There is perhaps no joint in the human body as complex, fascinating, or baffling as the shoulder. Its elegant design provides great range of motion, but not much stability, and pain can be a resultant factor in abuse.

This article addresses shoulder impingement, common in individuals with poor posture and scapula (shoulder blade) movement dysfunctions. These are caused by tightness in the chest muscles and weakness in the upper back muscles, particularly the serrateus anterior, allowing the shoulder blade to be pulled forward.

Impingement Syndrome is caused by the tendons of the rotator cuff becoming 'impinged' as they pass through a narrow bony space called the subacromial space – so called because it is under the arch of the acromion. By getting repeatedly 'scraped' against the shoulder blade, the tendon can eventually become frayed and weak.

This problem can also occur due to arthritis and bony spurs (problems with the bone of the acromion) which are chronically painful. Pain become more evident during activities when the arm is raised overhead and can get worse at night time. A reliable sign of impingement syndrome is a sharp pain when you try to reach into your back pocket, and as the condition worsens, the discomfort increases.

How is rotator cuff impingement syndrome diagnosed?

To help determine the cause of pain, an assessment with a therapist is necessary. This includes:

Examining the shoulder for swelling, bruising, muscle wasting/tightness, painful joints or postural issues.

Active and passive range of motion, as well as resisted muscle tests.

The therapist may use what is called an empty can test, a Neer’s test, and a Hawkins-Kennedy test, to look for impingement of the supraspinatus.

Treatment options

Treatment for rotator cuff impingement syndrome is similar to that for rotator cuff tendonitis. Rest from all aggravating activities, especially those involving overhead movements, but be careful to keep your shoulder mobile so that it does not stiffen up. Apply ice to the painful area for the first few days. 15 minutes at a time, every 2-3 hours, for about a week.

Mobility exercises and stretching should begin as soon as pain will allow and should avoid any areas of movement that cause pain. When lifting the arm out to the side (abduction) above horizontal should be done with the arm rotated outwards. The same applies to movements lifting the arm up forwards (flexion). And after a week of these, a strengthening routine should be started and progressed gradually throughout the program as pain allows.

If rotator cuff impingement syndrome is not recognized and treated promptly, it can lead to excessive wear and tear of the rotator cuff tendon, which can weaken and tear. Impingement is usually aggravated through recurrent injuries or repetitive work, so prevention is always better than a cure.