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What Causes Shoulder Impingement?

Shoulder pain that won’t quit when you lift your arm overhead or throw a ball could signal something more than mere overuse. If you feel a pinching, aching, or sharp jab near your shoulder joint when raising your arm, it may be time to explore what causes shoulder impingement, a condition that affects many people, especially those active in overhead sports or repetitive tasks.

If you’re experiencing persistent shoulder pain, don’t wait. Contact the practice of Benjamin W. Szerlip, DO, a fellowship-trained shoulder and sports medicine surgeon in Austin, Texas, for expert evaluation and care tailored to your needs.

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Topic at a Glance

  • Shoulder impingement syndrome happens when soft tissues get pinched in the shoulder joint, often involving the rotator cuff tendons and the subacromial space.
  • Risk factors include repetitive overhead sports/work (e.g., swimmers, young athletes), weak rotator cuff/shoulder blade muscles, bone spurs, and age-related changes.
  • Symptoms include shoulder pain (especially with lifting), weakness, reduced range of motion, night pain, and tenderness.
  • Treatment starts with non-operative approaches, including rest/modification, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and steroid injections; surgery is reserved for cases that fail conservative care.

What is Shoulder Impingement Syndrome?

Shoulder impingement describes a condition where the soft tissues, such as the rotator cuff tendons or the subacromial bursa (a fluid-filled sac), get compressed or “pinched” between the upper arm bone (the humerus) and the shoulder blade.

When the rotator cuff tendons are irritated or thickened, they are more likely to be caught in the narrow space beneath the acromion (part of the shoulder blade).

There are different variations of shoulder impingement. For example, subacromial impingement (external impingement) is the most common, and internal impingement may occur in throwing athletes.

A swimmer with shoulder impingement in Texas.

What Causes Shoulder Impingement?

Understanding what causes shoulder impingement helps you recognise why you might be at risk. Some key causes include:

  • Structural/anatomic factors: The shape of the acromion or the subacromial space may cause narrowing, leading to pinching of the rotator cuff tendons or bursa. For example, a hooked acromion or bone spurs can reduce space.
  • Soft-tissue changes: Thickening or degeneration of the rotator cuff tendons, known as rotator cuff tendinosis, or inflammation of the subacromial bursa, can shrink the subacromial space, making impingement more likely.
  • Overuse or repetitive activity: Frequent overhead movements can stress the rotator cuff and increase the risk of impingement syndrome.
  • Poor posture / improper mechanics: Forward-rounded shoulders, improper shoulder blade movement (scapular dyskinesis) can alter shoulder joint mechanics and reduce the subacromial space during motion.
  • Degenerative or age-related changes: As we age, wear and tear on the rotator cuff tendons and the shoulder bones (degenerative changes) may lead to bone spurs and impingement.
  • Trauma or injury: A fall, shoulder fracture, dislocation, or sudden impact can lead to inflammation/swelling of soft tissues in the shoulder, which then may get impinged.
 

In short, many cases of shoulder impingement are caused by a combination of structural, functional, and degenerative factors.

What Are Shoulder Impingement Risk Factors?

Those at risk of shoulder impingement include the following:

  • Repetitive overhead movement in sports or work.
  • Young athletes engaging in throwing/overhead sports.
  • Weakness of the rotator cuff and shoulder blade muscles.
 

What Are Shoulder Impingement Complications?

If shoulder impingement is not addressed, possible complications can include the following:

  • Progression to a rotator cuff tear occurs because the rotator cuff tendon is continuously irritated.
  • Development of adhesive capsulitis (frozen shoulder) due to chronic pain and restricted range of motion.
  • Chronic shoulder pain, impaired range of motion, weakness, and reduced quality of life.
  • Biceps tendon irritation (as the biceps tendon often lies near the shoulder region), secondary bursitis, or degenerative shoulder joint changes.
  • If structural impingement is severe, surgical intervention may become necessary.
 

What Are the Symptoms of Shoulder Impingement?

Recognising shoulder impingement symptoms is key to seeking treatment before more serious shoulder pathology develops. Typical shoulder impingement symptoms include:

  • Shoulder pain, particularly when lifting the arm overhead, reaching behind, or during a throw.
  • Pain is often located at the front or the top/outer aspect of the shoulder, sometimes spreading down the upper arm bone (humerus).
  • Night pain or pain when lying on the affected shoulder.
  • Weakness in the shoulder or upper arm during movement, reduced range of motion, and difficulty lifting or reaching.

If you’re experiencing shoulder impingement symptoms that persist, especially when combined with weakness or loss of range of motion, it’s best to seek evaluation.

How is Shoulder Impingement Diagnosed?

Diagnosis of shoulder impingement involves a combination of clinical assessment and imaging. Steps include:

  • Medical history: The clinician will review your activities, timing of your shoulder pain, prior shoulder injuries, posture/ergonomics, and what movements trigger the pain.
  • Physical examination: Special tests such as the Neer impingement sign and Hawkins-Kennedy test may reproduce pain when the shoulder is positioned in certain ways. The provider will also assess your range of motion, strength, and inspect for muscle imbalance or scapular dyskinesis.
  • Imaging tests: X-rays may reveal bone spurs, acromion morphology, AC joint changes, or narrowing of the subacromial space. MRI or ultrasound can evaluate the soft tissues.
 

Based on the combination of medical history, physical examination, and imaging tests, clinicians can diagnose shoulder impingement or rule out other shoulder pathologies. Early diagnosis helps avoid more serious outcomes.

A man strengthening his rotator cuff muscles in Texas.

Shoulder Impingement Treatment

Treatment for shoulder impingement typically includes the following:

Non-operative Management

  • Activity modification: Avoid or limit overhead or repetitive shoulder motions that trigger pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These help to reduce pain and inflammation.
  • Physical therapy: A physical therapist can provide exercises to help strengthen the rotator cuff tendons, stabilizing the shoulder blade (scapula), improving posture, restoring range of motion, and correcting movement imbalances.
  • Injections: If pain persists, steroid injections into the subacromial space or bursa may help relieve pain and inflammation.
 

Surgical Treatments

If conservative treatments fail and symptoms still persist, surgical treatments may be considered. The common surgical procedure is subacromial decompression, also called acromioplasty. An orthopedic surgeon from the shoulder joint team removes bone spurs or reshapes the acromion to create more space for the rotator cuff.

In some cases, if the rotator cuff tendon is torn, additional rotator cuff repair may be needed.

Can You Prevent Shoulder Impingement?

Yes, there are several steps to help prevent shoulder impingement or reduce its recurrence:

  • Maintain strong rotator cuff tendons and shoulder blade (scapula) muscles. Strengthening exercises help keep the upper arm bone centered in the shoulder socket and allow the shoulder joint to move smoothly.
  • Warm up properly before sports or overhead workloads; include dynamic stretches and mobility for the shoulder complex.
  • Use proper technique in sports (especially overhead throwing or swimming) and occupational tasks, avoiding repetitive overhead stress without rest.
  • Maintain good posture as poor posture can reduce the subacromial space and predispose to impingement.
  • Use ergonomic workstations when applicable.
  • Address shoulder pain early. If you notice pain or reduced range of motion in the shoulder joint, speak with a clinician early so that soft-tissue changes can be managed before structural damage occurs.
  • Avoid abrupt changes in workload, which can overload the rotator cuff tendons.
 

By taking these proactive steps, you can significantly reduce the risk of developing shoulder impingement or slow its progression if early changes are present.

Shoulder Impingement Treatment in Austin, Texas

If you’re experiencing persistent shoulder pain that may be related to impingement, or if you’ve been told you have rotator cuff tendon stress, narrowing of the subacromial space, or associated shoulder blade issues, reach out for expert evaluation. Schedule a consultation with Dr. Benjamin W. Szerlip, a fellowship-trained shoulder and sports medicine surgeon in Austin, Texas, and take control of your shoulder health today.

Request an Appointment

FAQs about Shoulder Impingement

What is the difference between shoulder impingement and a rotator cuff tear?

Shoulder impingement refers to the compression or pinching of soft tissues such as rotator cuff tendons or the bursa in the shoulder joint space. A rotator cuff tear occurs when one of the rotator cuff tendons is partially or completely torn. Impingement can lead to tendon degeneration and eventually a tear if untreated.

Recovery time varies depending on severity, but many patients begin to feel better within several weeks of initiating non-operative care. Full recovery may take several months. If surgery is required, rehabilitation may extend this timeframe.

Mild cases of impingement may improve with rest, activity modification, and good posture/technique adjustments. However, if underlying structural or repetitive-strain causes remain unaddressed, the condition may persist or worsen, potentially leading to tendon tears or chronic pain. Early intervention is best.

No, surgery is not always required. Most cases of shoulder impingement respond well to conservative treatments. Surgery is typically reserved for cases where non-operative treatment and significant structural issues remain.

You can take over-the-counter NSAIDs (after checking with your doctor), apply ice to the shoulder, avoid overhead or aggravating movements, and perform gentle range-of-motion stretches. However, working with a physical therapist to properly strengthen and restore mechanics is key to long-term relief.

  1. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis\
  2. https://www.orthobullets.com/shoulder-and-elbow/3041/subacromial-impingement


Dr. Szerlip has joined forces with Austin Orthopedic Institute

Located at: 11675 Jollyville Road Suite 207, Austin, TX 78759

and 1502 Blue Ridge Dr Suite 201, Georgetown, TX 78626

Call 512-856-1000 to request an appointment.