Your shoulder is made of three bones; these are your:
A band of muscle and tendon called your rotator cuff holds your arm securely in your shoulder socket. It covers the head of your humerus and attaches it to your scapula. There are fluid-filled sacs (bursae) that provide a cushion between your rotator cuff and the top part of your scapula (the acromion). The bursae allow your rotator cuff to move smoothly when you move your arm.
Shoulder impingement occurs when the space between your acromion and rotator cuff narrows. The acromion then rubs against (impinges on) the tendon of your rotator cuff and the bursae. It is a common cause of shoulder pain and it gets worse when you lift your arm or shoulder.
It can also be described as:
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:
Symptoms can develop gradually and be mild to start, including:
As shoulder impingement worsens, your symptoms will too. You may experience:
Severe tenderness of your shoulder can cause sudden pain. Eventually, all of your shoulder movements may become painful and restricted
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.
It usually takes three to six months for a full recovery. However, in more severe cases, it can take up to a year. In most cases, you can begin returning to your everyday activities after two to four weeks.
Your doctor may ask you lots of questions about the nature of your pain eg:
They will carry out a thorough physical examination and may also ask you to carry out certain movements with your arms, hands and shoulders. This will help them determine what kind of shoulder impingement you have based on criteria including:
In some cases, your doctor may suggest further tests including:
Causes of shoulder impingement include:
Treatments for shoulder impingement will vary depending on how serious it is.
Treatments for less serious shoulder impingement
Avoid things that cause your pain for a few days or weeks eg anything that involves repeatedly lifting your arms above your head, such as swimming or tennis. This is called activity modification.
Before you resume these particular activities, get advice from your GP or physiotherapist. However, do not stop moving your arm altogether and avoid wearing a sling. Try to complete your usual daily activities as much as you can to prevent your shoulder from becoming stiff and weak.
You can also try applying ice packs (or a bag of frozen peas wrapped in a tea towel) for up to 20 minutes several times a day. This will help reduce your pain and any swelling.
A common over-the-counter anti-inflammatory painkiller you can try is ibuprofen. If needed, your doctor can prescribe stronger anti-inflammatories.
If rest and exercises don't help on their own, your doctor may also recommend steroid injections. However, the effects only last a few weeks; if you stop your exercises after this time, your pain can come back.
You can only have two rounds of steroid injections. More steroid injections can damage the tendon in your shoulder and cause other side effects eg permanent dimpling or lightening of your skin.
A physiotherapist can advise you about simple shoulder exercises for shoulder impingement. These exercises will:
You may need to practice these exercises with a physiotherapist first before you do them at home. You will need to do these exercises regularly to see an improvement in your shoulder impingement. Your physiotherapist will usually suggest you do them for around six weeks.
If these exercises worsen your pain or your pain doesn't improve after a few weeks, see your GP or physiotherapist.
Treatments for more serious shoulder impingement
You will usually need surgery. There are two main types of surgery:
This keyhole surgery is used to widen the space around the rotator cuff tendon by removing some of the bony growth (spur) rubbing against it.
It is carried out under general anaesthetic. You don't usually need to stay in hospital and can go home on the same day of your surgery.
In most cases, the recovery time from surgery is usually three to six months but your consultant can give you more specific guidance about getting back to normal.
Subacromial decompression surgery
This keyhole surgery is usually only considered if other treatments haven't worked as it isn't clear how much it helps. It involves widening the space around the rotator cuff tendon to help stop it from catching or rubbing against anything.
As with shoulder arthroscopy, it is also carried out under general anaesthetic and you can usually go home on the same day.
Does shoulder impingement hurt all the time?
In most cases, shoulder impingement will hurt all the time, both at rest and with activity. However, to start, the pain may be mild. As the shoulder impingement worsens, your pain will increase and may feel worse at night.
How do you stretch a shoulder impingement?
Before you try doing any stretches, speak to your GP or physiotherapist to make sure you won’t make your shoulder impingement worse. There are two common stretches used to treat shoulder impingement:
What does shoulder impingement feel like?
Shoulder impingement can make your shoulder and top of your upper arm feel achy, painful and tender. Pain is usually constant but can increase in intensity when you raise your arm above your head.
How do you sleep with shoulder impingement?
Avoid sleeping on your affected shoulder; instead, sleep on your other side, back or stomach. You can place a pillow next to your affected shoulder to stop yourself from rolling onto it. You can also take an over-the-counter painkiller eg ibuprofen before bed.