Shoulder Impingement: Symptoms, Causes & PT Treatment
Updated October 20261 minute read
Shoulder impingement is pain that occurs when the rotator cuff tendons and bursa get compressed or irritated as you raise your arm — often felt as a pinch partway up. It overlaps closely with rotator cuff tendinopathy. It's not dangerous and responds well to physical therapy focused on rotator cuff and shoulder-blade strength. Most people improve within 6–12 weeks without surgery.
What is shoulder impingement?
Impingement describes painful compression or irritation of the tendons and bursa in the space beneath the top of the shoulder blade, usually with overhead movement. Today it's understood as part of the same picture as rotator cuff irritation rather than a purely "structural" pinch.
Symptoms
The classic feature is a painful arc — pain partway through raising the arm out to the side — plus pain with overhead reaching and sometimes night pain. Strength is usually preserved early on.
What causes it / risk factors
Repetitive overhead activity, weak rotator cuff and shoulder-blade muscles, poor movement control, and a sudden increase in load contribute. It's common in overhead athletes and workers.
How it's diagnosed
Diagnosis is clinical, using movement and strength tests. Imaging is reserved for cases that don't respond or have atypical features.
Physical therapy treatment
What a PT does. Your therapist improves how the shoulder blade and cuff coordinate, settles the irritation, and progressively rebuilds capacity. Exercises & progression (overview). Rotator cuff and scapular strengthening, movement retraining, and graded return to overhead activity. Exercise is first-line and as effective as surgery for typical cases. Recovery timeline. Many people improve within 6–12 weeks.
Treatment options compared
PT is first-line. Activity modification and short-term pain relief help. Injections and surgery are reserved for cases that don't respond to a good rehab trial.
Red flags
Seek care for arm pain with chest pressure (emergency), a hot feverish joint, sudden major weakness, or deformity after injury.
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Frequently asked questions
Usually not — exercise-based PT is first-line and works well for most people.
Sources (5)
- AAOS OrthoInfo: Shoulder Impingement/Rotator Cuff Tendinitis. — AAOS OrthoInfo
- Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a placebo-controlled, three-group, randomised surgical trial. Lancet. 2018. — The Lancet
- NIH MedlinePlus: Shoulder Injuries and Disorders. — NIH/MedlinePlus
- Steuri R, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017. — BJSM
- Karjalainen TV, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev. 2019. — Cochrane
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.