The MSK Studio - spinal physiotherapy and Clinical Pilates clinic in Adelaide

Shoulder Impingement Syndrome

Region affected

Subacromial space / Rotator cuff

Common in

Adults 30–60, overhead workers and athletes

Onset

Gradual

Related conditions

Rotator Cuff Tendinopathy, Shoulder Bursitis, Thoracic Pain

Shoulder impingement syndrome describes a pattern of pain that occurs when the soft tissues within the subacromial space, the rotator cuff tendons and the subacromial bursa, are compressed between the head of the humerus and the overlying acromion. This compression typically occurs during overhead movement and produces a characteristic painful arc between approximately 60 and 120 degrees of arm elevation.

Impingement is not a diagnosis of a single structure but rather a mechanical pattern driven by the relationship between the rotator cuff, the shoulder blade and the space available for movement. When the shoulder blade is not positioned or moving well, which is frequently driven by thoracic stiffness and poor scapular control, the subacromial space narrows and compression increases. This is why shoulder impingement in many cases cannot be fully resolved by treating the shoulder alone.

What Causes Shoulder Impingement?

Signs and Symptoms

Impingement develops when the balance between the rotator cuff, scapula and thoracic spine breaks down. Common causes include:

Shoulder impingement has a fairly consistent presentation pattern:

  • Poor scapular control reducing the upward rotation of the shoulder blade during overhead movement
  • Thoracic spine stiffness limiting shoulder blade mobility and increasing subacromial compression
  • Rotator cuff weakness reducing the ability of the cuff to depress the humeral head during elevation
  • Repetitive overhead activity at work or during sport, particularly swimming, throwing and racquet sports
  • Postural loading from sustained desk or screen use increasing thoracic kyphosis
  • Subacromial bursitis as a secondary consequence of ongoing compression
  • Pain on the outer side of the shoulder, often radiating into the upper arm
  • A painful arc, symptoms that come on during shoulder elevation between 60 and 120 degrees and ease above and below that range
  • Pain with overhead reaching, lifting or sleeping on the affected shoulder
  • Weakness with shoulder elevation or rotation, particularly against resistance
  • Night pain, typically worse when lying on the affected side
  • Clicking or catching in the shoulder with certain movements

What Causes Shoulder Impingement?

Impingement develops when the balance between the rotator cuff, scapula and thoracic spine breaks down. Common causes include:

  • Poor scapular control reducing the upward rotation of the shoulder blade during overhead movement
  • Thoracic spine stiffness limiting shoulder blade mobility and increasing subacromial compression
  • Rotator cuff weakness reducing the ability of the cuff to depress the humeral head during elevation
  • Repetitive overhead activity at work or during sport, particularly swimming, throwing and racquet sports
  • Postural loading from sustained desk or screen use increasing thoracic kyphosis
  • Subacromial bursitis as a secondary consequence of ongoing compression

Signs and Symptoms

Shoulder impingement has a fairly consistent presentation pattern:

  • Pain on the outer side of the shoulder, often radiating into the upper arm
  • A painful arc, symptoms that come on during shoulder elevation between 60 and 120 degrees and ease above and below that range
  • Pain with overhead reaching, lifting or sleeping on the affected shoulder
  • Weakness with shoulder elevation or rotation, particularly against resistance
  • Night pain, typically worse when lying on the affected side
  • Clicking or catching in the shoulder with certain movements

How The MSK Studio Treats
Shoulder Impingement

At The MSK Studio in Adelaide, shoulder impingement assessment includes a thorough evaluation of the rotator cuff, subacromial space, shoulder blade, the thoracic spine and cervical spine. Treatment targets the full kinetic chain rather than the shoulder in isolation. Thoracic mobilisation is used to improve the available space within the subacromial region, scapular control exercises address the positioning and movement of the shoulder blade during elevation, and progressive rotator cuff strengthening restores the dynamic stabilisation of the glenohumeral joint.

See our shoulder physiotherapy service below:

Shoulder Physiotherapy

Related Conditions

Rotator Cuff Tears & Tendinopathy

Thoracic & Upper Back Pain

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