Sub-Acromial Impingement

Sub-acromial impingement is not a diagnosis but a symptom of a muscular imbalance at the shoulder and scapula regions. This can be due to a rotator cuff strain, partial or full thickness tear, tendinopathy, trauma or simply muscle imbalance from poor sitting posture or overworking anterior muscles in the gym

This can occur if there is an abnormality affecting the rotator cuff, scapula function or the thoracic spin

Sub-Acromial Impingement

A.) Schematic anatomy of a healthy glenohumeral joint and subacromial space B.) Schematic anatomy of a shoulder joint with the presence of several etiologic mechanisms for Subacromial Impingement Syndrome

Subjective History

  • Acute or insidious onset 
  • A positive painful arc (between 60 and 120 degrees abduction)
  • In the acute stages a patient may have severely limited range of movement secondary to pain
  • Often activities such as overhead activities, putting a seat belt on, putting bra or tops on, or reaching up to top shelf cause pain

Objective Examination

  • There will be a painful arc on active range of movement
  • Full passive range of movement
  • A patient will commonly describe pain on the affected side, particularly on external rotation
  • They may have abnormal movements of the scapula through shoulder motion

Treatment / Management / Rehabilitation

  • Early referral to physiotherapy  which may include manual therapy, exercise and acupuncture can have a pain relieving effect
  • At the sub-acute stage passive treatments have little effect
  • Exercises will increase in difficulty and resistance, a focus on function will be introduced
  • Once normal function has returned, exercises to return patient to all their normal activities can then devised

Through all stages the patient should keep themselves physically fit by participating in non-aggravating exercise such as cycling


  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC

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