Shoulder impingement

Shoulder impingement is a disorder of the rotator cuff; a band of muscle and tendon around the top of your arm.

Impingement happens when the tendon in your rotator cuff rubs or catches on nearby tissue and the bone on the top of your shoulder (the acromion). It's a common cause of shoulder pain, and it gets worse when you lift your arm or shoulder.

It can also be described as:

• Impingement syndrome
• Painful arc syndrome
• Subacromial impingement
• Swimmer’s shoulder

It’s common in young athletes as well as middle-aged people who use their arms overhead or are involved in repetitive lifting, and suffer a rotator cuff injury.

Shoulder impingement can happen without warning or begin gradually.

If you have shoulder impingement you may feel:

• Pain in the top and on the outside of your shoulder
• Sudden pain when your arm is raised, especially above your head
• Pain or aching at night
• Pain or weakness when throwing a ball or placing your arm behind your back

However, if your shoulder is stiff you're more likely to have a different condition known as frozen shoulder.

Make an appointment to see your doctor or a physiotherapist if your shoulder pain lasts more than a few weeks or is affecting your everyday life.

Your doctor may ask you lots of questions about the nature of your pain (for example when it started, whether you’ve injured yourself, the impact the pain is having on your everyday activities, where the pain is etc) and carry out a thorough physical examination.

They may also ask you to carry out certain movements with your arms, hands and shoulders. In some cases, they may suggest further tests including:

• Blood tests – only if the doctor has a concern that there are signs or symptoms of some of other health concern such as weight loss, other joint pains, a fever, or recent respiratory problems
• MRI scan
• Ultrasound scan
• X-ray

Causes of shoulder impingement include:

• Injury (eg falling onto your hand or elbow), repetitive use of the arms overhead, and age-related wear and tear can all cause a swollen, thickened or torn tendon
• The fluid-filled sac (bursa) between the tendon and acromion (the bone at the end of your shoulder blade) becomes irritated and inflamed (known as bursitis) because of an injury or through overuse of your shoulder
• The acromion is misshapen/irregular, crowding into the space needed by the tendon, pinching or trapping the tendon when your arm is raised
• There are bony growths (spurs) on the acromion which can develop as you get older

Treatments for shoulder impingement will vary depending on how serious it is.

Less serious:

• Home care with rest using an ice pack to help reduce the pain and any swelling. Your doctor may talk about ‘activity modification’ (avoiding the things that cause you pain)
• Medication, including anti-inflammatory drugs (such as ibuprofen) or steroid injections (no more than two), as recommended by your doctor
• Physiotherapy for around six weeks

More serious:

• Your doctor may recommend a minimally invasive surgical procedure known as shoulder arthroscopy to widen the space around the rotator cuff tendon by removing some of the bony growth (spur) rubbing against it

In most cases, the recovery time from surgery is between three to six months but your consultant will be able to give you more specific guidance about getting back to normal.