What to know about shoulder impingement

People may use different terms to refer to shoulder impingement, including:

Shoulder impingement causes pain due to inflammation in the shoulder. This inflammation results from repetitive use of the shoulder. Aging and injuries can make the issue worse.

The shoulder is a complex area that serves as the meeting point of the upper arm, shoulder blade, and collarbone.

To protect these bones, a group of muscles and tendons called the rotator cuff surrounds the shoulder joint. The rotator cuff also holds the top of the upper arm in place in the shoulder socket.

Additionally, a fluid filled sac called a bursa cushions the shoulder joint, preventing friction in the socket. The bursa allows free motion of the tendons when a person moves their shoulder, preventing sticking and friction.

Impingement occurs when inflammation causes the tendons, muscles, or bones to push into the bursa or against each other.

The classic symptom of shoulder impingement is difficulty lifting the arm past shoulder height. It will also hurt to reach the arm behind the back.

People with shoulder impingement usually experience general stiffness and throbbing in the shoulder. This type of pain may resemble that of a toothache, rather than the tearing pain of an injured muscle. The person may also see or feel swelling in their shoulder.

The shoulder will typically ache and be stiff when at rest and then hurt more when the person uses it.

These symptoms may get worse over time, with pain increasing and strength decreasing. The pain may get worse if the person tries sleeping on the affected side of their body. Putting the arm over the head or behind the back may become increasingly difficult.

Without treatment, the tendons in the rotator cuff may wear down or tear, which can lead to worse pain, shoulder weakness, and difficulty lifting or using the shoulder at all.

Overuse is the leading cause of shoulder impingement.

Over time, any activity that repeatedly requires a person to move the arm up above the shoulder and toward the back may put them at risk of impingement.

Examples of these activities include:

• swimming
• tennis
• softball
• baseball
• painting
• packing
• lifting
• construction

Shoulder impingement occurs due to overuse, but age is also a factor. The longer the person has spent using the shoulder or doing these types of activities, the more likely symptoms become.

Injuries, such as a dislocated shoulder, are other important causes of shoulder problems, including impingement and rotator cuff tears.

Diagnosing shoulder impingement early on is important, as treatment can help prevent symptoms from getting worse.

Doctors will do a physical examination of the shoulder first, checking for any signs of injury, bruising, or swelling. They will also ask the person questions about when their symptoms started.

They may move the person’s arm in the socket or ask them to do a series of arm movements to check for any abnormalities.

In some cases, doctors may then order imaging tests, such as an X-ray or MRI scan, to rule out other possible causes of the pain. Other possible causes include bone spurs, injuries, and arthritis.

Conservative treatments are effective for many people. The authors of a 2017 study note that 60% of cases respond well to conservative treatment within 2 years. Minor cases may resolve more quickly.

Conservative treatment for shoulder impingement can include:

Physical therapy uses safe, gentle exercises to strengthen the muscles in the shoulder and restore the range of motion in this area of the body.

A small study in 2013 demonstrated that 10 weeks of physical therapy both improved function and reduced pain in people with shoulder impingement. The duration of healing will vary, however, depending on the individual case.

In cases where the body does not respond to these conservative treatments, doctors may recommend surgery.

The surgical procedure for shoulder impingement widens the space around the rotator cuff to prevent friction. If a person has a rotator cuff tear, surgical reparation may also be necessary.

Part of the treatment for shoulder impingement is learning to prevent future injury. Physical therapists will show the person how to use the shoulder correctly and train them on specific movements relevant to their occupation or sport to avoid injury in the future.

It is vital to follow any exercise plan that a physical therapist has set up. Anyone who has not booked an appointment with a doctor to discuss treatment should do so.

Below are a few possible exercises that a physical therapist might recommend to help heal shoulder infringement.

It is important to keep in mind that rest is vital to help the body recover and to avoid pushing too hard or doing too many of these exercises. If any new symptoms appear or existing symptoms get worse, a person should stop the exercise immediately.

Doorway shoulder stretch

To do a doorway shoulder stretch, a person can:

• Stand in a doorway.
• Hold the side of the doorframe with the affected arm, slightly below shoulder height.
• Turn the upper body away from the arm to feel a slight stretch in the shoulder.
• Hold for 20 seconds.

Shoulder blade flexes

To flex the shoulder blades:

• Stand with the back straight and the arms at the sides with the palms facing forward.
• Gently squeeze the shoulder blades together toward the back, holding for 5 seconds.
• Release and relax.
• Repeat 5 times.

Crossover arm stretch

To do this simple stretch:

• Stand straight and lift the affected arm straight out in front of the body, below shoulder height.
• Using the opposite arm, gently pull the affected arm across the body.
• Hold the arm here for 5–10 seconds, then relax back to the starting position.
• Repeat 5 times.

Shoulder impingement generally occurs due to a person overusing the shoulder. Swimmers, baseball players, and other athletes may be more likely to experience this type of injury.

People working in occupations that require a lot of lifting may also be more likely to experience shoulder impingement.

Preventing shoulder impingement by learning how to lift and move the shoulder correctly may be the best way to avoid injury. Most people respond well to simple treatments, such as rest and physical therapy. NSAIDs can also help reduce pain and inflammation.

Anyone uncertain about their symptoms or treatment options should talk to a doctor.