Shoulder impingement syndrome is a condition where your shoulders rotator cuff tendons are intermittently trapped and compressed during shoulder movements. This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements. Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called Rotator Cuff Tendonitis. Likewise, if the bursa becomes inflamed, shoulder Bursitis will develop. Both these conditions can co-exist or be present independently.

While a traumatic injury can occur (e.g. fall), it is repeated movement of your arm into the impingement zone overhead that most frequently causes the rotator cuff to contact the outer end of the shoulder blade (Acromion). When this repeatedly occurs, the swollen rotator cuff is trapped and pinched under the acromion. Injuries vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness rotator cuff tendon tears, which may require surgery.


The main causes of shoulder impingement syndrome are repetitive overhead movements (i.e. golfing, throwing, racquet sports, and swimming, or frequent overhead reaching or lifting). Other causes include trauma (i.e. slip and fall), bony abnormalities of the acromion, poor rotator cuff and shoulder blade muscle strength, thickening of the bursa, thickening of the ligaments in the area and/or tightness of the soft tissue around the shoulder joint called the joint capsule. Poor posture can also contribute to its development. If left untreated, a shoulder impingement can lead to more serious conditions, such as a rotator cuff tear.


There are many structures that can be injured in rotator cuff impingement. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual since your static and dynamic posture, muscle strength, flexibility and spine shape all have important roles to play.

Once you suspect any rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.

Your rotator cuff is an important group of control and stability muscles that maintain “centralization” of your shoulder joint. In other words, it keeps the shoulder ball centered over the small socket. This prevents injuries such as impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

  • Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
  • Regain Full Shoulder Range of Motion
  • Restore Scapular Control and Scapulohumeral Rhythm
  • Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
  • Restore Rotator Cuff Strength
  • Restore High Speed, Power, Proprioception and Agility Exercises
  • Return to Sport or Work

For more information of the different treatments offered at our practice, please see the pages labeled Graston therapy, Rapid Release and Ultrasound.