has been proven to be an effective method of treating shoulder impingement. Research indicates that specific exercise combined with a customized manual therapy treatment program is the optimal approach for treating this condition 4.
Each exercise program and manual therapy treatment is specific to each patient’s presentation, however for shoulder impingement, a program can be expected to include:
- Thoracic spine mobilization
- Glenohumeral joint mobilization
- Improving control and strength of scapular stabilizers
- Rotator cuff strengthening
- Shoulder stretching
- Pectoral stretching
- Posture education
- Ergonomic and lifestyle modification
Authored by: Kevin DiGiulio, PT, DPT, COMT
DiGiulio Physical Therapy & Wellness, LLC
- Sizer P, Phelps V, Gilbert K. Diagnosis and Management of the Painful Shoulder. Part 2: Examination, Interpretation, and Management.Pain Practice. 2003;3(2):152-185. doi:10.1046/j.1533-2500.2003.03022.x.
- David Z. Shoulder Impingement Syndrome.WebMD. 2014. Available at: Available at: http://www.webmd.com/osteoarthritis/guide/impingement-syndrome. Accessed June 15, 2015. Accessed August 4, 2015.
- SOLEM-BERTOFT E, THUOMAS K, WESTERBERG C. The Influence of Scapular Retraction and Protraction on the Width of the Subacromial Space.Clinical Orthopaedics and Related Research. 1993;&NA;(296):99???103. doi:10.1097/00003086-199311000-00018.
- Bang M, Deyle G. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. J Orthop Sports Phys Ther. 2000;30(3):126-137. doi:10.2519/jospt.2000.30.3.126.