Shoulder pain – Could it be Subacromial impingement?


Shoulder pain is one of the most common musculoskeletal conditions that we treat in our clinic, and Subacromial Impingement is likely one of the most common causes of shoulder pain. Subacromial impingement is characterized by compression/irritation of the subacromial structures, such as the subacromial bursa and the rotator cuff muscles, against the external structures of the shoulder joint complex, such as the Acromion process, the Acromio-clavicular joint, and the Coracoacromial ligament.”

Shoulder Joint Complex:                                          Our shoulder complex is made up of Humerus (the arm bone), Scapula (shoulder blade), Clavicle (collar bone) and the Sternum (chest bone and yes Sternum is also part of the shoulder complex).   Image courtesy: – retrieved on 22 Sep 2023.

Movement at Shoulder Complex:                                                                        Shoulder movements are never isolated; any movement occurring in the shoulder is always a combination of movements in the joints made by the bones. When elevating the arm overhead, the following movements occur in combination:

  • Elevation of the Humerus

  • Outward rotation of the Humerus

  • Posterior tipping of the Scapula

  • Upward rotation of the Scapula

Normally, these movements occur together, and under normal circumstances, there is adequate space in the subacromial region, allowing unrestricted movement in the shoulder joint. However, when there are issues with weakness and tightness in the muscles of the shoulder complex, it results in biomechanical alterations leading to impingement and pain.

Image courtesy: – retrieved on 22 Sep 2023.

Typical Presentation:

Commonly presented as persistent pain while elevating the arm overhead,  Subacromial Impingement Syndrome exhibits the following characteristics:

  • Prominent pain between 60-120 degrees, often referred to as the “Painful Arc.”

  • Frequent night pain, especially when lying on the affected side.

  • Postural deviations caused by pain and muscle weakness.

Physiotherapy Management for Sub-Acromial Impingement:

The most important thing to recognize in subacromial impingement is that the cause of the pain is almost always beyond the site of pain. While the pain may result from the compression of structures between the Humerus and the acromion, this compression is often due to weakness and tightness in the muscles of the shoulder complex.

We will conduct a thorough assessment, which includes evaluating movement patterns and assessing the strength and flexibility of the muscles in the shoulder complex.

To address the pain stemming from the sensitized subacromial structures, we will employ physiotherapy modalities such as Therapeutic Ultrasound, Laser therapy, and, in some cases, Shockwave therapy or Dry needling.

To address muscle tightness and weakness, we will perform manual therapy to release tight myofascial structures and provide structured stretching and strengthening exercises.

In addition, we may apply Kinesiology tape to relieve some stress on the subacromial structures and promote improved joint position sense and joint tracking during movements.

We will also discuss ergonomic strategies to minimize the impact of work and posture on the shoulder joint.

Our goal is not only to address the current pain presentation but also to prevent future recurrences.”

If you or somebody you know is having shoulder pain, it could be due to subacromial impingement, but there could be other causes as well. We would suggest you to consult a physiotherapist to identify the cause of pain and start appropriate physio interventions to relieve pain and regain your function. 

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