Shoulder impingement syndrome occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space under the coraco-acromial arch. It results in pain, weakness, and loss of movement, especially in an arc between 45-160 degrees of shoulder abduction and elevation. Causes include repeated overhead arm use, trauma, poor posture, and degenerative changes. Clinical features are pain at rest or with movement, and limited range of motion. Diagnosis involves x-rays and MRI, while special tests like Neer's and Hawkins' tests reproduce shoulder pain. Treatment consists of rest, anti-inflammatories, physical therapy including stretching,

1. Presented
By
MD. MONSUR RAHMAN
MPT (Musculoskeletal disorders)

2. Introduction
 Shoulder impingement syndrome, also called subacromial
impingement, painful arc syndrome, supraspinatus
syndrome , swimmer's shoulder, and thrower's shoulder, is
a clinical syndrome which occurs when the tendons of the
rotator cuff muscles become irritated and inflamed as they
pass through the subacromial space, the passage beneath
the acromion. This can result in pain, weakness and loss of
movement at the shoulder
 The shoulder joint arc of abduction and elevation is
painful at the range of 45-160 degree.
 Occur beneath coraco-acromial arch

3. Cont…
 Outside of this range,
abduction is painless.
 Major site of
compression is slightly
anterior to angle of
acromion.

4. Causes:
 Crack fracture of the greater tuberosity of humerus.
 Repeated use of arm.
 Overhead in occupation.
 Functional or sports stresses.
 Degenerative change.
 Over stress to tendon due to muscle weakness, tight muscle,
tight capsule, or bony impingement.
 Poor posture.
 Poor body mechanic.
 Minor tear to the supraspinatus tendon.
 Friction and compression of the tendon.
 Previous trauma.
 Sub-acromian bursitis.

5. Pathology
 The painful arc syndrome is characterized by pain
referred to the lateral aspect of the upper arm in the
region of the bulk of the deltoid muscle and its
insertion.
 The pain may be felt at rest, characteristically
more so at night, and is typically exacerbated within a
certain arc of movement. A painful arc between 45 and
120 degrees of abduction indicates some disorder of
the subacromial region.

6. Clinical feature:
 Pain at rest.
 Pain radiate lateral and upper & lateral aspect of the
arm.
 Movement restricted.
 Muscle weakness of the shoulder.
 Muscle wasting of the Shoulder.
 Loss of functional activity.
 Limited range of motion.

7. Investigation X-ray
 An antero -posterior view of a
superior type lesion. The
medium lies in the
supraspinatus tendon. In 90
degrees of abduction a kink is
seen in the tendon where the
coraco-acromial ligament
impinges upon it. The
acromio-clavicular joint is
degenerate.

8. Cont…
 MRI showing
subacromial
impingement with
partial rupture of the
supraspinatus tendon.
However, no retraction
or fatty degeneration of
the supraspinatus
muscle.

9. Special test
NEER'S TEST
 Neer's impingement sign is
elicited when the patient's
rotator cuff tendons are
pinched under the coraco-
acromial arch. The test is
performed by placing the arm
in forced flexion with the arm
fully pronated . The scapula
should be stabilized during
the maneuver to prevent
scapulothoracic motion. Pain
with this maneuver is a sign
of subacromial impingement.

10. Cont…
HAWKINS' TEST
 The Hawkins' test is
another commonly
performed assessment of
impingement. It is
performed by elevating the
patient's arm forward to 90
degrees while forcibly
internally rotating the
shoulder . Pain with this
maneuver suggests
subacromial impingement
or rotator cuff tendonitis.

11. Management (in acute stage)
1.Conservative:
 Rest and avoid overhead
activities
 Anti-inflammatory drugs
 Analgesics
 Steroids
2. Surgical
 Rotator cuff tendon transfer
 Tendon grafting

12. PT management ( in chronic stage)
 Modalities
 Manual therapy
 Stretching
 Mobilizing exercise
 Strengthening exercise
 Home advice

13. Modalities
 Hot pack
 UST
 IRR
 TENS
 IFT

14. Manual therapy
 Relax passive movement
 Active resisted exercise
 Progressive resisted exercise
 Stretching exercise
 Strengthening exercise
 Soft tissue manipulation.
 Functional activity

15. Stretches
Codman’s
Pendulum
Swings
Triceps Stretch
Horizontal
Adduction
Stretch
Internal
Rotation
Stretch

16. Stretches Cont..
External Rotation
Standing
Adduction
Stretch
Chest and Biceps
Stretch

17. Exercises to Strengthen SITS
muscles
Bent over
rows
Seated Dips
Active Flexion

18. Home advice
 Avoid heavy weight lifting
 Avoid forceful contraction
 Avoid repeated activity of the hand
 Do exercise regularly