What is Shoulder Impingement?
Shoulder impingement is when the outer edges of the shoulder blade, called the acromion, rubs against or pinches off the rotator cuff tendon. This results in pain and irritation and is one of the most common causes of shoulder pain.
Mechanism of Injury:
Shoulder impingement is often caused by repetitive overhead motions, such as painting, overhead throwing sports, and lifting. This causes irritation of the bursa and rotator cuff tendons, leading to pain and dysfunction of the shoulder. Commonly, poor mechanics of the shoulder exacerbate or make this condition worse, like slouching and poor posture.
Symptoms and Diagnosis:
This condition often causes pain on the lateral or side of the shoulder and the back of the shoulder, especially with lifting overhead. This can also lead to weakness in the shoulder. Shoulder impingement is commonly diagnosed with a history and physical examination in the doctor’s office. X-rays are recommended to evaluate the bones in the shoulder to look for other causes of pain, bone spurs as well as normal curvature of the bones that could worsen this condition.
Treatment of Shoulder Impingement:
Shoulder impingement is mainly treated with rest, ice, anti-inflammatories, and a good physical therapy (PT) program. PT is the most important aspect to treat this condition by improving the mechanics of the shoulder, increasing the strength of the shoulder, and working on better posture which will decrease the symptoms of this condition. Cortisone injections are sometimes recommended if initial symptoms do not improve. Lastly, surgical options do exist as a last resort in the event symptoms persist despite adequate PT and non-operative treatments.
For more information, please consider the following link that was produced by the AAOS.
https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
Symptoms
Impingement has a fairly characteristic pattern, and recognising it is usually more informative than any single test:
- Pain when reaching overhead, or out to the side at roughly shoulder height
- A painful arc — discomfort through the middle of raising the arm that eases at the top
- Pain reaching behind you, such as into a back pocket or fastening a seatbelt
- Night pain, especially lying on that side
- Weakness that is mostly pain-limited rather than true loss of power
- Aching down the outer upper arm, often stopping around the elbow
Pain that radiates past the elbow, or comes with numbness and tingling, points away from simple impingement and towards the neck — worth saying, because a neck problem referring pain to the shoulder is a common misdiagnosis in both directions.
Why it happens
Impingement is a description of a mechanical problem, not a diagnosis in itself, and the useful question is what is producing it. Contributors include the shape of the acromion, bone spurs, thickening of the bursa, weakness or poor timing of the rotator cuff, and — very commonly — poor control of the shoulder blade. If the scapula does not rotate properly as you lift, the space available for the tendons is reduced with every repetition.
That last point is why treatment that only targets the shoulder joint itself often disappoints.
Treatment
Non-surgical care, which resolves most cases
- Activity modification — reducing the specific provoking movement, usually repetitive overhead work, rather than resting the arm completely
- Physical therapy — the mainstay, and the treatment with the best evidence
- Anti-inflammatory medication for symptom control
- Corticosteroid injection — can reduce pain enough to make therapy productive; most useful as an enabler rather than a standalone treatment
Exercise: what a good programme targets
Effective rehabilitation for impingement is not general shoulder strengthening, and it is emphatically not repeatedly lifting into the painful arc. A well-designed programme usually addresses three things: rotator cuff strength (particularly the external rotators), scapular control so the shoulder blade positions the socket correctly through range, and mobility of the posterior capsule and thoracic spine where those are limiting.
Working into sharp pain is counterproductive. Because the right emphasis depends on which of those elements is actually deficient in your shoulder, the programme should follow an assessment rather than a generic list — two people with the same diagnosis often need quite different work.
When surgery is considered
Surgery is considered when a genuine trial of therapy — typically several months, properly done — has not resolved things. Arthroscopic subacromial decompression creates more space by removing bone spur and inflamed bursa. It is most successful when there is a clear structural cause; it is least successful when the underlying problem was scapular control that was never addressed, which is why the therapy comes first.
Frequently asked questions
How long does shoulder impingement take to heal?
With consistent therapy many people improve substantially within six to twelve weeks, though more established cases can take several months. Improvement usually tracks with how consistently the exercise programme is done.
What exercises should I avoid with shoulder impingement?
Generally, anything that drives you repeatedly through the painful arc — overhead presses, upright rows, lateral raises above shoulder height and behind-the-neck movements are the usual culprits. The point is not to stop using the arm but to stop repeatedly provoking the pinch while the tendons settle.
Can shoulder impingement heal on its own?
Mild cases sometimes settle with rest and activity adjustment. Because impingement is usually driven by mechanics that do not correct themselves, it commonly recurs unless the underlying strength and control problem is addressed.
Is shoulder impingement the same as bursitis or a rotator cuff tear?
They are related and frequently coexist. Impingement describes the tendons and bursa being compressed; bursitis is inflammation of the bursa within that space; a rotator cuff tear is structural damage to the tendon itself. Long-standing impingement can contribute to a tear over time.
Next step
If this is limiting what you can do, an evaluation will tell you what is actually wrong and which treatments genuinely apply. Call 916-732-3005 or request an appointment. Related: rotator cuff tears · frozen shoulder.