Do you ever have that sharp “pinching” pain when raising your arm up? Many individuals deal with what is known as shoulder impingement. Shoulder impingement is often characterized by a painful arc of movement in which one of the rotator muscles becomes impinged or “pinched” within the subacromial space.
This subacromial space is essentially the area between the roof of the shoulder (acromion) and the head of the humerus (upper arm). This subacromial space contains many important structures some of which include rotator cuff muscles, long head of the biceps tendon, and bursa.
Causes of Shoulder Impingement
Although the signs and symptoms associated with shoulder impingement or subacromial pain syndrome (SAPS) may be similar, there are a variety of causes which may result in the condition.
- Overuse/Repetitive overhead movements: Activities or jobs involving extensive utilization of the arm in an overhead movement pattern
- Bone spurs/Age related changes: Over time tendons can degenerate and bony formations (bone spurs/osteophytes) can occur leading to shoulder impingement. Arthritis can also have an impact on the surrounding structures which may lead to shoulder impingement
- Scapular dysfunction/Poor posture: An often overlooked area of shoulder impingement stims from the shoulder blade (scapula) in which abnormal scapular movement patterns or poor posture affecting the positioning of the scapula can result in shoulder impingement
- Rotator cuff dysfunction: A weakened rotator cuff or inflammation of the rotator cuff muscles may be a cause as well.
- Trauma: Trauma can lead to inflammation and mechanical changes in the shoulder which may be a result of joint dislocation, damage to the rotator cuff, or shoulder labrum.
Conservative treatment for Shoulder Impingement
Conservative treatment may include a patient specific therapy program and another option within this section may include corticosteroid injections. These corticosteroid shots are anti-inflammatory medications that are injected into the joints, tendons, or muscles. Corticosteroid injections alone demonstrated worse outcomes in the three areas of pain, passive range of motion, and range of motion in comparison to corticosteroid injections + therapy have been shown to display significant improvements in pain, range of motion, and passive range of motion (2).
Evidence-based therapy may include manual therapy, stretching, and strengthening in which these aspects combined have shown to result in improved functional capacity (5).
Surgical Treatment for Impingement
Subacromial decompression is a surgery that is often done using an arthroscope; During this surgery, the acromion is reshaped and damaged tendons are removed or repaired as well as any other underlying factors may be addressed. The goal of this surgery is to increase the space between the acromion and rotator cuff tendons to decrease impingement of the shoulder. Surgery is typically reserved for patients who fail to improve after prolonged conservative treatment (often 3–6 months) or those with structural abnormalities contributing to persistent symptoms.
It should also be noted that from previous studies that arthroscopic decompression + arthroplasty was found to be more effective than decompression itself. Despite significant differences in range of motion and pain, the difference in passive range of motion was not significant (2).
Following surgical intervention, you will often wear a sling for a period of time as advised by the medical professional performing the surgical intervention. In addition to this, it will be advised that you should perform a rehabilitation program to restore ROM as well as strength due to muscular atrophy (weakness) that may be present.
Comparing Both Treatment Options
Following a 10 year study on the comparison of surgical intervention (subacromial decompression) versus conservative treatment with therapy services, individuals within the conservative treatment group had significantly higher mean Constant-Murley Score (CMS) which helps to assess shoulder function and pain (3).
Similar findings were noted in another study in which the utilization of nonconservative treatment was underutilized in the perspective of the authors. In this study, it was noted that prior to surgical intervention it was recommended that evidenced based non-operative care be performed prior to surgical intervention. This non-operative care was noted to be supervised therapeutic exercise to address the deficits associated with the condition (1).
In the case of high level symptoms, another study recommended corticosteroid injection + therapy as the first option to treating the condition followed by acromioplasty + therapy if the symptoms show minimal improvement over time. In the case of the latter of the two, acromioplasty + therapy yielded excellent outcomes in terms of pain, passive range of motion, and range of motion (2).
The Takeaway
Over the years, there has been extensive research completed regarding the utilization of therapy services to facilitate decreased pain, increased functional independence, and increased pain free ROM. Conservative treatment, which includes a patient specific exercise program, remains the cornerstone of shoulder impingement management and should be exhausted before considering surgery. A patient-specific approach guided by symptom severity, functional demands, and response to therapy can often yield the best outcomes.
If conservative treatment does not create the desired outcomes, then surgical intervention (subacromial decompression + arthroplasty) may be a next step approach. With the cost and potential for surgical complications, it is often recommended that conservative options are utilized as a first option of treatment (4). Overall, these are options that you should discuss in detail with your medical provider to further look at the options that may be best for you and your condition.
And, if you want guidance about what movements to do and which to avoid to work on your shoulder impingement, schedule an appointment with a physical or occupational therapist near you.
Be sure to check out our resources and courses to learn more about pain, movement, and living an active, pain-free life!
References
[1] Hando, B. R., Rhon, D. I., Greenlee, T. A., Cleland, J. A., & Snodgrass, S. J. (2025). Do Patients With Shoulder Pain Exhaust Nonoperative Care Prior to Undergoing Subacromial Decompression Surgery? Results From a Large Retrospective Observational Study of US Service Members. Physical Therapy., 105(9). https://doi.org/10.1093/ptj/pzaf104
[2] Lavoie-Gagne, O., Farah, G., Lu, Y., Mehta, N., Parvaresh, K. C., & Forsythe, B. (2022). Physical Therapy Combined With Subacromial Cortisone Injection Is a First-Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta-Analysis. Arthroscopy : The Journal of Arthroscopic & Related Surgery., 38(8), 2511–2524. https://doi.org/10.1016/j.arthro.2022.02.008
[3] Petersson, A. H., Björnsson Hallgren, H. C., Adolfsson, L. E., & Holmgren, T. M. (2025). No need for subacromial decompression in responders to specific exercise treatment: a 10-year follow-up of a randomized controlled trial. Journal of Shoulder and Elbow Surgery : JSES., 34(6), e477–e487. https://doi.org/10.1016/j.jse.2024.10.027
[4] Saltychev, M., Äärimaa, V., Virolainen, P., & Laimi, K. (2015). Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disability and Rehabilitation., 37(1), 1–8. https://doi.org/10.3109/09638288.2014.907364
[5] Tauqeer, S., Arooj, A., & Shakeel, H. (2024). Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial. BMC Musculoskeletal Disorders., 25(1). https://doi.org/10.1186/s12891-024-07294-4
