Shoulder pain can occur because the shoulder is the most mobile joint in the body and is physically very complex. These muscles not only help move the shoulder but also help keep the ball of the shoulder correctly placed in its socket. One of the four muscles (supraspinatus) lies between two bones in the shoulder and is very often a cause of shoulder pain or something called subacromial pain syndrome (SAPS).

shoulder pain comes from the structure of the shoulder

Did you know? SAPS is the most common cause (up to 65%) of shoulder pain.3

shoulder pain can be tested with the arc movement

Painful arc is seen often in shoulder impingement syndrome.

Simply put, it is a collection of signs and symptoms in the shoulder caused by problems in the shoulder tendons or the structures around the tendon1. The image you see shows the back of a person’s shoulder indicating the rotator cuff muscles (marked with stars).

Commonly, people suffering from this problem complain of pain in the front and/or side of the shoulder and the pain can sometimes also go down into the upper arm.

Frequently, pain at night is also present. Often a painful arc is present in shoulder impingement syndrome, which means that most pain is felt between 60˚ and 120˚ when the arm is lifted up to the side3.

Diagnosis of Shoulder Pain

One of the problems that may cause pain was previously thought to be caused by the tendon physically being pinched between the two bony surfaces of the shoulder, because the space between the bones had become smaller. There is no evidence that pain may, in fact, be caused by the tendon in the shoulder becoming thinner, thereby reducing the space it has in which to move5.

shoulder pain due to impingement in the rotator cuff

Alternatively, the pain can also be due to a tear in a muscle or tendon at the shoulder. The familiar term of ‘swimmer’s shoulder’ can fall into this category. Should your physiotherapist suspect that this is the case, they will refer you to a specialist for a simple investigation that will help confirm the tear.
There are also specific tests that your physio can do during an assessment to help diagnose the problem.

What are the contributing factors to Shoulder Pain?

Factors that contribute to SAPS development include the following6:

  • Poor posture at the shoulder
  • Prolonged hand-arm vibration at work
  • Repetitive shoulder or hand/wrist movement at work
  • Having to use lots of strength or prolonged strength in the arms while at work
  • High psycho-social workloads. This includes factors such as a lot of pressure at work, poor job satisfaction and poor social support from family/friends.

Treatment Options for Shoulder Pain

shoulder pain can be caused by rotator cuff problemsThe most important treatment option for patients with SAPS, when there is no muscle tear, is physiotherapy. This will include:

There is an option for surgery should physiotherapy fail, but there are many studies that show that surgery followed by physio is no more beneficial than physio alone. 4, 6

This article was submitted by Wendy Snyders, Associate Manager at the Tygervalley Practice. If you have questions about shoulder pain, contact Wendy or any of the Lamberti Physiotherapy physios by using our handy appointment form.


  1. Justin De Yan Tien and Andrew Hwee Chye Tan (2014). Shoulder impingement syndrome, a common affliction of the shoulder: A comprehensive review. Proceedings of Singapore Healthcare 23 (4).
  2. Gebremariam, L et al (2013).Subacromial impingement syndrome – effectiveness of physiotherapy and manual therapy. British Journal of Sports Medicine.
  3. W Dong et al (2015). Treatments for Shoulder Impingement Syndrome. Medicine 94 (15).
  4. Dr Lori Michener (2017). Rotator cuff tendinopathies: mechanisms and diagnosis. PowerPoint presentation at WCPT 2017.
  5. LA Michener et al (2015). Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome. Physical therapy and Human Movement Sciences.
  6. Diercks, R et al (2014) Guideline for diagnosis and treatment of subacromial pain syndrome. A multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthopaedica 85(3).