Rotator cuff

Subacromial Impingement

Pinching of rotator cuff tendons under the acromion. Bigliani acromion classification. Cornerstone of shoulder rehabilitation.

Subacromial impingement is a pinching of the rotator cuff tendons (mainly supraspinatus) and the subacromial bursa between the humeral head and the coracoacromial arch (acromion, coracoacromial ligament, acromioclavicular joint). It is the most common mechanism of shoulder pain. The Bigliani classification of acromion morphology identifies 3 types: type I (flat), type II (curved), type III (hooked — most at risk). Internal impingement (postero-superior, in abduction + external rotation) affects overhead athletes. Treatment is primarily conservative (physiotherapy 70-80% success) before considering acromioplasty.

Characteristics

  • Painful arc between 60° and 120° of elevation. Pain worsened by overhead movements. Night pain when lying on the affected shoulder. Progressive onset.
  • Impingement tests: Neer (passive flexion forcing the greater tuberosity under the acromion), Hawkins (flexion 90° + forced internal rotation). A positive impingement test = subacromial injection: pain relief confirms the diagnosis.
  • AP radiograph: acromion morphology assessment (Bigliani type I, II, III). Supraspinatus outlet view for the coracoacromial arch. Subacromial space measurement (normal > 7 mm).

Medical and surgical management

  • Conservative treatment first line (70-80% success): physiotherapy 3-6 months, NSAIDs, subacromial corticosteroid injection (diagnostic and therapeutic, max 3/year).
  • Failure of conservative treatment after 6 months: arthroscopic acromioplasty (bursal resection + anteroinferior acromion resection). Rapid return to activities (6-12 weeks).
  • Internal impingement in overhead athletes: specific rehabilitation (posterior capsular stretching, GIRD correction). Surgery rarely necessary (labral and rotator cuff debridement).

Physiotherapy rehabilitation

  • Dynamic humeral head re-centering: the cornerstone of subacromial impingement treatment. Strengthening of depressors (infraspinatus, teres minor, subscapularis) to lower the humeral head.
  • Correction of scapular dyskinesis: serratus anterior and lower trapezius strengthening. Restore posterior scapular tilt. Reduce upper trapezius dominance.
  • Postural correction: thoracic kyphosis reduction, shoulder protraction correction. Pectoralis minor stretching. Thoracic spine extension exercises.

Average duration

6 to 12 weeks

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.