Impingement syndrome affects a wide range of today's active population with various pathologies and presentations. Tendinitis can cause further subacromial loading, unless specific attention is directed at interrupting this disorder. Today's emphasis in high-risk populations, such as pitchers and swimmers, is on prophylaxis. Once symptoms occur, the majority can be successfully managed with nonoperative measures. Prolonged failure of conservative care prior to rotator cuff tear requires surgical decompression with predictable success in most. Results can be optimalized if strict attention is paid to patient selection, surgical technique, and a carefully supervised rehabilitation program following surgery.