Shoulder pain can really impact your life, since every time you reach for something on a shelf, move your arm to pull on a jacket or toss a ball to a child you use your shoulder. Plus, it’s an essential joint for stabilizing your wrists and forearms when you’re doing daily activities like cooking or working at a computer.
If you have shoulder pain, there’s a good chance that shoulder impingement is to blame. “It accounts for about half of all shoulder complaints,” said Leah Brown, MD, an orthopedic surgeon with Banner - University Medicine. And shoulder pain is often chronic or recurring—more than half of the people who have shoulder pain live with it for three years or more.
What is shoulder impingement?
Shoulder impingement is a condition that develops when part of your shoulder blade rubs against your rotator cuff. This contact causes irritation and pain (also referred to as rotator cuff tendonitis). There are different types of shoulder impingement, based on where, exactly, they occur in the shoulder.
- External impingement is the most common form of impingement. “It’s what most people assume when they are discussing impingement,” Dr. Brown said. It’s caused by inflammation, irritation and degeneration in the area between the top bone of the shoulder and the ball-and-socket joint. With external impingement, your rotator cuff muscles get compressed and inflamed, and you can develop bursitis, which is where the tiny sacs of fluid that cushion your shoulder become inflamed.
- Subcoracoid impingement is another form of external impingement, but it’s much less common. It develops in the space between a hook-shaped bone called the coracoid process and the bone in the upper arm, called the humerus.
- Internal impingement is also less common. “It’s primarily seen in athletes who use overhead motions with their arms,” Dr. Brown said. It occurs when you move your arm away from your body and rotate it externally when you’re throwing. These motions can compress the space between the bottom of the rotator cuff and the shoulder blade.
What causes shoulder impingement?
Various factors can cause this condition:
- Repetitive overhead motions
- Poor rotator cuff muscle strength
- Poor posture and shoulder blade muscle strength
- Wear and tear changes within the shoulder joint or rotator cuff tendons
- Degeneration of the rotator cuff tendons
With degeneration, impingement and bursitis can be the first stages of rotator cuff disease, which can progress to partial or complete tendon tears, massive rotator cuff tears and a joint condition called rotator cuff tear arthropathy. People move through this progression at different speeds, depending on how the disease affects them.
Can you prevent shoulder impingement?
You can’t entirely avoid shoulder impingement, since sometimes, your shoulder structure makes you more prone to it. But you can take certain steps to reduce your risk:
- Keep your shoulders strong, balanced and flexible.
- Avoid sitting or standing with slumped or rounded shoulders, which compresses your tendons and bursa.
- Take regular breaks from repetitive activities.
- Warm up and stretch before physical activity.
- Lift and carry items close to your body.
- If you have shoulder pain, avoid carrying a heavy purse or backpack on that shoulder.
- As with most health conditions, choose healthy eating habits and avoid tobacco.
How can you diagnose and treat shoulder impingement?
Your health care provider will ask about your medical history and examine your shoulder to see where you feel pain. They may test the strength and range of motion in your shoulder. They’ll ask about your activities and what you’ve tried to do to alleviate the pain. They may recommend imaging studies such as X-rays, MRI or ultrasound.
To treat and recover from shoulder impingement syndrome, you and your health care team need to work together to develop a treatment plan. “Every person has unique factors to consider,” Dr. Brown said. “Seeing a sports medicine specialist or physical therapist who educates and engages with you leads to the best possible outcomes.”
As long as you have little or no structural damage to your shoulder, it’s likely that trying nonsurgical treatments for three to six months can bring relief. This plan can include:
- A controlled exercise program. Shoulder impingement physical therapy can help your shoulder heal. You can usually see a physical therapist for one or two appointments and learn how to stretch your shoulder and improve flexibility and your range of motion. As your pain decreases, your physical therapist can help you add strengthening exercises for your rotator cuff.
- Icing your shoulder once or twice daily to help reduce inflammation.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.
- Trying corticosteroid injections, which can provide stronger pain relief.
- Activity modification. Taking a break from activities where you must reach overhead or behind your back since these motions can worsen your impingement.
If you have structural problems in your shoulder, if your disease has progressed or if physical therapy doesn’t relieve your pain, you may need surgery. Surgery can usually be performed arthroscopically, with specialized scopes and tools that are inserted through small incisions in your shoulder.
Your surgeon can remove a small part of your shoulder blade to make more room for your rotator cuff, so it isn’t compressed. If you have other shoulder problems, such as arthritis, a partial rotator cuff tear or an inflamed biceps tendon, your surgeon may be able to repair those issues at the same time.
The bottom line
Shoulder impingement, where your shoulder blade rubs against your rotator cuff, is a common cause of shoulder pain. In lots of cases, you can treat shoulder impingement with physical therapy and other noninvasive options. If those treatment options don’t work, minimally invasive surgery might relieve pain.