FORM Hand Therapy

Shoulder Impingement and Rotator Cuff Tears

The shoulder joint is one of the most mobile joints in the human body, and occupational therapy is the most important treatment for conditions like shoulder impingement and rotator cuff tears.

The shoulder joint is one of the most mobile joints in the human body, and occupational therapy is the most important treatment for conditions like shoulder impingement and rotator cuff tears. Our occupational therapists not only understand the importance of regaining shoulder range-of-motion and strength but the treatment that is focused on specific skills you need for the demands of your everyday living and working. Our unique and comprehensive approach to therapy combines exercises, manual therapy techniques, physical agent modalities, electrotherapeutic modalities, task analysis, activity modifications, and education of proper shoulder mechanics to gain a successful return to activity without further injury.

Shoulder Impingement

Shoulder Impingement occurs when the bone on top of the shoulder (acromion) puts excessive pressure on the rotator cuff tendons or bursa (cartilage) beneath it causing shoulder irritation and pain. The compression or “impingement” can be due to chronic and repetitive overhead movements, shoulder injury, arthritis, bone abnormalities, or adhesive capsulitis (frozen shoulder). This impingement can then further cause rotator cuff tendonitis and tears, and bursa inflammation and scarring.

anatomy of shoulder impingement


  • Shoulder pain with activity such as overhead arm movements, throwing, and side movement.
  • Shoulder pain at rest.
  • Pain that radiates from the front of the shoulder to the side of the arm.
  • Pain at night when attempting to sleep on the affected side.
  • Limited range of motion due to weakness.


Physicians frequently recommend nonsurgical treatment for shoulder impingement. Research has shown that patients who have actively participated in therapy as first-line treatment for shoulder impingement are able to avoid surgery and have similar outcomes to those who had decompression surgery.

Our occupational therapists have advanced knowledge in the complex arrangement of structures of the shoulder joint, and the contribution of these structures to shoulder movement and stability. Our highly skilled therapists will manage your pain by identifying what movements cause pain and make modifications to activities to reduce impingement.

Our therapists may also use therapeutic modalities such as iontophoresis or ultrasound to reduce pain. Depending on the level of your impingement, they will determine what range-of-motion and strengthening exercises to progress you through, and employ hands-on manual therapy techniques for proper shoulder movement to avoid impingement. Most importantly, they will educate you on proper shoulder mechanics to assist you in returning to a pain-free function.

If you have had decompression surgery for shoulder impingement, therapeutic rehabilitation is absolutely necessary to regain range-of-motion and strength. Our therapists will collaborate with your surgeon to progress you through a rehabilitative program based on clinical criteria and timeframes appropriate to you and your specific surgery.

Rotator Cuff Tears

A rotator cuff tendon injury is a common cause of shoulder pain. The rotator cuff is susceptible to degenerative changes over time. Bone spurs can develop on the underside of the acromion, a bone that forms the roof of the shoulder. As we age, the blood supply to the rotator cuff can decrease, making it more difficult for the body to repair tendon damage naturally. This “wear and tear” on the rotator cuff can increase the likelihood of a rotator cuff tear or another injury.
Diagram of a rotator cuff tear


Symptoms of a rotator cuff tear include shoulder pain and a crackling sensation when moving the shoulder. You may feel pain even while the shoulder is at rest, as well as pain and weakness when lifting and lowering the arm. Most people experience pain at night and have trouble sleeping, especially when lying on the affected shoulder. If the tear is sudden, you may hear a snapping sound and have immediate weakness in the upper arm.

If you are experiencing any of these symptoms, you should seek medical treatment.


A rotator cuff injury can cause significant shoulder weakness. Proper treatment can help patients regain shoulder strength and function after an injury.

If you have surgery to repair your rotator cuff tear, our hand therapists will work with you postoperatively and start you off with passive range of motion exercises where the therapist or equipment moves the joint through the range of motion with no effort from the patient. As healing progresses, the therapy will advance to a more active range of motion program where the patient performs the exercises to move the joint without any assistance to the muscles surrounding the joint. Other therapeutic interventions may include strengthening programs, modalities, home/workplace modifications, custom splint fabrication, and manual therapy techniques.

Contact Us

If you have a question about whether your shoulder condition should be treated by one of our hand therapists, call FORM Hand Therapy at (510) 585-2535. You may also request a consultation online.

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