What shoulder impingement is
The rotator cuff tendons pass through a space under the acromion, the bony tip of the shoulder, with the subacromial bursa cushioning them. When the tendons or bursa become irritated, raising the arm becomes painful. The modern term subacromial pain recognises that the problem is mainly in the tendons rather than simply “pinching”.
See shoulder bursitis.
Symptoms
- Pain at the top and outer side of the shoulder, often spreading to the upper arm.
- Pain when raising the arm, particularly between shoulder and head height.
- Pain reaching overhead or behind the back, such as fastening a bra or putting on a coat.
- Pain lying on the affected shoulder at night.
- Weakness due to pain.
Causes and risk factors
- Repetitive overhead work: painting, plastering, stacking shelves.
- Overhead sports: swimming, tennis, volleyball and throwing.
- Age-related tendon changes, common after 40.
- Weakness of the rotator cuff and shoulder blade muscles.
- A sudden increase in activity, such as DIY or gym training.
How it is diagnosed
Diagnosis is based on symptoms and examination, including the painful arc and strength tests. An X-ray may show arthritis or calcium deposits. Ultrasound or MRI is used if a rotator cuff tear is suspected, especially after an injury or with significant weakness.
See also frozen shoulder, which causes stiffness in all directions.
What you can do
- Modify, but do not completely stop, painful activities.
- Keep the arm moving below shoulder height.
- Use simple painkillers if appropriate.
- Sleep with a pillow under the arm or on the other side.
- Avoid heavy lifting overhead for a while.
Exercises for shoulder impingement
- Isometric rotation: press the hand into a wall or door frame outwards and inwards.
- External rotation with a band: elbow at your side, rotate the forearm outwards.
- Shoulder blade squeezes and rows with a band.
- Wall slides: slide the arms up a wall within comfort.
- Side-lying external rotation with a light weight.
- Gradual overhead loading as pain allows.
Mild discomfort during exercise is acceptable if it settles within 24 hours. See rotator cuff exercises.
Physiotherapy
A physiotherapist designs a progressive programme, adjusts load, addresses posture and shoulder blade control, and guides return to work or sport. Improvement usually takes 6 to 12 weeks, sometimes longer.
Steroid injections
A steroid injection into the subacromial space can reduce pain for several weeks and help you do your exercises. Repeated injections are not recommended, as they may weaken tendons.
Is surgery needed?
Subacromial decompression surgery used to be common. A large UK trial (CSAW) found that it was no more effective than placebo surgery, in which the shoulder was examined but nothing removed. Surgery is now reserved for specific cases, such as some rotator cuff tears or when long-term rehabilitation has failed.
Clicking and popping
Clicking without pain is common and usually harmless. Painful clicking or catching may indicate a tendon or labrum problem.
See shoulder popping.
Work and daily life
- Keep frequently used items between waist and shoulder height.
- Use a step stool instead of reaching overhead.
- Take regular breaks from overhead work.
- Keep your elbows close to your body when lifting.
- Adjust your computer set-up so your shoulders are relaxed.
See posture exercises.
Returning to sport
Swimmers, tennis players and throwers usually return gradually, reducing volume and intensity at first and building up over weeks. Technique review, such as stroke mechanics in swimming or serve technique in tennis, can reduce load on the shoulder. Continuing the strengthening programme after symptoms settle helps prevent recurrence.
When to seek urgent help
- Sudden inability to lift the arm after an injury or fall.
- A hot, red, swollen shoulder with fever.
- Deformity after a fall.
- Shoulder pain with chest pain or breathlessness.
- Unexplained weight loss or night pain.
Key points to remember
- Impingement causes pain when raising the arm, especially at shoulder height.
- It involves irritated rotator cuff tendons and bursa.
- Exercise-based physiotherapy helps most people.
- Surgery is rarely needed.
Questions about shoulder impingement
These answers are general information and do not replace an examination or individual medical advice.
Why does my shoulder hurt when I raise my arm?
Irritation of the rotator cuff tendons and bursa, often called impingement, is the commonest cause.
How long does shoulder impingement take to heal?
Usually 6 to 12 weeks of exercise, sometimes several months.
Should I rest my shoulder completely?
No. Modify activities and keep moving; complete rest causes stiffness.
Can I go to the gym with shoulder impingement?
Yes, with modified exercises and gradual overhead loading.
Do steroid injections help?
They can relieve pain for a few weeks to help you exercise.
Does impingement need surgery?
Rarely; decompression surgery was no better than placebo surgery.
How should I sleep with shoulder impingement?
On the other side or your back, with a pillow under the painful arm.
Can impingement turn into a rotator cuff tear?
Tendon problems and tears can coexist with age; most people with impingement do not develop a significant tear.
Is heat or ice better for shoulder impingement?
Either can ease pain; use whichever feels better.
Sources
- OrthoInfo (AAOS) · Shoulder impingement/rotator cuff tendinitis
- NHS · Shoulder pain
- Beard DJ et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW). Lancet. 2018
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.