Rob Rosa, MPT. Rob is a Graduate of the Physical Therapy
Program at Stockton. He was also a student athletic trainer
for 5 years.
The shoulder is the most complex joint in the human body. It is
designed primarily for mobility, which allows the athlete to perform the
precise and efficient motions necessary in many sports including throwing,
striking, and reaching. However, the structure of the shoulder that
gives you so much mobility, sacrifices joint stability. This lack
of stability makes you vulnerable to several shoulder instability injuries,
one of which is impingement syndrome.
What is it?
Impingement is a compression or grinding of tendons or bursa found within
the shoulder joint. Normally there is a space between the humerus
and the acromion (lateral tip of the shoulder). However, with
inflammation or with overuse injuries, this space may get smaller and
the tendons and bursae in the joint may become pinched with movements.
As with any syndrome, there are several possible causes to the pain
felt with impingement in the shoulder.
It hurts where?
Sharp shoulder pain will be felt throughout an arc with overhead activities
including throwing and reaching. This painful arc usually begins
when the arm is lifted to shoulder level. As the condition worsens,
the pain may become a dull ache throughout the entire motion.
If the supraspinatus tendon is being impinged the anterior/lateral aspect
of the shoulder will present with pain. The same symptoms occur
when the subacromial bursa (a friction-reducing pad in the shoulder)
is being impinged. If the infraspinatus tendon (part of the rotator
cuff) is being irritated you will be tender to touch on the back part
of your shoulder when you reach across your body with the painful arm.
How does it happen?
In most athletes, impingement syndrome is an overuse injury. Throwing
athletes tend to have laxity in the shoulder joint from repetitive overhead
activities which causes the shoulder structures to become stretched.
The rotator cuff muscles can stabilize this laxity but when they become
fatigued the tissues between the humerus and the acromion get compressed
and microtrauma results. Other causes include , poor posture,
faulty positioning of the scapula, and structural variations in the
Initially the pain will be felt near the tissue structures being impinged,
on resisted muscle contraction, and when the tissue is stretched.
If left untreated a painful arc will be felt with overhead activities
and weakness or poor endurance in the scapular stabilizers and rotator
cuff muscles will be noted. Impingment syndrome is classified
clinically in three stages:
Stage 1: swelling and pain from tissue compression
Stage 2: development of tendinitis.
Stage 3: rotator cuff tear from repetitive microtrauma.
Impingement syndrome is linked to several other specific injuries to
the shoulder. All athletes with impingement must be monitored
for shoulder instability and shoulder subluxation and/or dislocation.
This is because the impingement may be secondary to the instability.
If significant shoulder instability is found, an orthopedic consult
may be indicated to determine the exact cause and level of risk the
athlete faces with a return to athletic participation. Rotator
cuff tears can occur from direct trauma to the shoulder and all athletes
presenting with signs and symptoms of impingement syndrome should also
be screened for rotator cuff tears.
Ice wrapped around the shoulder for 20-25 minutes is an effective way
to aid in decreasing the inflammation found with impingement.
The athlete will also benefit from a rotator cuff/ scapular stabilizier
rehab program to improve endurance, strength, and proprioception (Body
Blade exercises, for example). By improving these aspects of the
shoulder complex you greatly enhance the stability of the joint. The
athlete will be limited in activities that aggravate the condition for
at least one week. This will be followed by a slow and carefully
monitored return to overhead activities.
1. Athletes in stage 1 will follow an ice and rehab program along with
limited participation in activities that aggravate the condition.
2. Athletes in stage 2 will follow an ice and rehab program and will
be required to avoid aggravating activities for at least one week.
3. Athletes suspected of stage 3 impingment syndrome will be referred
to an orthopedist before further participation in activity will be allowed.