Shoulder Impingement
Shoulder impingement involves compression of subacromial structures during arm elevation, often due to poor scapular control and soft tissue tightness.
Shoulder - PathologyBiomechanical Mechanism
Decreased subacromial space from scapular dyskinesis, posterior capsule tightness, and humeral head migration.
Clinical Rationale
Impingement is often secondary to scapular and thoracic dysfunction. Corrective strategies reduce compression and restore mechanics.
Practical Solution
Address scapular control and posterior capsule stiffness, then gradually reintroduce overhead loading.
Common Compensations
- Painful arc during elevation
- Scapular hiking
- Reduced overhead ROM
Correctives
- Scapular stabilization drills
- Posterior capsule mobility
- Rotator cuff activation
- Thoracic mobility
Progression
- 1Level 1: Pain-free mobility
- 2Level 2: Scapular activation
- 3Level 3: Rotator cuff strengthening
- 4Level 4: Overhead integration
Regression
- Avoid painful arcs
- Reduce load
- Use supported positions
Red Flags
- Severe pain at rest
- Night pain
- Loss of strength
Differential Diagnosis
Rotator cuff tearBursitisLabral pathology
Related Assessments
painful arc assessmenthawkins kennedy assessmentneer test assessment
Related Exercises
wall elbow walk bandy raise swiss ballsleeper stretch
