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Shoulder impingement ( also known as shoulder impingement syndrome) occurs when a tendon in the shoulder catches or rubs on bone or nearby tissue as the arm is raised. As your arm is lifted, the impingement can cause pain on the outside of your shoulder and/or weakness in your arm.
Many people find their symptoms improve over time with suitable shoulder exercises, but a small number may need further treatment to resolve the problem.
If you have been struggling with pain, stiffness or weakness in your shoulder, an early diagnosis can help give you clarity about the best way forward.
Circle Health Group has the UK's largest network of private hospitals, so it's easy to book a consultation at a hospital nearest you. If treatment is needed - whether it's physiotherapy, pain relief medication or even arthroscopic subacromial decompression - it can be easily arranged for you, without the need to spend weeks or months on a waiting list.
Many of our hospitals offer appointments six days a week (Monday - Saturday), with many also offering evening appointments to fit in with your busy schedule. Call or book online today.
Consultant Orthopaedic Surgeon Mr Ben Gooding from The Park Hospital points out that the term 'impingement' implies a mechanical problem. So, to understand shoulder impingement, it is helpful to have an understanding of shoulder anatomy.
The shoulder is a 'ball and socket' joint, formed by the:
- Humerus (upper arm bone)
- Scapula (shoulder blade)
- Clavicle (collarbone)
The 'ball'; is formed by the head of the humerus, while the 'socket' is a shallow, cup-like structure in the scapula, known as the glenoid.
The joint is surrounded by a layer of tendons known as the rotator cuff. The rotator cuff connects the top of your arm to the muscles around the shoulder and helps with movement. Every time you lift your arm up to the front or the side, the rotator cuff passes through a narrow space at the top of the shoulder, known as the subacromial space.
Sometimes, small growths of bone (bony spurs) can form in the subacromial space. When these bony spurs catch on the tendon as the arm is raised from the side, it is known as shoulder impingement.
Shoulder impingement is more common in middle-aged people. Although it can result from injury, Mr Gooding says that the most common cause is overuse of the shoulder joint.
Causes of shoulder impingement include:
Overuse
Our shoulders are used countless times each day, often without conscious thought. Certain activities and exercises use a lot of shoulder movements. These include swimming, tennis and shoulder presses, as well as throwing sports like javelin and discus.
In Mr Gooding's experience, shoulder impingement is very common in manual workers whose jobs involve a lot of overhead movements. Examples include painters, decorators and plasterers.
Swelling in the tendon
With limited space available within the subacromial space, any swelling of the tendon increases the chance of it catching as the arm is used.
Natural wear and tear in the joint
As we age, the surfaces of our joints can become worn, increasing the chance of a tendon catching as it moves over the bony surfaces.
Formation of a bone spur
As mentioned previously, a bony spur may form within the joint space. The tendon can easily catch on this spur as it moves.
A natural curve or 'hook' in the acromion
People with a natural curve or 'hook' in the acromion will normally have had it from birth.
Bursitis
Bursae are fluid-filled sacs that sit between moving tissues. Inflammation of a bursa is known as bursitis. If the bursa that sits between your rotator cuff and the acromion becomes irritated or inflamed, it may cause shoulder impingement.
Poor posture
Posture is important, and poor posture can increase the chance of developing a shoulder impingement. If you slouch, your shoulders are pushed forwards more than normal. Similarly, an imbalance in the rotator cuff muscles may cause your arm to be pulled into a higher position than normal.
Shoulder impingement is a very common shoulder problem, causing pain when you lift your arm overhead.
Mr Gooding describes the common symptoms he sees in people with shoulder impingement:
"People will tend to present with pain in their shoulder that is related to activity or certain positions of the arm. Typically, the pain occurs as the arm is lifted up through the middle of the range (we call this the arc), and then when it comes down again.
"They may also have a lower-level aching and discomfort in their shoulder. This comes from tendons that have been irritated through the impingement process."
A shoulder impingement will not normally cause pain when the arm is in the lower and higher reaches. Pain tends to be felt in the shoulder when the arm is lifted to about 60 degrees. This pain will remain as you continue lifting your arm higher, but will usually then stop when your arm gets to around 120 degrees.
Other symptoms of a shoulder impingement include:
- Pain in the top, outermost part of your shoulder
- Pain in your shoulder when doing overhead exercises (like lifting a weight)
- Pain at night which may disturb sleep
Simple activities like putting on a coat, painting a wall or lifting something into a high cupboard can become incredibly painful. You may find that you can't put your arm behind your back without pain.
Shoulder impingement can affect the left and right shoulder, although it is rare to have it in both shoulders at the same time.
If you have any type of shoulder pain, you will need a diagnosis as soon as possible so that you can get the right treatment started. Fortunately, diagnosis of shoulder impingement can normally be made from your clinical history and an examination of your shoulder.
When you meet with a consultant at your local Circle Health Group hospital, they will talk with you about your symptoms. Your consultant will also want to know:
- When your shoulder pain started
- Where (and when) you experience the pain in your shoulder
- What movements trigger or aggravate the pain
- Whether the pain has been getting worse over time
- How your shoulder pain is affecting your normal activities and/or exercise
A physical examination of the shoulder is also helpful, and your doctor will move your arm into certain positions to assess the extent of any shoulder impingement.
In some cases, diagnostic tests may be needed to confirm a diagnosis or to rule out other causes, but these are not always needed.
Diagnostic tests for shoulder impingements
If imaging is needed, a shoulder X-ray may be done to look for a bony spur on the shoulder blade, or for signs of arthritis that might be presenting as impingement. In other cases, an ultrasound or MRI scan can be helpful, particularly if damage to the rotator cuff is suspected.
While these scans can sometimes take a while to arrange in many places, Circle Health Group hospitals can provide you with fast access to specialist imaging, significantly reducing the time you'll be waiting to get a diagnosis confirmed.
Once a diagnosis has been confirmed, your consultant will discuss treatment options with you.
If you would like to meet with one of our shoulder specialists for expert assessment and fast access to treatment, why not book a private consultation today?
Shoulder impingement will sometimes naturally resolve over time.
If it doesn't, or the pain is too severe to cope with for long, several treatments are available to help get you out of pain and back to better movement and function in your shoulder again. These range from conservative (non-surgical) methods through to surgical treatment options.
Exercise therapy
Mr Gooding explains how shoulder impingement is initially treated:
"The primary treatment for impingement is exercise therapy. This may be self-directed or with the help of a physiotherapist. The aim of this exercise therapy is to strengthen the rotator cuff, so that as the arm is raised, it doesn't cause trapping of the tendons.
"There is some very good evidence around this, showing that a suitable exercise programme needs to be delivered (and adhered to!) for a minimum of three months to get significant benefit. Most people who follow this programme will gain significant benefits, as long as there is no underlying structural damage."
Your Circle Health Group consultant can arrange for you to meet with one of our physiotherapists for expert guidance.
Some of the exercises or stretches you are asked to do as part of your treatment may feel difficult at first, and you may find them challenging. While they may not be comfortable, they should not cause you pain. If you do get pain at any point, it is important to stop. Your physiotherapist will give you more advice about this.
While exercise therapy is very effective for many people, it is not a quick or instant fix. It will take time to start seeing the benefits, but by following the exercise programme set by your physiotherapist, you stand to gain the greatest benefits.
Stretching
Stretching tight muscles can help to relax and strengthen them. If your shoulder impingement has caused you to tense your shoulder muscles and hold it in an unnatural way, your physiotherapist may give you some stretches to carry out regularly to help correct this.
Depending on your specific issues, these stretches may involve the upper and lower back, chest, neck and/or arm. You may also be given stretches that specifically target the muscles around the scapula.
Over time, you will begin to see the benefits of your exercises and stretches programme. As your symptoms improve, your physiotherapist may give you different exercises and stretches to do. Rubber resistance bands can help introduce different levels of resistance into your exercise, helping to engage and activate your muscles and making them work harder.
Pain relief
Over-the-counter pain relief medication may help to manage your shoulder pain. Before you take any medication, always check it is safe for you to do so. If you have any queries, please speak with a pharmacist or doctor for advice.
Injection of anaesthetic and/or steroids
An injection of an anaesthetic directly into the subacromial space will usually relieve pain almost immediately. (Incidentally, this can also be used to confirm a diagnosis of shoulder impingement.)
Often a corticosteroid will be injected at the same time, and this can help calm down the irritated and inflamed tendons and open up the space slightly.
Following a cortisone injection into your shoulder, you may find it easier to do some of the exercises set by your physiotherapist.
Shoulder surgery
Most people with shoulder impingement will find their symptoms resolve with the treatments described above.
However, a small proportion of patients may need further treatment. This will normally involve surgery, with an operation called arthroscopic subacromial decompression.
If you are in the minority of people who need surgery to treat shoulder impingement, you may wonder what your recovery will be like.
As with any type of surgery, the recovery time from subacromial decompression surgery varies for everyone. Most people will feel significantly better within a couple of weeks of their surgery, although it may take up to a year for you to see the full benefits.
The speed of your recovery, and how fully you recover, from a shoulder impingement will depend on several factors, including:
- The cause of the impingement
- Your general health
- The extent of any damage to the subacromial space or tendon
- How well you adhere to your exercise therapy programme
Subacromial decompression is carried out through keyhole surgery. This means you will only have a few very small incisions made in the skin of your shoulder, and these usually heal quickly. A waterproof dressing will cover the shoulder, so you will be able to shower once you are home.
With the UK's largest network of private hospitals, it is no wonder so many people choose to visit their local Circle Health Group hospital for expert assessment and treatment of a shoulder problem.
Each Circle Health Group hospital provides you with:
Rapid access to a shoulder specialist
Many Circle Health Group hospitals have private consultations available six days a week (Monday - Saturday), and some consultants run evening clinics, particularly helpful for people who would prefer not to have to take time off work for a medical appointment.
An earlier diagnosis
You will always see a consultant at your private consultation and will never be seen by a more junior doctor.
By getting assessed by a consultant from the beginning, diagnosis and treatment planning is much more streamlined. An earlier diagnosis means that any treatment plan can be started at an earlier date.
Flexible appointments
You can book a private consultation on a day of your choosing and at a time that is convenient to you. You can also choose your consultant if you would like. It is easy to book a private consultation at your local Circle Health Group hospital, you can book online or call us direct if you'd prefer.
Fast access to imaging
The most important part of making a diagnosis of shoulder impingement is the clinical examination. Often, this will be all that is needed.
If diagnostic imaging is needed to confirm a diagnosis, or to rule out another cause for your shoulder pain, each Circle Health Group hospital provides fast access to X-ray, MRI and ultrasounds. Dedicated radiologists provide on-site reporting so that results are back with your consultant quickly.
If you are struggling with any type of shoulder problem, whether it has only recently started or has been troubling you for a while, the shoulder specialists at your local Circle Health Group hospital would be delighted to help you get the support you need as soon as possible.
Whether you need physiotherapy or joint injection, advice on stretching or shoulder surgery, we are here to help you. Contact us today to book your private shoulder consultation.
We look forward to welcoming you to your local Circle Health Group hospital and helping get you out of pain and back to better movement and function in your shoulder once more.
Content reviewed by Circle in-house team in August 2022. Next review due August 2025.
