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Shoulder Impingement Syndrome

cAUSES, SYMPTOMS, TREATMENT, AND oTHER rESOURCES

Shoulder pain can make simple chores almost impossible.  Have you ever reached for an object high on a shelf only to have pain that takes your breath away?  What causes shoulder pain when reaching across the body?  What is shoulder impingement?  What does shoulder impingement feel like?  Can a shoulder X-ray show shoulder impingement?  What are the treatment options for shoulder pain when reaching across the body?  Let’s dig in.

Why Does My Shoulder Hurt When I Reach Across My Body?

Shoulder impingement and rotator cuff injuries are among the most common causes of shoulder pain (1).  Both can cause shoulder pain when reaching across the body.

Shoulder Impingement

Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed.  This occurs in any area called the subacromial space which is immediately beneath the AC joint.  This area contains the rotator cuff tendons and bursae and is identified by the red in the illustration below (2).  A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross boney surfaces.  A tendon is a thick collagen tissue that connects muscles to bones. The rotator cuff tendons provide important support and enable movement in the shoulder.

Rotator Cuff Injuries

There are four rotator cuff tendons:  supraspinatus, infraspinatus, subscapularis, and teres minor.  Injuries can include inflammation of the tendon called tendonitis and tears in the tendon.  Tears can be partial thickness where they only involve a portion of the tendon or full-thickness when they involve the entire tendon.  If the tendon fibers pull apart from one another this is called a retraction.  Rotator cuff tears are common and the incidence increases with age.  A recent large study demonstrated a prevalence of rotator cuff abnormalities of 9.7% in patients younger than 20 which increased to 62% in patients aged 80 and older (3).  Factors that increase your risk for RC tears include advancing age, hand dominance (4), and smoking (5). Learn more about our non-surgical rotator cuff tear treatment.

What Does Shoulder Impingement Feel Like?

Pain is the most common symptom.  It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder.  Impingement can also cause shoulder pain when reaching across the body.

Arm Pain at Night

Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes?  When should I worry about it?  What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7. Sandwiched between the bones is a disc that functions as an important shock absorber. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Common disc injuries include disc bulges, and herniations. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. It can…

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Left Shoulder Blade Pain

Learn to know the symptoms and causes of shoulder blade pain as well as the diagnostic tests to run for it and its treatment options. Shoulder blade pain can be a common, annoying, hard to diagnose problem. There are many different causes of shoulder blade pain and the exact cause of the shoulder blade pain will determine what type of treatments would be recommended.

Read More About Left Shoulder Blade Pain

Shoulder Cracking

The Scapula is your shoulder blade. It is a large triangular bone that compromises part of the shoulder joint. The Scapula is positioned over the back chest wall and ribs where it moves in different directions with shoulder movements (1). The Scapula meets with the arm bone (humerus) to form the shoulder joint. It also meets with the clavicle to form the AC joint. Multiple structures attach onto the Scapula which provides important support and movement for the scapulae and shoulder joint (2). These include:- Muscles/Tendons: Multiple muscles attach to the Scapula which include the deltoid, supraspinatus, infraspinatus, triceps, and teres minor.

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Shoulder Pain at Night

There are several reasons why shoulder pain at night occurs or is aggravated; The common explanations include: Sleep typically involves a static position lasting hours at a time with little or no movement. Sleeping on your side places additional pressure on the tendons and bursa of the shoulder. Sleep can cause muscles and tendons to settle in a slightly different position resulting in additional pressure and reduced blood flow. Identifying the underlying problem is important!  This allows therapy to focus exclusively on the exact problem or problems.  When appropriate conservative care is always the first line of treatment.  Focus is typically on strengthening and improving range of motion. 

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Shoulder Pain When Reaching Across Body

Shoulder pain can make simple chores almost impossible.  Have you ever reached for an object high on a shelf only to have pain that takes your breath away?  What causes shoulder pain when reaching across the body?  What is shoulder impingement?  What does shoulder impingement feel like?  Can a shoulder X-ray show shoulder impingement?  What are the treatment options for shoulder pain when reaching across the body? ulder impingement and rotator cuff injuries are among the most common causes of shoulder pain (1).  Both can cause shoulder pain when reaching across the body. Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. 

Read More About Shoulder Pain When Reaching Across Body

Why Does My Shoulder Hurt When I Lift My Arm?

Shoulder pain can be very non-specific, meaning that multiple structures and issues can cause identical pain in the shoulder. Most shoulder examination maneuvers are very limited in their ability to assess exactly what the problem is.  With pain when lifting your shoulder, it is critical to take a detailed history, good examination, coupled with imaging to fully understand what is causing the shoulder pain.  Many conditions can present with these symptoms

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What is the Cause of Shoulder Impingement Syndrome?

Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6).  The subacromial space is the area between the top of the arm bone (humerus) and the AC joint.   This narrowing compresses or pinches the rotator cuff tendons and bursa.  If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.

Causes of  Subacromial Space Narrowing

  • Inflammation or injury of the AC joint
  • Instability of the AC joint
  • Increase in the rotator cuff volume due to inflammation or injury.
  • Ligament thickening
  • Muscular imbalance

Can an X-ray Show Shoulder Impingement?

No!  X-ray images bone only.  Bursa and tendons can not be seen on x-ray.  An x-ray may demonstrate arthritis and or a bone spur on the AC joint which can narrow the subacromial space which in turn can potentially compress or pinch the rotator cuff tendons.  An MRI is a much better imaging choice as it visualizes bone, ligaments, rotator cuff, and bursa.  An MRI can identify shoulder impingement.

Treatment Options

Conservative Care

Conservative care is the initial treatment of choice if no major damage is present.  Options include immobilization, muscular strengthening, physical therapy, ultrasound, acupuncture, and manual therapy.

Steroid Injections

Steroid injections are often recommended as they are powerful anti-inflammatory agents.  These should be avoided as steroids are toxic to orthopedic tissue and may compromise rotator cuff tendon strength and healing. (7)

Surgery

Surgery is often recommended when conservative treatment fails.  The most common surgery for impingement is subacromial decompression where part of the AC joint and bursae are cut away.  Unfortunately, the supporting shoulder ligaments are also cut away thereby making the shoulder unstable.  New research involving 32 hospitals, 51 surgeons, and more than 300 patients in the United Kingdom demonstrated that decompression surgery is no more effective than a placebo (8).  To better understand the consequences of decompression surgery please click on the video below.

Platelet Rich Plasma and Stem Cells

PRP is useful in the treatment of shoulder impingement (9).   At the Centeno-Schultz Clinic, we have extensive experience in the treatment of shoulder impingement and rotator cuff tears. The instability of the AC joint and shoulder can be treated with ultrasound-guided injections of both PRP and bone marrow concentrate containing stem cells.    Mesenchymal stem cells are a type of cell found in your body including bone marrow and fat.  They are an all-purpose repairman of the body and these cells have the ability to help tendon injuries heal (10).  We published the world’s first research paper on the use of bone marrow concentrate cells on patients with rotator cuff tears with and without arthritis (11).  We demonstrated excellent results characterized by a reduction in pain and increase in function after bone marrow concentrate injections.

In Conclusion

Shoulder impingement and rotator cuff injuries are among the most common causes of shoulder pain when reaching across the body.  Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. This is typically caused by the narrowing of the subacromial space in which shoulder pain when reaching across the body is common. An X-ray may suggest shoulder impingement but MRI is a better imaging choice.  Treatment includes conservative care.  Steroids should be avoided.   Subacromial decompression is a common surgery that is no better than a placebo.  PRP and bone marrow concentrate injections are effective, nonsurgical treatment options for shoulder impingement.

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Our Doctors Who Assist With Shoulder Impingement

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Shoulder Pain

  • Rotator Cuff Tear Relief Without Surgery: A How-To Guide

    INTRODUCTION: Welcome to the How-to Guide for Rotator Cuff Tear Relief Without Surgery. If you want to avoid Rotator Cuff surgery, you’re in the right place! Let’s start with the basics. Basics The basics of Rotator Cuff tears include 4 different muscles, 1 in the front, 1 on the top and 2 in the back. … Continued


  • When Not to have Rotator Cuff Surgery? Know Your Options

    It happened as you were playing racketball. There was loud pop followed by immediate pain. Moving your shoulder is almost impossible. What is the rotator cuff? What causes rotator cuff tears? What is rotator cuff surgery? When not to have rotator cuff surgery? Let’s dig in.What Is the Rotator Cuff? (4 Tendons) The rotator cuff is a group of four muscles and tendons that stabilize the ball and socket shoulder joint (1). The four muscles that compromise the rotator cuff are the: Supraspinatus, Infraspinatus, Subscapularis, and Teres minor. The rotator cuff is also important in shoulder functions such as reaching outward, reaching overhead, and putting your hand into your back pocket. Tendons attach muscles to bones. Tendons are susceptible to acute inflammation, degeneration, and tears. Rotator cuff tears are common…


  • KT Tape Shoulder: Facts You Need to Know!

    KT Tape is used extensively for shoulder injuries. Dr. Schultz discusses what KT tape is, what it is used for, how it helps shoulder pain, whether it really works and a better solution.


  • Rotater Cuff Tear Surgery

    Shoulder Pain Shoulder pain can come in many different forms and be caused by many different issues. Many structures exist in a small area making it more difficult to accurately diagnose what is causing pain without spending appropriate time to diagnose the issue. Common causes of shoulder pain include shoulder arthritis, acromioclavicular (AC) joint sprain … Continued


  • MRI Images Showing Torn Rotator Cuff

    What Is the Rotator Cuff? The Rotator Cuff is a group of 4 principal muscles that stabilize and support the shoulder joint. The four muscles, and their attached tendons that comprise the Rotator Cuff are the supraspinatus, infraspinatus, subscapularis, and teres minor, and any of these could be where we could find Rotator Cuff tears. … Continued


  • Regenexx Rotator Cuff Tear Home Self-Exam

    Hi It’s Dr. Centeno, and this is my series “You’ve Got the Power”, which is all about what you can do at home to understand why various issues are going on. In this episode, we’re going to cover why your shoulder hurts and focus on your Rotator Cuff. So, if you’re stuck at home, what … Continued



  1. Cohen RB, Williams GR: Impingement syndrome and rotator cuff disease as repetitive motion disorders. Clin Orthop 351: 95-101, 1998

2. Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33-9. doi: 10.1016/j.math.2010.08.004

3..Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23:1913–1921.DOI: 10.1016/j.jse.2014.08.001.

4. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19:116–120.

5. Baumgarten KM, Gerlach D, Galatz LM, Teefey SA, Middleton WD, Ditsios K, Yamaguchi K. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res. 2010;468:1534–1541. DOI: 10.1007/s11999-009-0781-2

6.Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765–776. doi:10.3238/arztebl.2017.0765

  1. Wei AS, Callaci JJ, Juknelis D, et al. The effect of corticosteroid on collagen expression in injured rotator cuff tendon. J Bone Joint Surg Am. 2006;88(6):1331–1338. doi:10.2106/JBJS.E.00806
  2. Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-38.DOI: 10.1016/S0140-6736(17)32457-1
  3. Pasin T, Ataoğlu S, Pasin Ö, Ankarali H. Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome. Arch Rheumatol. 2019;34(3):308-16.DOI: 10.5606/ArchRheumatol.2019.7225
  4. Costa-Almeida R, Calejo I, Gomes ME. Mesenchymal Stem Cells Empowering Tendon Regenerative Therapies. Int J Mol Sci. 2019;20(12):3002. Published 2019 Jun 19. doi:10.3390/ijms20123002
  5. Centeno CJ, Al-Sayegh H, Bashir J, Goodyear S, Freeman MD. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015;8:269–276. Published 2015 Jun 5. doi:10.2147/JPR.S80872

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