Shoulder Sub-Acromial Impingement

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Shoulder sub-acromial impingement can be described as a pinching of soft tissues structures under the acromion (a joint at the end of you collar bone attaching to your shoulder). This pinching leads to irritation of the tissues and can lead to pain and inflammation.

Causes & Classifications
Primary Impingement: caused by degeneration or/and wear and tear of tissues (muscles, ligaments or bones)
Secondary Impingement: caused by imbalances of tissues within the shoulder (commonly an imbalance of muscle dynamics). This can be a development due to for example poor posture, injury or repetitive strain in adjacent structures to the sub-acromial space.


  • Patients may experience mild to severe pain in the general shoulder region (most commonly at the front of the shoulder)
  • Pain commonly radiates down the front of the arm and can go to the back of the shoulder.
  • Pain is often worse when bringing the arm up and away from the body - it can often be sharp with certain movements.
  • Night pain is common during the acute phase
  • Pain or discomfort can wake you at night (especially with certain movements)


An osteopath will take a full past medical history and perform a physical examination to determine which structures are causing the pain. There are some specific stress tests for the shoulder that may help to determine the cause of the problem. An examination of the function of the shoulder and its relationship with movement with the rest of the body will also help with determining secondary causes of impingement (e.g poorly functioning muscles).

An x-ray and/or ultrasound may assist in providing some more definitive information about some of the tissues that may be involved. An MRI will provide a more detailed image of the structures of the shoulder.


A detailed examination will dictate the structures required to be treated. Generally your osteopath will spend a lot of time ensuring that structures relating to shoulder are functioning as normally as possible with an aim to reducing the impingement.
Reducing pain will be the initial aim of your osteopath. A detailed examination should identify structures that require relaxation to reduce pressure on the inflamed area. Your osteopath will also go through rehabilitation exercises if there are secondary causes of impingement (e.g. muscle weakness).
Your osteopath will refer you to your GP or specialist should there be degenerative changes not responding to conservative treatment.
Self Management
  • Rest: there should be a relative period of rest from aggravating activities. Inflammation that is not aggravated should settle quicker. Pain and discomfort with certain movements are identified as aggravating factors.
  • Stretching all the structures around the shoulder may assist with freedom of movement and a reduction in impingement (your osteopath will advise on stretches specific to the areas requiring attention). General stretches to the whole body will also assist in freedom of shoulder motion.
  • Strengthening the muscles of the shoulder will assist with correcting any imbalances that may be contributing to impingement. Most commonly rotator cuff and scapular/shoulder blade strengthening is prescribed but your osteopath will identify appropriate exercises.
  • Lifestyle/Ergonomics: if there are postural or movement imbalances contributing to the impingement then making appropriate adjustments will assist in reducing symptoms. Your osteopath will identify this through your history and and physical examination.
  • You may benefit from pain relieving medication during the acute or painful phase of your injury so you may be referred to your pharmacist or GP.
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