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Impingement Syndrome: Causes, Symptoms & Treatment

Impingement syndrome is a painful shoulder condition in which tendons or bursae become pinched in the joint. It causes pain when lifting the arm.

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Things worth knowing about "Impingement syndrome"

Impingement syndrome is a painful shoulder condition in which tendons or bursae become pinched in the joint. It causes pain when lifting the arm.

What is Impingement Syndrome?

Impingement syndrome (also known as shoulder impingement or subacromial impingement syndrome) is one of the most common causes of shoulder pain. It occurs when soft tissue structures – primarily the tendons of the rotator cuff and the subacromial bursa – become compressed between the head of the humerus (upper arm bone) and the acromion (the bony roof of the shoulder) during arm elevation. This leads to pain, inflammation, and progressively restricted shoulder movement.

Causes

Several factors can contribute to the development of impingement syndrome:

Repetitive overhead activity: Sports such as swimming, tennis, or throwing, as well as occupations that require repeated overhead movements (e.g., painters, construction workers)
Anatomical variations: A hooked or curved acromion (Type II or III) naturally narrows the subacromial space
Muscle imbalances: Weakness or imbalance of the rotator cuff or shoulder stabilizers alters the position of the humeral head
Inflammatory conditions: Bursitis or tendinitis increases the volume of soft tissue within the already limited space
Degenerative changes: Calcium deposits in the tendons (calcific tendinopathy) or age-related wear and tear

Symptoms

The most common signs and symptoms of impingement syndrome include:

Shoulder pain when raising the arm, especially between 60 and 120 degrees of elevation – known as the painful arc
Night pain, particularly when lying on the affected shoulder
Pain radiating into the upper arm
Weakness or fatigue in the shoulder
Reduced range of motion, especially during lifting or rotating the arm

Diagnosis

Diagnosis is typically made by a physician through a combination of:

Medical history and physical examination: Specific clinical tests such as the Neer test and the Hawkins-Kennedy test reproduce typical impingement pain
Imaging: X-rays identify bony abnormalities or calcium deposits; MRI (magnetic resonance imaging) provides detailed visualization of the tendons and soft tissues
Ultrasound: Allows dynamic assessment of tendons and the bursa during movement
Diagnostic injection: Injection of a local anesthetic into the subacromial space confirms the diagnosis if it provides significant pain relief

Treatment

Conservative Treatment

The majority of patients respond well to non-surgical treatment:

Physiotherapy: Targeted exercises to strengthen and stretch the rotator cuff and improve shoulder mechanics and posture
Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac to relieve pain and reduce inflammation
Corticosteroid injections: Local injection of corticosteroids into the subacromial bursa to reduce inflammation effectively
Shockwave therapy: Particularly effective in cases involving calcific tendinopathy
Heat and cold therapy: To manage acute pain and relax surrounding muscles
Activity modification: Avoiding provocative movements, especially overhead activities, during the recovery phase

Surgical Treatment

If conservative treatment fails to provide sufficient relief after approximately three to six months, surgery may be considered:

Arthroscopic acromioplasty: A minimally invasive procedure in which the undersurface of the acromion is shaved down to increase the subacromial space
Bursectomy: Removal of the inflamed bursa
Rotator cuff repair: Performed when concurrent tendon tears are present

Prognosis

With early and consistent treatment, the prognosis for impingement syndrome is generally favorable. Most patients achieve significant improvement through physiotherapy alone. Early diagnosis and adherence to a structured rehabilitation program are key to preventing chronic tendon damage and joint deterioration.

References

Neer CS 2nd. Impingement lesions. Clinical Orthopaedics and Related Research, 1983; 173:70-77.
Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics, 2003; 18(5):369-379.
Diercks R et al. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica, 2014; 85(3):314-322.

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