
Shoulder impingement happens when the tissues in your shoulder become swollen and pinch against nearby bones. This can cause pain when you lift your arm or reach overhead. It’s often caused by overuse, injury, or wear and tear as you age. Common symptoms include shoulder pain, weakness, and difficulty moving your arm. Treatment usually involves rest, physiotherapy, pain relief, and sometimes surgery. Understanding the causes and types of shoulder impingement can help you manage and prevent it.
Shoulder impingement occurs when the outer edge of your shoulder blade, known as the scapula, rubs and pinches your rotator cuff underneath it. This condition, also called impingement syndrome, causes pain during movement due to the rubbing or pinching within your joint.
The rotator cuff, a group of four muscles and their tendons connecting your shoulder blade to your upper arm bone (humerus), is essential for raising and rotating your arm. However, it sits in a narrow space between the humerus and the acromion (the top part of your shoulder blade), making it prone to being pinched.
If you experience ongoing shoulder pain or difficulty moving your shoulder, it’s important to consult a healthcare provider for proper assessment and treatment.
Shoulder impingement can be classified into specific conditions. Key types include:
Common symptoms of shoulder impingement include:
Pain
Typically felt at the top, front, or side of your shoulder.
May radiate from the front of your shoulder to the side of your arm.
Often worsens during certain movements like raising your arm above your head, lifting or lowering your arm, or reaching behind your back.
Can become more intense at night, interfering with sleep.
Tenderness
Your shoulder may feel tender to the touch, especially in the areas affected by swelling or inflammation.
Weakness
Difficulty lifting or holding weight with your affected arm.
Reduced ability to perform tasks requiring shoulder strength, such as dressing, washing hair, or putting on a seatbelt.
Reduced Range of Motion
Pain or stiffness that limits shoulder movement, especially when attempting overhead or twisting motions.
Difficulty with daily activities like reaching into a back pocket or throwing a ball.
Gradual or Sudden Onset
Symptoms may appear gradually due to wear and tear or overuse, or suddenly after injury or a specific event.
Progressive Symptoms
In the early stages, mild pain might occur at rest or during use.
Over time, the condition can lead to severe pain, noticeable weakness, and difficulty performing basic activities.
These symptoms can significantly impact daily life, especially if left untreated. Addressing them early can prevent progression and improve shoulder function.
Shoulder impingement is often linked to repetitive stress or structural changes in your shoulder. Here are some common causes:
Overuse injuries trauma or sudden injury - impingement may result suddenly from an injury, such as a fall, car accident, or sports-related impact. These events can lead to inflammation or structural damage in your shoulder. They include:
Repeated overhead movements, known as overhead rotation motions, are major contributors. Activities such as swimming, baseball, tennis, and volleyball often involve these movements, making athletes particularly susceptible.
Jobs involving repetitive lifting or overhead tasks, like construction work, painting, or paper hanging, can place excessive stress on the shoulder joint and rotator cuff over time.
Idiopathic causes – when shoulder impingement develops without a clear or obvious cause, known as idiopathic impingement.
Age and wear-and-tear - older people are at risk due to natural degeneration of the rotator cuff and associated tendons. Bone spurs or changes in the acromion shape can also develop with aging, increasing the likelihood of impingement.
Rotator cuff strain - mild injuries to your rotator cuff, even without an obvious traumatic event, can cause pain and inflammation over time, leading to impingement.
Several factors can increase a person's likelihood of experiencing shoulder impingement. These include:
Understanding these contributing factors can help in preventing shoulder impingement through better practices, like modifying activities or incorporating strengthening exercises.
Effective treatment for shoulder impingement focuses on reducing pain and improving mobility through pain relief, physiotherapy and surgery therapies and lifestyle adjustments.
Over-the-counter NSAIDs can help ease pain and reduce swelling. You should consult your healthcare provider if you plan to use them for more than 10 consecutive days.
These prescription medications reduce inflammation. Your provider might recommend cortisone injections directly into your shoulder for targeted relief.
Physical therapy for shoulder impingement focuses on restoring movement, reducing pain, and building strength. It includes stretching exercises to improve your range of motion, strengthening your rotator cuff, posture correction, and activity modifications to prevent strain. Therapists may also use hands-on techniques like massage and educate patients on care at home to maintain progress.
Surgery may be recommended for shoulder impingement if nonsurgical treatments fail to provide relief. Common procedures include:
Arthroscopic shoulder decompression - a minimally invasive surgery that removes inflamed tissue and bone spurs from the acromion to create more space for the rotator cuff. Learn more about shoulder arthroscopy
These surgeries are often performed using keyhole surgery, using small incisions and specialised instruments, including an arthroscope, for quicker recovery.
Exercises for shoulder impingement often focus on improving your mobility, strengthening your rotator cuff, and enhancing posture. Here are some exercises that may be recommended for shoulder impingement to strengthen and improve shoulder function. If you repeat these exercises daily, you should expect to feel an improvement in shoulder pain within about two weeks:
Isometric shoulder internal and external rotation
Place a rolled-up towel under your arm of the affected shoulder for support.
Internal rotation - stand by a wall with your elbow bent at 90 degrees. Push your flat hand into the wall at 25-50% pressure and hold for 10 seconds. Repeat 10 times.
External rotation - turn so your outer hand pushes against the wall at 25-50% pressure. Hold for 10 seconds and repeat 10 times. Gradually increase pressure as tolerated.
Side-lying shoulder external rotation
Lie on your uninjured side with a towel under your affected arm.
With your arm bent at 90 degrees, lift a light weight (like a 1-pound water bottle) upward until it aligns with your shoulder, then slowly lower it.
Perform 3 sets of 10 reps, gradually increasing weight up to 5 pounds if tolerated.
Shoulder scaption exercise
Stand holding a light weight in your hand on the affected side.
Lift your arm at a 45-degree angle away from your body until fully extended, then lower it slowly.
Perform 3 sets of 10 reps, increasing weight as strength improves.
Each type of impingement has its own set of causes and treatments, and healthcare providers usually diagnose the specific issue based on symptoms, physical examination, and imaging studies.
X-rays - help identify bone abnormalities, such as spurs, that may contribute to impingement.
MRI (Magnetic Resonance Imaging) - provides detailed images of soft tissues, including tendons and muscles, to detect inflammation or tears.
These tests not only diagnose shoulder impingement but also rule out other conditions like rotator cuff tears, biceps tendon injuries, or arthritis.
Recovery from shoulder impingement varies, but most patients notice improvement within a few weeks of starting treatment. However, full recovery can take several months, especially if physiotherapy or exercises are part of the plan. It's important to avoid intense physical activity or sports until your healthcare provider confirms it's safe, even if your symptoms seem to improve.
To reduce the risk of shoulder impingement:
Treating a shoulder impingement usually involves a combination of rest, physical therapy, and pain relief methods like over-the-counter NSAIDs or corticosteroid injections. Strengthening exercises and posture correction can help improve shoulder function and prevent future issues. If these do not help to relieve your symptoms then surgery might be necessary to address structural problems. You should speak with a healthcare provider for personalised advice.
You might suspect shoulder impingement if you feel pain in the front or side of your shoulder, especially during overhead movements or when reaching behind your back. The pain may worsen at night, making it hard to sleep, and you might notice weakness or difficulty lifting your arm. If these symptoms persist, consult a healthcare provider for a proper diagnosis.
Shoulder impingement may improve with rest and activity modification, but it often requires treatment like physiotherapy, exercises, or pain relief to reduce swelling and strengthen and restore function. Without proper care, it could worsen over time, so consulting a healthcare provider is recommended.
Releasing shoulder blade impingement typically involves stretching and strengthening exercises to improve mobility and relieve tension in the surrounding muscles. Physiotherapy can help restore proper movement patterns, while posture correction reduces strain on the area.
Avoid activities that worsen shoulder impingement, such as repetitive overhead movements or heavy lifting. Don't ignore persistent pain or continue exercising through discomfort, as this can lead to further injury. You should rest your shoulder and seek medical advice for appropriate treatment and management.
Shoulder impingement typically progresses through four stages: inflammation, fraying of the rotator cuff tendons, partial tears, and finally, severe damage or complete tears. Early stages involve mild pain and swelling, while later stages can lead to significant pain, loss of motion, and the need for surgical intervention. Early diagnosis and treatment are key to preventing progression.
Conditions like rotator cuff injuries, frozen shoulder, arthritis, and labral tears can mimic shoulder impingement symptoms. These issues often cause pain, stiffness, and reduced mobility, making it essential to consult a healthcare provider for an accurate diagnosis.
Massaging a shoulder impingement can help relieve tension, improve blood flow, and reduce discomfort. However, it’s important to avoid deep or aggressive techniques that might worsen inflammation.
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