Subacromial impingement syndrome is said to have multiple
causes.1 Several structures, such as the subacromial bursa, the
tendons of the rotator cuff, the acromion, the coraco-acromial
ligament, and the caput longum tendon of the biceps brachii
muscle, are involved in the pathogenesis of subacromial
impingement syndrome (fig 1⇓). Multiple factors have been
proposed as contributing to the development of subacromial
impingement syndrome, including altered shoulder kinematics
associated with dysfunction of the rotator cuff and scapular
muscles,2-4
capsular tightness,5
poor posture,6 7
and overuse
secondary to sustained intensive work.8 9
Conservative treatment is the first choice, often with
corticosteroid injection or different physiotherapy interventions,
or both.10 Some studies have reported specific exercise treatment
to be effective,11 12 but the summarised evidence for its
effectiveness is uncertain because of the limited number of
studies and several with methodological concerns.