Shoulder Impingement

One of the more common injuries I see at Range of Motion Physical Therapy is shoulder pain. Our shoulders are made up of several joints combined with tendons and muscles that allow a great range of motion of the arm. The shoulder is vulnerable to many different problems, I will focus on the more common source of pain and injury, the rotator cuff and impingement.The rotator cuff keeps the head of the humerus in the shoulder socket.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa allows the rotator cuff tendons to glide freely when you move your arm. (see image above)

Types of complications:
Tendinitis. The rotator cuff tendons can be irritated or damaged.

Bursitis. The bursa can become inflamed and swell with more fluid causing pain.

Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

Rotator cuff injuries are common in both athletes and middle-aged people, athletes who participate in overhead sports such as swimming, baseball, or tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible from over use issues.


  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements

As the problem progresses, the symptoms can worsen:

  • Pain at night lying on shoulder
  • Loss of strength and motion in the shoulder
  • Shoulder pain reaching arm behind the back

I would always advise people seek help for an injury that persists for more than 10 days.


In most cases, initial treatment is conservative involving rest, ice and gradual return to function. A physical therapy treatment will include postural assessment and orthopedic test to identify any postural/muscle imbalances in the shoulder and the cause of the impingement. Treatment will involve hands on soft tissue work, strengthening and stretching targeted muscles, to improve movement patterns and prevent the impingement and pain. As your pain is improving, a shoulder strengthening program for the rotator cuff muscles will be initiated.

If you are suffering from shoulder pain and please contact me for an assessment and treatment.