Shoulder Impingement Syndrome

Shoulder Impingement Syndrome: Symptoms, Causes

Shoulder impingement syndrome is becoming more common among individuals who work for prolonged periods in static positions with raised arms (such as plumbers, builders, painters, and plasterers). Patients often initially attribute their symptoms to fatigue after a long day or muscle strain, and thus may not promptly seek orthopedic and surgical intervention. Eventually, this could escalate into a serious problem requiring surgical intervention.

The upper limb of the body plays a crucial role in anyone’s life, performing numerous functions daily. The shoulder joint in our body (where the shoulder connects to the bone) is considered the most mobile.

Specific sets of muscles and tendons play a role in the movement of the shoulder branch. Many muscles, such as the subscapularis, supraspinatus, infraspinatus, and teres minor muscles, are connected to the bone and shoulder. These muscles are interconnected by a set of tendons known as the rotator cuff.

Subacromial Impingement Syndrome:
Subacromial impingement syndrome, or secondary impingement syndrome, is a disorder in the normal function of the shoulder joint, where the tendons in the rotator cuff undergo wear and tear against the prominence of the bone, also known as the acromion. Hence the alternative name for this condition – subacromial impingement syndrome or impingement syndrome under the acromion.

When the arms move, the space under the acromion in the shoulder joint decreases, hindering the function of all muscles and tendons in this area. Therefore, it becomes challenging for us to perform a variety of physical tasks with raised arms. Generally, shoulder impingement syndrome results from inflammation, tearing, compression, and wear of joint elements due to friction. In rare cases, the disease may be due to a genetic factor, such as a specific structure of the shoulder bone and its prominence in an individual.

Since patients often delay seeking medical attention, unaware of the initial symptoms of the disease, subacromial impingement syndrome may acquire a chronic or even advanced form, necessitating surgical treatment.

Symptoms of Shoulder Impingement Syndrome:

  • Pain – the primary symptom of shoulder impingement. However, symptoms may manifest differently depending on the stage of development or severity of the injury.
    For example, patients may experience:
    • Dull but persistent pain in the shoulder area (properly manifests only when the disease is in its developmental stage).
    • Pain in a resting position (e.g., when the arms are raised behind the head while sleeping).
    • Sharp pain when moving the arm backward or raising it upward.
    • Pain when pressing on the tendons associated with the supraspinatus and infraspinatus muscles on the shoulder bone.

There is a simple way to diagnose shoulder impingement. It suffices for the patient to raise their hand to the side, and if the pain increases during the passage of the midpoint of this side, it can be considered a sufficiently accurate symptom. Regardless of the degree of pain, if it appears in the shoulder joint, the patient should seek medical attention for accurate joint diagnosis.


If you notice similar symptoms, consult your doctor. Do not self-medicate – it poses a risk to your health!

Diagnosis of Shoulder Impingement Syndrome:

Currently, there are several highly accurate methods to detect subacromial impingement syndrome and differentiate it from other conditions. We will discuss some key methods for diagnosing shoulder impingement:

  1. Impingement Test:
    The doctor alternately raises the patient’s arms to test positions. If there is pain in these positions, it indicates the presence of this condition. These practical tests contain a high level of diagnostic documentation.

For example, using a practical test to determine the nature of a shoulder joint injury:

  • Neer’s Pain Arc: The patient’s arms are placed on both sides of the body and moved actively or passively from the initial position. It is observed whether there is pain when moving the arm between 70° and 120°. If the patient feels it, it is considered a sign of injury to the upper muscle tendons, which are compressed during movement between the large prominence on the shoulder bone and the acromial formation.
  • Neer’s Painful Arc (forced forward flexion and straight abduction): The doctor stabilizes the patient’s posterior shoulder in a fixed position while simultaneously pushing their other hand in two directions (forward and upward and centrally at shoulder level). If the patient experiences severe pain at this time, it indicates the presence of shoulder impingement syndrome.
  1. Diagnostic Imaging:
    Our clinic doctors in St. Petersburg resort to this type of research if clinical tests indicate the possibility of serious damage, such as tendon tears or muscle tissue injuries, or injuries and deformities in bone tissues.

The possibility of using diagnostic imaging depends on the results of clinical tests or is assessed by the doctor after the initial examination.

Several tests can be assigned to the patient, including MRI, X-rays, ultrasound imaging, or endoscopic exploratory research.

  1. Neer’s Test:
    This test is an important diagnostic method that helps differentiate between shoulder impingement syndrome and other conditions. The test involves injecting anesthetic agents with lidocaine into the subacromial space. If the patient’s pain decreases or disappears, it confirms the diagnosis of shoulder impingement syndrome.

Conservative Treatment for Shoulder Impingement Syndrome:

If the patient seeks timely treatment from our doctors in St. Petersburg and does not allow the disease to progress, conservative treatment, i.e., non-surgical treatment, may suffice.

Conservative treatment methods include:

  • Corticosteroid injections.
  • Physical therapy.
  • Anti-inflammatory therapy.
  • Platelet-rich plasma injections.
  • Medical treatment for exercise therapy.

The duration of conservative treatment can be up to 4 months depending on the doctor’s recommendations. Surgical treatment is determined for the patient if positive improvements do not appear after several months.

Surgical Treatment for Shoulder Impingement Syndrome and Rehabilitation Operations:

Surgical treatment is determined if there is no improvement in conservative treatment or if significant tendon damage is discovered, and also if the disease progresses severely.

This operation is called correcting changes in the space containing the acromion. This procedure involves relieving pressure on the acromion, removing the bursa, and performing acromion reshaping surgery. These procedures are performed in our clinic hospital using modern endoscopic equipment.

Additionally, the rehabilitation period after surgery is determined to ensure wound healing and shoulder function restoration. This may include physical therapy sessions and exercises to strengthen the muscles surrounding the shoulder.

The optimal treatment is determined according to each patient’s condition and disease progression, and doctors make appropriate decisions to provide effective healthcare.

Article Author:

Dr. Ibrahim Mansour
A general practitioner and orthopedic specialist with 9 years of experience in the emergency department. Specializes in treating infectious diseases and gastrointestinal diseases, with a focus on skeletal aspects using therapeutic, surgical, and conservative methods for injuries, including sports-related ones, and major joint diseases in the extremities. His area of interest includes joint-preserving procedures in the knee and hip joints.