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What is Shoulder Impingement?

What is Shoulder Impingement?

Shoulder impingement is a very common condition that is frequently seen by physiotherapists.

The shoulder joint is complex, with many different structures providing a very large range of movement while maintaining stability throughout range.

Shoulder impingement refers to when some of these structures become pinched in the subacromial space (underneath the bony part on the top of your shoulder).  This can be caused by a few different structures.

  • Subacromial bursa: Bursae a fluid filled sacs that provide cushioning for tendons around bony sites. If there is a biomechanical dysfunction (frequently caused by weakness of the rotator cuff muscles), this can cause the bursa to come under strain that it is not used to and cause inflammation.
  • Bony spurs: Sometimes a small spur of bone may form on the acromion which can irritate the tendons or bursa that sit underneath it.
  • Rotator cuff tendinopathy: As we get older, sometimes the tendons can under go some normal degenerative changes. However, sometimes these changes are pathological as a result of injury or overuse/biomechanical issues. Tendinopathy can cause the tendons to become enlarged meaning there is less space for normal movement leading to impingement.

These issues can cause pain with movement and issues with function of the upper limb as well as difficulty sleeping.  Pain can range from mild to severe.

Occasionally an injection may be required to settle inflammation down if the problem is not responsive to pain management through physiotherapy, and in the worst-case scenario a surgical intervention may be offered known as a subacromial decompression.

In most cases physiotherapy can help with shoulder impingement through management of pain and improving strength and function of the shoulder girdle as well as improving movement patterns of the upper limb

Tara lawson
Chartered Physiotherapist

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