Overview
what it is and why it matters
The subacromial space is the narrow corridor between the humeral head and the undersurface of the acromion (the "roof" of the shoulder). The rotator cuff tendons and the subacromial bursa pass through this space. Impingement occurs when the space narrows — from a hook-shaped acromion, a bone spur, shoulder muscle weakness causing superior humeral migration, or thickening of the bursa — and the tendons are repetitively pinched.
Subacromial impingement is one of the most common causes of shoulder pain in adults over 40 and in overhead athletes. It exists on a spectrum from simple bursitis to rotator cuff tears.
Diagnosis
exam first, imaging secondPain with overhead activities and the painful arc (60–120° abduction). Neer and Hawkins-Kennedy impingement tests are positive. X-rays may show a hooked acromion, acromial spur, or narrowed subacromial space. MRI evaluates the rotator cuff for tears and the degree of bursal thickening.
Treatment Path
how care progresses at OSI1
Physical therapy
Improving rotator cuff strength and scapular mechanics to dynamically widen the subacromial space — the most effective intervention.
2
NSAIDs
Reduce bursal inflammation.
3
Subacromial corticosteroid injection
Direct injection into the subacromial bursa — high short-term effectiveness for pain relief, enabling physical therapy participation.
Activity modification
Reducing overhead loading while undergoing rehabilitation.
Surgical Options at OSI
if non-operative care isn't enoughSurgery is considered when pain persists despite 3–6 months of physical therapy and injections and a structural cause (hook acromion, spur) is identified.
Providers Who Treat Subacromial Impingement
sports-medicine team
David B. Templin, M.D.
Trent Twitero, M.D.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: