Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
Table of Contents
- What is a Painful Arc?
- Understanding the Anatomy
- Causes of Painful Arc
- Signs and Symptoms
- Chronic Impingement Syndrome
- Diagnostic Tests
- Treatment Options
- Prolotherapy
- Frequently Asked Questions
- Case Studies
- Clinic Information
- Author Bio
- References
What is a Painful Arc?
Painful arc is a syndrome(1) that is characterized by severe pain in the shoulders; it’s commonly known as Shoulder Impingement Syndrome.
Symptoms usually occur when the arms are raised overhead or above shoulder level, or when the arm is moved from sideways to the body. This shoulder pain results when repetitive injuries in the rotator cuff tendons cause inflammation in the muscles making the movements full of pain. Locating the exact site of lesions causing the painful arc is important to give the appropriate healthcare service.
Understanding the Anatomy
The Painful Arc occurs at the glenohumeral joint, i.e., the shoulder, and is the result of the vicious cycle that causes friction of the rotator cuff(2) which is present between the humerus and the top bone that lines the shoulder. There is a deltoid muscle area, the base of which connects with the clavicle and the scapula. The top outer edge of the shoulder has a blade called the acromion process. This blade rubs against and causes the rotator cuff tear.
A rotator cuff is a group of four muscles that line the shoulder which include the supraspinatus, infraspinatus, teres minor, and subscapularis. The muscles sit in the space between the bones called the subacromial space. These muscles originate on the shoulder blade and are attached to the rotator cuff. They help you move the arm overhead and sideways without damaging bones.
Causes of Painful Arc
Because of the closely positioned bones of the humerus, scapula, and clavicle, friction may occur causing subacromial impingement syndrome.(3) Causes include:
- Swollen or torn tendons/ligaments, e.g., coracoacromial ligament due to repetitive activity.
- Supraspinatus tendinopathy from overuse, especially in middle age.
- Wear and tear of muscles due to age or injury, causing flexion and arm pain.
- Damage or fluid loss in the subacromial bursa.
- Bone spurs or irregular acromion shape.
People Susceptible to Painful Arc
Active individuals performing rotational arm exercises like swimming, volleyball, basketball, baseball, and tennis are at greater risk.(4)
Signs and Symptoms of Painful Arc
- Pain extending to reach objects
- Pain lifting the arm above the head
- Pain at rest
- Pain reaching behind
- Pain radiating from shoulder to arm
- Difficulty sleeping on affected side
- General arm weakness/stiffness
Chronic Impingement Syndrome
If pain persists and the acromioclavicular joint fails to adjust, inflammation worsens, leading to chronic impingement.(5)
Diagnostic Tests for Painful Arc
Diagnosis includes physical examination, radiological assessment, local anesthetic injection, and specialized tests (Painful Arc Test, NEER Test, Hawkins-Kennedy Test). (6)
Treatment of Shoulder Impingement Syndrome
Physiotherapy
Physical therapy strengthens muscles and improves mobility under professional guidance.
Medications
Corticosteroids and NSAIDs may be prescribed. Pain relief gels can provide localized relief without systemic effects.
Home Remedies
Temperature therapy like heat or cold packs may reduce symptoms.
Surgery
Subacromial decompression surgery may be recommended if non-surgical options fail.(8)
Prolotherapy
Prolotherapy is a regenerative injection treatment targeting the root cause of shoulder pain, stimulating collagen repair, and providing long-term relief.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Frequently Asked Questions
What does a Painful Arc indicate?
Sign of underlying shoulder issues, often due to bursa or rotator cuff tendon impingement.
What is a Glenohumeral Painful Arc?
Pain during 60-120° outward elevation indicating glenohumeral joint disturbance.
What is a positive painful arc test?
Pain experienced during scapula elevation between 60-120°, confirming impingement.
How painful is impingement?
Throbbing, stiffness, and limited range of motion, sometimes compared to a toothache.
How do you test for impingement syndrome?
Kennedy impingement test, internal rotation with pain indicates a positive test.
How long can shoulder impingement last?
Typically 3–6 months for mild/moderate cases; severe cases may take longer.
Case Studies
Case 1: A 45-year-old swimmer with persistent overhead shoulder pain underwent prolotherapy and physiotherapy. Within 6 weeks, the patient regained full range of motion and reported minimal discomfort.
Case 2: A 52-year-old office worker with chronic rotator cuff inflammation used NSAID patches and prolotherapy. After 8 weeks, significant reduction in pain was observed with improved daily functionality.
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating shoulder pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with shoulder pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Linkedin profile: https://www.linkedin.com/in/oliver-eaton-4338225b/
References:
- AlmekindersMD, L. C. (2001, July). IMPINGEMENT SYNDROME. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S0278591905702659
- Yamamoto MD., A. (2010, January). Prevalence and risk factors of a rotator cuff tear in the general population. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S1058274609002043
- Symonds, G. (1977, November 12). Painful shoulders and painful arcs. NCBI – NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1632417/
- Impingement syndrome in athletes. (1980, May 1). SagePub. https://journals.sagepub.com/doi/abs/10.1177/036354658000800302
- Bone & Joint. (1985, November 1). Bone and Joint. https://online.boneandjoint.org.uk/action/cookieAbsent
- Çalış, M. (2000, January 1). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the Rheumatic Diseases. https://ard.bmj.com/content/59/1/44.short
- Non-Operative Treatment of Subacromial Impingement Syndrome* : JBJS. (1997, May). LWW. https://journals.lww.com/jbjsjournal/Abstract/1997/05000/Non_Operative_Treatment_of_Subacromial_Impingement.13.aspx
- Dorrestijn MD, O. (2009). Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S1058274609000718
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.