Common Signs and Symptoms of Subacromial Impingement

Considered the most common type of shoulder pain among adults, subacromial impingement syndrome affects shoulder movement and reduced quality of life if not properly diagnosed and treated. Other parts of the shoulder such as the rotator cuff may also present pain when injured or torn, making it necessary for a clear identification of the patient’s symptoms prior to the creation of a management and treatment plan.

Signs and Symptoms:

The abrasive action of the surface under the acromion against the soft tissues located between the acromion and the humeral head of the shoulder can lead to the following symptoms of subacromial impingement syndrome.

Shoulder pain: Pain can occur when the shoulder is moved during an overhead motion. The sensation of pain can increase when the arm is elevated.

Tenderness: The affected area can feel tender usually at night when sleeping on the affected shoulder or with the arm above the affected shoulder.

Limited range of motion: Pain and inflammation can affect shoulder mobility, limiting its usual range of motion.

Oedema: Excess fluid can accumulate at the point of impingement and may be accompanied by warmth at the affected area.


3 Stages of Subacromial Impingement Syndrome:

Stage 1: Often seen in young adults under the age of 25, impingement is characterised by oedema and haemorrhage in the tendon area. Surgery may not be required.

Stage 2: This stage of impingement involves tendinitis at the rotator cuff which may require invasive procedures such as bursectomy and coracoacromial ligament division, often seen in patients between the age of 25 and 40 years old.

Stage 3: Impingement is associated with bone spurs and a ruptured tendon often manifested in patients over 40 years old. Anterior acromioplasty which aims to surgically remove a portion of the acromion to create more space for the movement of the rotator cuff may be required.


Certain risk factors may increase the chances of impingement:

  • repetitive overhead throwing activities performed by baseball pitchers
  • occupations that perform repetitive work in elevated shoulder postures such as painting, welding and carpentry
  • high volume competitive swim training
  • shoulder instability
  • scapula or shoulder blade dysfunction
  • poor thoracic postures
  • posterior shoulder soft tissue tightness


Examination of the patient’s history and physical condition is important and this includes documenting properly the patient’s symptoms as constant or intermittent, sharp or dull, aching or burning, and numb or tingling. The patient must also be examined for any presence of neck pain and pain radiating to the arm. A patient’s pattern of symptoms from day through night must be recorded, including changes in symptoms.

Other symptoms such as dizziness and sudden swelling of upper extremities may require referral to appropriate specialists.


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