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Leaflet: Subacromial impingement information and exercises

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Subacromial impingement information and exercises

1.What is subacromial impingement?

The shoulder complex is made up of three bones and has many muscles which control its function. There is an arch over the top of the ball and socket joint (gleno humeral joint) consisting of the acromion (end of the shoulder blade) and the collar bone or clavicle.

The space under this arch is called the subacromial space. Subacromial impingement syndrome (SIS) occurs when this space is compromised and the soft tissues within this space become caught or impinged in certain positions.

2. Causes of subacromial impingement

There are many possible causes that contribute to SIS and pain:

  • Can result from trauma but often comes on ‘out of the blue’.
  • Bony changes often linked to age related changes.
  • Shoulder instability – this can be related to poor muscle control.
  • Supporting structures around the shoulder can become tight affecting the way the shoulder moves.
  • Stiffness in the upper spine can affect the way our shoulder moves.
  •  Muscle control of the shoulder blade.
  •  Postural factors – a slumped posture can cause changes to shoulder function and result in pain.
  •  Soft tissue injury or swelling

3. Symptoms

Pain felt from SIS is normally on the outside of the upper arm. It can radiate as far as the elbow and rarely into the lower arm. Often patients with SIS will also experience pain in the neck muscles on top of the shoulder. There is often a dull ache at rest as well as sharp pain associated with certain positions e.g. sudden forward movement of the arm.

4. Treatment

There is a growing body of evidence finding that conservative management is very effective at managing this condition. This will include pain management including medication, activity modification and specific exercises. More details on this can be found below. Alternative treatment options may include local injections and as a last resort surgical management.

5. Pain relief

Rest from painful activities
It is always important to keep moving, however resting from painful activities in the short term can ease strain on the shoulder allowing it to recover. Once pain has settled we can gradually return to normal activities.

This condition is normally worse when the arm is lifted forward or sideways to shoulder height. Avoiding this position will help the shoulder improve. If you need to lift an object consider bending your elbow first, or reducing the amount you are lifting. Where possible you should avoid lifting objects to shoulder height.

Pain relief
Paracetamol and ibuprofen are the first choice of pain medication. They can be taken together although it is recommended you stagger dosing. It is important to take these according to the packet information to gain the most benefit safely.

Other pain medications can be prescribed by your health care provider and these should be used following their guidance.

You should only take medicines if it is safe for you – if concerned speak with your prescriber or pharmacist first.

Heat or cold application can also help to reduce pain but ensure you apply either safely. Many methods are available such as cold/heat packs, gels and creams. If applying heat or cold packs a maximum of 10 minutes per use is advised to be used up to five times daily. If using gels or creams supplied by a pharmacy follow the pharmacist advice or packet guidelines.

Stand with your feet hip width apart and leaning forward onto your good arm. Make sure your free arm is fully relaxed. Slowly swing your affected arm forwards and backwards in a comfortable range 10-15 times.

Stand or sit with your elbow bent to half way with a pillow under your arm and your forearm against the wall. Push your arm into the wall as hard as you can comfortably. Hold 5-10 sec and repeat 10 times. As this becomes easier you can complete this with your arm further away from your body.

Stand with your feet hip width apart with your hands on the wall and your elbows straight. Keeping your elbows straight push your shoulder blades forward and backwards. Repeat 10-15 times.

Stand with your back against the wall with a tennis ball against your shoulder blade. Lean onto the tennis ball and gently roll the ball under your shoulder blade. Hold this for 30-60 seconds and repeat up to 10 times.

Aim to do all exercises 2-3 times daily as your pain allows.

Our spinal and shoulder posture can have a significant effect on how our shoulders move. The picture below demonstrates both good and bad posture. When sitting we should aim to have our back straight, our feet comfortably on the floor and our shoulder relaxed but not pulled forward. Try to focus on achieving a good posture about once an hour while sitting. If you can you should avoid sitting in excess of 30 mins without moving.

6. What to do if your condition continues

Following the above advice symptoms should gradually settle over 6-12 weeks allowing a full return to function. If symptoms fail to improve in this time or become more painful further treatment or investigation may be required. If symptoms are persisting you should discuss further management with your health care provider.