Subacromial Shoulder Pain (Impingement): Symptoms, Causes, Treatment

The term does not mean that bony compression is the only cause. Assessment distinguishes tendon-related pain from a major tear, frozen shoulder or referred neck pain.

Related reading: Elbow tendon pain and load adjustment.

Raising or lowering the arm, lying on that shoulder, dressing and work may hurt. Marked weakness following an injury requires assessment for other damage.

Repeated overhead loading, age-related tendon changes and abrupt activity increases may contribute. An imaging finding alone does not explain pain severity or establish a need for surgery.

Throwing, swimming, repetitive overhead work and age-related tendon changes increase risk. Treatment is adapted to examination findings and individual activity needs.

Examination assesses movement, strength, the neck and pain patterns. X-rays, ultrasound or MRI are selected when useful, particularly after injury or when a tear is suspected.

Guided exercise, load modification and suitable pain relief come first. Steroid injections may offer temporary relief in selected cases. Routine subacromial decompression is not recommended for chronic atraumatic shoulder pain.

Pain can disrupt sleep, work and daily activities; underuse may contribute to weakness or stiffness. Persistent symptoms warrant reassessment rather than automatically proceeding to surgery.

Build loads gradually, break up overhead tasks and maintain comfortable movement within a rehabilitation plan. Avoid prolonged immobilization or forcing the shoulder through severe pain.