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Tight subacromial space / Impingement syndrome

Jamming of the shoulder tendon underneath the flat bone of the shoulder (acromion) is one of the most common sources of shoulder pain. The acromial bone, which protects the shoulder joint, may have a crooked anterior edge which is in close contact with the underlying supraspinatus tendon. Therefore, the fundamental problem may be considered anatomical.

Most often, the onset of the trouble is around the age of 40. Since the anatomical shape of the acromion generally remains the same throughout life, the question of why the symptoms occur at such a late age is often asked. However, the problem is not the bone but the supraspinatus tendon. At the early phase of the problem, the reason for pain may be bursitis under the acromion. When the situation proceeds, the supraspinatus tendon gets frayed and inflamed. The bone above the tendon begins to induce friction, which in turn induces more irritation and swelling of the tendon leading to a vicious circle called impingement syndrome.


In most cases, the symptoms of impingement syndrome begin spontaneously without any preceding trauma. However, the symptoms may occur after a minor trauma or overuse of the shoulder. Pain in lifting up the arm and painful rotatory movements are among the most common symptoms. The patient may experience aching of the shoulder at night and may not be able to sleep on the affected side.


The basic treatment of the “subacromial impingement” is conservative: relative rest, physiotherapy and steroid injections (treating the bursitis). Muscle balancing and strength is important to regain optimal biomechanics. Often the symptoms are due to posture: a hunched position of shoulders may increase the impingement pain. If the shoulder pain continues in spite of conservative treatment and clear anatomic findings are present, operative treatment may be necessary. The lower surface of the acromion can be grinded and leveled in an arthroscopic operation to make more space for the underlying tendon.

Postoperative treatment

The operated arm is kept in a sling for a day or two. However, it is not obligatory to use any support at all. From the beginning, the patient may use his/her arm freely depending on the severity of the pain. There is no danger in harming the arm by moving it.

Rehabilitation begins after the initial healing. It is important to concentrate on muscle balancing and muscle exercises to regain healthy biomechanics; in some respects, returning to the original conservative treatment plan to achieve sustainable results.