Subacromial Impingement
Dr. Pramod Bhor · Shoulder Impingement Specialist
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Causes of Subacromial Impingement
Vascular Factors
The tendons which make up the rotator cuff have sufficient vascularisation except the supraspinatus muscle tendon. Its blood supply relies on vessels from the anterior circumflex humeral artery and the sub- and suprascapular muscle arteries. The critical area—about 1 cm medial to the insertion—is relatively avascular, so nutrients that flow through the tendon diminish with age, making the tissue more vulnerable.
Mechanical Factors
Neer proved that during shoulder adduction the rotator cuff chafes against the underside of the acromion. Aggressive acromion shapes (types II and III) or acromial osteophytes further narrow the space. An unfused acromion (os acromiale) and thickening of the subacromial bursa can also cause abnormal rubbing of the cuff tendons.
Degenerative Factors
Degenerative changes to the rotator cuff occur predominantly in individuals over 50 years of age. Friction against the acromion accelerates this degeneration, triggering progressive cuff weakness and pain.
Symptoms of Subacromial Impingement
- Insidious and progressive onset of pain
- Gradual loss of shoulder strength
- Dull, persistent shoulder pain with a sensation of tiredness, especially at night
- Exacerbation of pain with excessive movement
- Radiating pain to the elbow
- Intensified pain when raising arms above the head or placing them behind the back
FAQs For Subacromial Impingement
What are the common causes of subacromial impingement?
Vascular limitations within the supraspinatus tendon, mechanical friction from aggressive acromion shapes or os acromiale, thickened bursae, and age-related degeneration collectively narrow the subacromial space and irritate the cuff.
What are the typical symptoms of subacromial impingement?
Gradual shoulder pain, night discomfort, strength loss, radiating pain to the elbow, and difficulty lifting the arm above the head are classic indicators.
How is subacromial impingement diagnosed?
A detailed clinical exam evaluating range of motion, provocative impingement tests, and imaging (X-ray, ultrasound, or MRI) helps confirm tendon irritation and identify contributing bone shapes.
What treatment options are available?
Early care focuses on activity modification, anti-inflammatory support, and targeted physiotherapy. Persistent cases may need injections, arthroscopic subacromial decompression, or acromioplasty to enlarge the space.
What are the possible complications if untreated?
Ongoing impingement can trigger rotator cuff degeneration, partial or full-thickness tears, chronic pain, and reduced shoulder function.
Can subacromial impingement be prevented?
Maintaining shoulder mobility, strengthening the rotator cuff, correcting posture, and avoiding repetitive overhead strain lower the risk.
What lifestyle changes help alleviate symptoms?
Adopt ergonomic work setups, pace overhead tasks, integrate stretching breaks, and avoid sleeping on the painful shoulder.
Is physical therapy beneficial?
Yes. Tailored physiotherapy improves scapular mechanics, strengthens the cuff, and relieves friction within the subacromial space.
What are the surgical options if needed?
Arthroscopic subacromial decompression, acromioplasty, or combined procedures that address bursae and spurs can restore space when conservative care fails.
How soon can one expect relief?
Mild cases improve within weeks of therapy, whereas chronic impingement may need several months or post-surgical rehabilitation for sustained relief.