Subacromial impingemnet

Subacromial Impingement

Subacromial impingement is a common condition that causes pain in the shoulder and upper arm. It occurs when the tendons of the rotator cuff or the space (bursa) overlying them become pinched in a tunnel called the subacromial space.

What is it?
The rotator cuff is a group of four muscles that wrap closely around the shoulder joint. The muscles attach from the shoulder blade and connect to the arm bone (humerus) via four tendons. These tendons run through a tunnel that is called the subacromial space (so named because it is beneath the acromion bone). Narrowing of this tunnel, which can occur either because of a bony spur or injury and thickening of the tendons, can cause the tendons to catch in the tunnel. This is referred to as Subacromial Impingement.

What are the Symptoms?

Shoulder pain is the most common symptom classically occurring when lifting the arm out to the side, or with overhead activities. Pain tends to occur over the point of the shoulder and the upper arm. Putting the arm into a sleeve of clothing often exacerbates symptoms. Pain at night can also occur, which may disrupt sleep.


The diagnosis can often be made from the history of symptoms and a detailed examination. An X-Ray will typically be taken to assess the bony anatomy of the shoulder and to exclude other conditions, such as arthritis and Calcific Tendonitis. An Ultrasound scan or MRI scan may also be arranged to identify injury to the rotator cuff tendons.

Treatment options

Available treatment options for subacromial impingement:

This can be highly effective. Avoiding activities which worsen the shoulder pain will help to reduce the stress on the tendons and promote healing.

Pain killers and anti-inflammatory medication may help to reduce and control symptoms, particularly in mild cases. Physiotherapy can also help to improve shoulder posture and the strength of the rotator cuff tendons, improving symptoms.

An injection of local anaesthetic and steroid may also be given into the subacromial space to help reduce inflammation around the tendons. This can be painful for the first 24 hours but, in combination with physiotherapy, can be very effective in reducing symptoms.


If symptoms are not alleviated by the above measures, surgery may be required to improve symptoms. This is often undertaken as a keyhole (arthroscopic) procedure. This involves removing bony spurs and inflamed bursa from the subacromial space to prevent further rubbing against the rotator cuff tendons. This is often performed as a day case procedure (where you go home on the same day). If there is a tear to the rotator cuff tendons, this may be repaired at the same time.


Following surgery you will have a dressing over the shoulder and be in a sling. The sling is usually required for the first 24 hours or so. Physiotherapy is essential post-operatively to enable return of movement and shoulder strength. Recovery from surgery typically occurs over a 6 week to 3 month period. Surgery will successfully treat symptoms in 85% of patients.

We’re ready to give expert advice on Subacromial Impingement