Definition: Painful arc syndrome is shoulder pain that occurs during active abduction, usually between 60° and 120°, because the structures in the subacromial space become
Pathomechanics:-
1)Narrowing the subacromial space
This increases pressure on the soft tissues.
2)Compression (Impingement) During shoulder abduction, the following structures may get compressed:
#Supraspinatus tendon
#Subacromial bursa
#Long head of the biceps tendon
3)Abnormal movement of the humeral head
Weakness of the rotator cuff (especially supraspinatus and infraspinatus) or overactivity of the deltoid allows the humeral head to migrate upward.
4)Upward migration further reduces the subacromial space.
5)Scapular dyskinesis
Reduced upward rotation, posterior tilt, or external rotation of the scapula prevents normal clearance beneath the acromion.
This increases impingement during arm elevation.
Inflammation and tendon degeneration
Repeated impingement causes inflammation of the bursa and tendons.
# Chronic cases may progress to tendinopathy or partial/full-thickness rotator cuff tears.
Painful Arc
0–60°: Usually little or no pain.
60–120°: Painful arc due to maximum impingement.
120–180°: Pain often decreases because the greater tuberosity passes beneath the acromion and the compressed tissues are relieved.Exercise Progression Criteria
Progress only when:
Pain ≤2/10
Full ROM
No painful arc
Scapular dyskinesis corrected
External rotation strength ≥80% of opposite side
Avoid
❌ Empty Can in early painful stage
❌ Heavy overhead press
❌ Behind-the-neck press
❌ Upright row above shoulder height
❌ Repetitive painful abduction
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