What is shoulder impingement?
Shoulder impingement is one of the most common causes of shoulder pain. This condition is particularly felt when you reach overhead, and it can limit your ability to do daily activities.
If left untreated, shoulder impingement can lead to weakness, bursitis, tendinitis or rotator cuff injuries. Therefore, early diagnosis and treatment is important to prevent further shoulder damage.
People who repeatedly use over-the-head motions, such as individuals whose jobs involve frequent reaching or athletes such as swimmers, are more likely to develop the condition. Shoulder impingement is sometimes referred to as rotator cuff impingement, shoulder impingement syndrome or impingement syndrome.
What causes shoulder impingement?
The shoulder is the most movable joint in the body. It allows for a wide range of motion, but as a result, it can become unstable if the surrounding muscles are not strong.
The shoulder joint requires support from muscles, tendons and ligaments. Weak muscles and stretched ligaments – from overuse, underuse or wear and tear – mean the shoulder can move too much, becoming unstable.
Impingement occurs when the acromion part of the shoulder blade (near the top of the shoulder above the arm) puts pressure on or rubs against the rotator cuff when the arm is lifted. The rotator cuff holds your shoulder joint in place and allows you to rotate your arm.
Shoulder impingement pain can result from repeated lifting or overhead activity, injury or unknown causes. While it’s common for shoulders to get sore from overuse, shoulder impingement is only diagnosed if the symptoms don’t go away and you’re unable to do your daily activities.
What are the risk factors for shoulder impingement?
People who repeatedly move their arm or arms overhead are more likely to develop shoulder impingement. This includes athletes such as swimmers, tennis players, golfers, weight lifters, gymnasts, volleyball players and baseball or softball pitchers.
Certain workers are also prone to shoulder impingement if their job involves reaching or lifting – for example, stocking shelves, painting and doing overhead mechanical repairs.
Age, too, increases the risk due to wear and tear on the body.
What are the symptoms of shoulder impingement?
- Minor pain that persists when you rest or are active
- Pain that radiates from the front of the shoulder down the side of the arm
- Difficulty reaching up behind your back
- Sudden pain when you lift your arms over your head or reach
- Shoulder muscle weakness
- Waking at night from pain caused by pressure on the shoulder area
- Pain when throwing or serving a ball
How is shoulder impingement diagnosed?
Several components in the shoulder can contribute to impingement pain, so your doctor will do a physical examination to try to detect the precise cause of the pain.
To start, your doctor will ask about the location of the pain, type of pain (sharp, dull, constant, sporadic, etc.), if any activities or exercises worsen or improve your pain, when the pain started, its severity, if you have any numbness or weakness, and whether you have any other symptoms.
He or she will check both your shoulders and your neck area to rule out problems that aren’t associated with shoulder impingement. Your doctor will test your range of motion by asking you to move your arm in various positions, and he or she will check to see if you have tenderness in specific parts of the shoulder.
The exam will also involve tests to determine the strength of various muscles around your shoulder.
To get a more accurate diagnosis, your doctor may suggest an X-ray, ultrasound or MRI, although these tests may not be necessary if you notice an improvement after starting treatment. An X-ray can help your doctor assess the condition of the bones in your shoulder, while an MRI or ultrasound can reveal tears in the rotator cuff.
Some doctors may inject a small amount of pain medication into your shoulder. If you notice significant pain relief, this can help confirm a shoulder impingement diagnosis.
What are the treatment options?
Shoulder impingement requires treatment of both the symptoms and the condition. The first step usually involves eliminating any activity that aggravates your shoulder and causes pain. Your doctor may recommend the following until your symptoms improve:
- Lift objects close to your body; avoid lifting overhead.
- Raise your arms no higher than your shoulders.
- Avoid reaching overhead or across the body.
- If you must reach overhead, reach overhead and in front rather than overhead with your arms out to the side.
- Refrain from leaning on your elbows.
- Don’t lie on the affected side; sleep on your back or the opposite side, supporting the affected side with a pillow behind the shoulder.
- If you swim, stick to sidestroke or breaststroke; avoid freestyle, butterfly or backstroke.
- Don’t serve overhand in tennis or volleyball.
- Pay attention to your posture when you are sitting a desk, writing or at work.
Reducing inflammation is also part of treating shoulder impingement. Ice your shoulder for 15 minutes every four to six hours, as needed.
Pain medication such as acetaminophen (e.g., Tylenol) or nonsteroidal anti-inflammatory drugs such as ibuprofen (e.g., Advil, Motrin) or naproxen (e.g., Aleve) can also ease pain and inflammation. Your doctor will recommend the appropriate dosage, which you should take for as long as he or she recommends. In some cases, your doctor may advise a cortisone shot into the shoulder as well.
Wearing an arm sling to limit activity is usually not recommended because a lack of activity may cause a stiff shoulder joint (also known as frozen shoulder).
Exercise is a key part of treatment and prevention for shoulder impingement. Appropriate exercises can help maintain joint mobility and keep your shoulder muscles and tendons flexible. When you are doing the recommended exercises, warm up properly or begin after you have heated your shoulder, per your doctor’s instructions.
While doing the exercises, you should only feel mild pain. Sharp or tearing pain is not normal. If you experience this, immediately stop what you are doing and call your doctor.
Muscle strengthening exercises are also a normal part of shoulder impingement recovery. However, strengthening should wait until the inflammation has subsided, after you have had a steroid injection in the shoulder joint, or one to two weeks after beginning the mobility/flexibility exercises.
Exercises should be done under the direction of a physical therapist. Your exercise plan will focus on strengthening and stretching each of the individual rotator cuff muscles to gain full motion again.
If, after three months of conservative treatment, your symptoms do not improve or your doctor suspects a tear, you may be referred to an orthopedist. An orthopedic surgeon can discuss other treatment methods, such as surgery to remove the impingement and make more space for the rotator cuff.
How is shoulder impingement prevented?
Shoulder impingement is a condition brought on by overuse and, therefore, can be prevented. Try to avoid repetitive motions that irritate the rotator cuff.
However, if your job or your athletic activities require you to repeatedly reach above your head, talk to your doctor or a physical therapist about a program to will help you strengthen your shoulder and keep the involved muscles strong.
What is the short- or long-term impact of shoulder impingement?
Impingement often leads to bursitis, tendinitis, tendinopathy or tendon tears (partial or complete). Bursitis and tendinitis are the most common associated problems. Treatment for shoulder impingement will also focus on treating and preventing these conditions.
If you get to the point where you have shoulder pain when you reach over your head, especially if it limits your ability to go about your everyday activities, see your doctor.
If not treated, shoulder impingement can lead to other long-term problems, such as frozen shoulder, partial rotator cuff tears that may become complete tears, degenerative osteoarthritis of the shoulder joint or partial shoulder dislocation (subluxation).
If shoulder impingement is diagnosed and managed, especially early into the condition, the chances of a full recovery are excellent.
Questions to Ask Your Doctor
- Do I have shoulder impingement?
- What caused my shoulder impingement?
- Will you do any tests to verify the diagnosis or rule out other problems?
- What's the first step in treating shoulder impingement?
- What can I do to relieve pain?
- Is there anything in particular that I should do or avoid?
- For how long will I need to do or avoid this?
- Should I do any stretching or strengthening exercises? Would I work with you or with a physical therapist?
- How long before I notice relief?
- If more conservative treatments don't work, what are the next steps?
- How long does full recovery typically take?
- When should I see you again?
- Is there a possibility that shoulder impingement will come back after it has gone away?
- What can I do to prevent shoulder impingement from getting worse or returning?
Our Medical Advisory Board
Wiser Motion's physician advisors review all information on the site to ensure its accuracy, relevance, and consistency with medical best practices.
James Herndon, MD
Orthopaedic surgeon at Massachusetts General Hospital (Boston, MA) and Professor at Harvard Medical School
Leslie Scott Matthews, MD
Chief of Orthopaedic surgery at the Union Memorial Hospital (Baltimore, MD) and Asst. Professor at Johns Hopkins Hospital
Peter Johnson, MD
Medical Director of occupational medicine and employee health at the McLeod Regional Medical Center (Florence, SC)