Shoulder Impingement Syndrome and Rotator Cuff Syndrome

Shoulder impingement syndrome is a type of shoulder pain typically felt with lifting your arm and which usually occurs due to repetitive stress. This condition is also sometimes called Rotator Cuff-Related Pain (RCRP) or Subacromial Pain Syndrome (SAPS).

It can involve problems in one or more of the tissues around the shoulder joint, including bursae (bursitis), rotator cuff tendons and muscles, or the biceps tendon. It can often limit your ability to reach and lift, do housework or yard work, or participate in your desired form of exercise; sometimes it can make prolonged computer work painful and difficult.

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Causes of Shoulder Impingement Syndrome

Shoulder Impingement Syndrome usually begins due to some sort of repeated stress to the shoulder that progresses into worsening irritation of muscles, tendons, or other surrounding tissues. It is often associated with work that involves repetitive movement of the shoulder and arm, requires a lot of upper arm strength, or exposes your arm to prolonged vibration. Muscle imbalance around the shoulder alters normal movement and causes pinching or rubbing of tendons attached at the front of the shoulder. If not treated, it can gradually progress to a rotator cuff tear, which is much more difficult to treat and may require surgery.

Poor ergonomics or certain postures can also predispose you to this condition. General stress can also be a contributing factor. Certain variations in the anatomy of the shoulder joint can also predispose some people to this condition. The longer you experience these symptoms for, the more challenging it can be to deal with, so early treatment can be beneficial.

  • Repetitive Stress to Shoulder
  • Repetiive Movements of the Shoulder and Arm
  • Prolonged Vibration of Shoulder
  • Prolonged Stress
  • Other Risk Factors
  • Medical Conditions

Symptoms of Shoulder Impingement Syndrome

If you have Shoulder Impingement Syndrome, you might feel pain around the top, side, front or back of the shoulder; sometimes the pain can refer further down your arm, and the muscles around your shoulder blade or neck may also feel tight. Typically your symptoms will be aggravated with reaching or lifting above shoulder height; you may feel like there is decreased strength in your shoulder. Sharp shoulder pain occurs with movements such as reaching overhead or into the back seat of the car.

  • Pain around the Top, Side, Front, or Back of the Shoulder
  • Pain Down Arm
  • Tight Muscles Around Neck and Shoulder Blade
  • Decreased Strength
  • Pain When Lifting or Reaching

Diagnosis of Shoulder Impingement Syndrome

Shoulder Impingement Syndrome is best diagnosed through a combination of clinical tests, which your physical therapist will perform at your initial evaluation by taking your shoulder through a series of different movements. Imaging is not required to diagnose this condition, and is not recommended if you have had this pain for less than 6 weeks. If your symptoms are chronic or not improving with conservative care, sometimes ultrasound imaging or MRI will be recommended.

In most states, you can start being treated by a physical therapist for this problem without a referral from another doctor, since conservative treatment via exercise and manual therapy is the preferred treatment method. Your physical therapist can refer you to a primary care doctor or orthopaedic specialist if the need arises.

Treatment of Shoulder Impingement Syndrome with Physical Therapy

Your physical therapist will start by assessing your shoulder movement, the strength and control of the muscles around your shoulder, any areas of tightness or stiffness that could be affecting your movement, and any postural or ergonomic factors that might be contributing to your pain. Physical Therapy treatment involves strengthening the muscles that hold the shoulder joint in the right place while stretching/releasing tight muscles that are pulling the shoulder in the wrong direction. Stiffness in the neck or upper back may also contribute to this problem, and good therapy will always evaluate these areas as well. It is likely that your therapist will also your neck and upper back as well, because stiffness or strength limitations in these areas can sometimes contribute to Shoulder Impingement Syndrome.

From there, treatment with your physical therapist may include hands-on manual therapy or dry needling to decrease pain and improve areas of tightness, a progressive, individualized exercise program, advice on how to modify your current activities, and other modalities to help decrease pain and irritation, such as taping techniques.

It is important to have a plan that is individualized to your current needs and demands of your day-to-day activity level. Sometimes corticosteroid injections can be helpful if used in conjunction with physical therapy, but are not as effective on their own. Surgery is no more effective than physical therapy for treating Subacromial Pain Syndrome; however, if left untreated, this condition can sometimes progress to a rotator cuff tear, which may warrant surgery.

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Prevention Tips for Shoulder Impingement Syndrome

A regular strengthening program and participation in sports have been shown to be beneficial in reducing the likelihood of Shoulder Impingement Syndrome, as well as improving ergonomics and combatting repetitive stresses in your work and daily life.

If you have this condition, your physical therapist can help you make a plan for ongoing exercise once you finish your course of PT, in order to help prevent this pain from recurring. Research shows that the sooner you can get back to activity, the better chance you have for success with your shoulder.

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References and Additional Research Reading

  1. Diercks, Ron, et al. “Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome: a Multidisciplinary Review by the Dutch Orthopaedic Association.” Acta Orthopaedica, Informa Healthcare, June 2014,
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