Shoulder impingement

Symptoms of shoulder impingement

Shoulder impingement can start suddenly or come on gradually.

Symptoms include:

• pain in the top and outer side of your shoulder
• pain that's worse when you lift your arm, especially when you lift it above your head
• pain or aching at night, which can affect your sleep
• weakness in your arm

Your shoulder won't usually be stiff. If it is, you might have a frozen shoulder instead.

Read about other causes of shoulder pain.

When to get medical help

See your GP if you have shoulder pain that doesn't go away after a few weeks or is stopping you from doing your normal activities.

Your GP will look at your shoulder and ask you to move your arm in different ways to see how easily you can move it and if movement makes the pain worse.

They may suggest some treatments you can try or refer you to a physiotherapist for treatment advice. You probably won't need to go to hospital for any scans.

You can also go straight to a physiotherapist without seeing your GP, but you might need to pay. Read about finding a physiotherapist.

Treatments for shoulder impingement

Things you can do

• Avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head (such as swimming or playing tennis) for a few days or weeks. Ask your GP or physiotherapist when you can restart these activities.
• Don't stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder doesn't become weak or stiff. It's usually best to avoid using a sling.
• Hold an ice pack (or a bag of ice cubes or frozen vegetables) to your shoulder for around 20 minutes several times a day – but don't put it directly on your skin, wrap it in a towel first.
• Take painkillers – anti-inflammatory painkillers (such as ibuprofen) or paracetamol may help. Your GP can prescribe stronger painkillers if needed.

Shoulder exercises

Your GP may be able to advise you about simple shoulder exercises you can do.

Physiotherapists can also diagnose shoulder impingement and suggest exercises to help improve shoulder posture and further strengthen your muscles to improve your pain and range of movement.

You may need to do these exercises with a physiotherapist at first, but after a while you'll usually be able to continue doing them at home.

Return to your GP or physiotherapist if the exercises make your pain worse or your pain doesn't improve after a few weeks.

Steroid injections

Steroid injections into your shoulder can help relieve pain if rest and exercises on their own don't help.

But it's still important to do your shoulder exercises, as injections usually only have an effect for a few weeks and your pain may come back if you stop the exercises.

While the injection can be repeated if needed, having more than two isn't usually recommended because it might damage the tendon in your shoulder in the long term.

The injections can also have side effects, such as permanent dimpling or lightening of the skin where the injection is given.

Surgery

An operation called a subacromial decompression may be an option if other treatments haven't worked, although there's some uncertainty about how much it helps.

The operation involves widening the space around the rotator cuff tendon, so that it doesn't rub or catch on anything nearby.

The operation is usually done using small surgical instruments passed through small cuts in your shoulder – this is a type of keyhole surgery known as arthroscopy. It's usually done under general anaesthetic (where you're asleep).

Most people can go home the same day or the day after surgery and are able to use their shoulder normally again after a few weeks.

Causes of shoulder impingement

When you lift your arm, the rotator cuff tendon passes through a narrow space at the top of your shoulder, known as the subacromial space.

Shoulder impingement occurs when the tendon rubs or catches on the bone at the top of this space, called the acromion.

This can happen if:

• the tendon becomes swollen, thickened or torn – this can be due to an injury, overuse of the shoulder (for example, from sports such as swimming or tennis) or "wear and tear" with age
• the fluid-filled sac (bursa) found between the tendon and acromion becomes irritated and inflamed (bursitis) – this can also be caused by an injury or overuse of the shoulder
• the acromion is curved or hooked, rather than flat – this tends to be something you're born with
• there are bony growths (spurs) on the acromion – these can develop as you get older