Shoulder Impingement Syndrome

Shoulder Impingement Syndrome: Signs and Symptoms
Calcific deposition
Abnormal shoulder morphology
Static subacromial narrowing
Abnormal scapular rotation and tilt
Scapular winging Weakness
Degenerative changes to rotator cuff tendons
Dynamic subacromial narrowing
Repetitive overhead activity/shoulder overuse
Muscle fatigue
Repetitive compression forces on subacromial space
Glenohumeral instability or stiffness
Janelle Wai
Dalal Awwad Reviewers:
M. Patrick Pankow Reza Ojaghi Usama Malik Sunawer Aujla Ryan Shields*
* MD at time of publication
Internal/ Posterior Impingement
Compression of rotator cuff tendons between humeral head and posterosuperior glenoid edge during end stage of throwing
Pain with passive extension and lateral rotation
+ Posterior Internal Impingement Test
Laxity of glenohumera l joint
Stiffness: Scapular winging with downward tilt, shoulder protraction
Primary/ Structural Impingement
Any anatomical abnormalities
Secondary/Functional Impingement
Normal anatomy with motion abnormalities
Impingement of underlying rotator cuff muscle-tendon unit and inflammation of subacromial bursa
Rotator Cuff Syndrome
External/ Subacromial Impingement
Compression of subacromial bursa and rotator cuff (i.e. supraspinatus tendon) on the anterolateral acromion and coracoacromial ligament
X-Ray: Normal Ultrasound: +/- Tendinopathy, muscle atrophy
Pain with
overhead movement
Pain at night
(e.g., sleep position, gravity)
Pain with lifting
(e.g., weight- training, groceries)
Pain (between 60°-120°) with passive shoulder abduction
+ Painful arc Test
Pain with passive shoulder flexion
+ Neer’s Test
Pain with passive shoulder flexion (to 90°) + internal rotation
+ Hawkins-Kennedy test
Sign/Symptom/Lab Finding
First published May 27, 2018; updated Jan 11, 2024 on