Recognizing the Warning Signs of Shoulder Impingement

Do you repeatedly reach over your head, in sports like swimming or tennis or with your job? Or are you experiencing pain in your shoulder that makes it difficult to reach up over your head? You may have shoulder impingement syndrome — or you may be on your way to having the condition, even if you don’t have pain now. 

Shoulder impingement syndrome causes pain and problems with mobility. It is the result of chronic or repeated compression of the tendons and ligaments in the shoulder. Your body sends warning signs to let you know when shoulder impingement is imminent.

While injury may cause shoulder impingement, it’s more likely to be the result of repeated overhead arm movements, such as occurs with manual laborers and athletes like weightlifters, volleyball players, and baseball pitchers. Another cause can be poor posture.

Shoulder impingement should be treated as soon as it’s discovered to prevent further issues, like a rotator cuff tear. You can decrease pain and improve motion through at-home therapies, hands-on care, and rehabilitation exercises.

What Is Shoulder Impingement?

You may experience shoulder impingement when the top outer edge of your shoulder blade rubs against or pinches your rotator cuff, which is beneath it. Your rotator cuff is a group of four muscles that start on the shoulder blade and attach onto your upper arm bone. 

Your rotator cuff is used to raise your arm overhead and to rotate your arm both toward and away from your body. Because of the rotator cuff’s location between two bones in the shoulder, it can be pinched between the bones, resulting in impingement syndrome. 

What Are Risk Factors of Shoulder Impingement?

Shoulder impingement is fairly common and suspected to be the culprit in 44 to 65 percent of shoulder pain complaints, according to the Cleveland Clinic. This condition is extremely common in individuals who regularly and repeatedly raise their arms to or above shoulder level. Activities which may be considered risk factors include:

  • Swimming
  • Throwing
  • Playing tennis or pickleball
  • Playing golf
  • Playing volleyball
  • Lifting weights
  • Painting
  • Doing gymnastics
  • Stocking shelves

What Are the Warning Signs of Shoulder Impingement?

Shoulder Impingement Syndrome is typically not defined by a single event or injury, but rather is a range of symptoms that develop over time. It occurs when the tissues within and around the shoulder joint become inflamed or compressed. If the compression remains untreated, eventually there will be a structural breakdown in the shoulder, resulting in impingement syndrome.

There are three warning signs of shoulder impingement, with each sign typically affecting a different age group.

First Warning Sign: Typically seen in individuals younger than 25, this sign involves swelling and inflammation.

Second Warning Sign: Seen in ages 25 to 40, this second warning sign adds onto the swelling and inflammation to also include a weakening of the tendons in the shoulder called tendinopathy.

Third Warning Sign: This final sign occurs in individuals over 40. It consists of advanced tendinopathy, rotator cuff tear, biceps tendon tear, or changes to the shoulder bones. 

What Causes Shoulder Impingement?

We already know that shoulder impingement is the result of soft tissues in the shoulder getting pinched or compressed by the bones in the shoulder joint. But why does this happen? There are a number of reasons for soft tissues to become impinged. 

  • One possible reason is the joint could loosen or become unstable causing the humerus (or arm bone) to become more mobile than it should be. 
  • You could have been born with bones that are shaped in a way that makes them more likely to compress nearby tissues. 
  • If the bones develop spurs, shoulder impingement could occur. Bone spurs are more likely to develop in individuals who spend a lot of time at a desk or computer with their head forward and shoulders hunched. 
  • The bursa is inflamed or irritated. The bursa is a fluid-filled sac between your tendon and a shoulder bone called the acromion. Muscles and tendons glide easily over bones with the help of the bursa. It can become inflamed due to overuse or injury. 
  • You were born with an acromion that is not flat. 
  • The tendon in your shoulder becomes torn or swollen. This, too, can be caused by overuse due to repetitive actions, injury, or age-related wear and tear.

How Can You Tell If You Have Shoulder Impingement?

The main symptom of shoulder impingement syndrome is pain. You’ll notice a painful sensation when you lift your arms above your head or behind you. You’ll feel the pain at the shoulder, near the top of your arm, or running down the outside of the arm. The pain is more frequent at night or if you lie down on the affected side.

In athletes, the symptoms are a little different. They’ll notice a stiffness with the pain and a prolonged warm-up period. They’ll feel the pain mostly when they pull the arm behind them in preparation of a throw or when they begin moving the arm forward to throw the ball. They may have difficulty determining where the pain is centered, but eventually the pain localizes at the back of the shoulder. 

Athletes who serve, such as tennis or volleyball players, notice pain when they are finishing a serve or following through after the ball has been hit. 

How Is Shoulder Impingement Treated?

If you suspect that you have shoulder impingement, you should rest the affected arm and shoulder and avoid reaching up over your head, or doing other activities that cause pain. Ice the shoulder for twenty minutes using an ice pack covered in a thin towel. Do not put ice or an ice pack directly on your skin. You can alternate ice and heat, using a heating pad or warm shower.

Rehabilitative exercises are also recommended for individuals with shoulder impingement. Visit your chiropractor to receive a series of stretches and exercises that will help restore mobility and strengthen the muscles and tendons. 

The exercises provided by your chiropractor are designed to help ease your pain while allowing you to regain as much function in your shoulder as possible. They will focus on range-of-motion exercises, exercises that stretch the tissues, strengthening exercises, stabilization exercises, and for athletes, training on the proper technique for their sport. 

Chiropractors can also manipulate the spine and shoulder to restore proper location of bones, joints, and muscles. In some cases, spinal adjustments may not only restore complete mobility, but also relieve pain entirely.

Dr. Tim Swift proudly serves San Clemente, San Juan, Dana Point, and the surrounding areas of Orange County, California.

This article is for informational purposes only and is not a substitute for in-person advice or care from a medical professional.

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Dr. Tim Swift

Dr. Tim Swift combines his chiropractic expertise with regenerative medicine to bring a passion for restoring health, mobility, and vitality to help his community feel and function better.


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