Shoulder Impingement

Shoulder impingement happens when your rotator cuff tendons get compressed or irritated in the narrow space at the top of the shoulder. The rotator cuff is a group of muscles and tendons that help stabilize your shoulder and allow you to lift and rotate your arm.

Shoulder impingement can cause pain and limited movement. It is one of the most common reasons you may see a health care provider for shoulder pain, especially if you do repetitive overhead work or sports. 

What causes shoulder impingement?

Shoulder impingement happens when a space in your shoulder narrows and puts pressure on your rotator cuff tendons. This space is called the subacromial space, a tunnel between the top of your arm bone and the roof of your shoulder.

This narrowing can be due to:

• Structural factors: Bone shape or spurs
• Functional factors: Muscle weakness, poor mechanics or posture

Common causes and risk factors

These factors may put you at higher risk: 

• Repetitive overhead movements in sports or work, like swimming, tennis, baseball, volleyball, stocking shelves, painting, window washing or construction work
• Rotator cuff inflammation or injury
• Bone spurs
• A naturally curved or hooked tip of the shoulder that narrows the space around the rotator cuff
• Previous shoulder conditions such as bursitis, rotator cuff tendinopathy or arthritis
• Muscle imbalance or shoulder weakness 
• Sudden trauma, such as a fall or direct blow to the shoulder 
• Poor posture
• Aging and wear and tear 

With shoulder impingement, you may notice:

• Pain when you lift your arm overhead
• Trouble with everyday tasks like putting on a coat, fastening a seatbelt or brushing your hair because of pain
• Pain at the top or outside of your shoulder
• Pain that radiates down the side of your upper arm
• A “painful arc” where pain is worst as you lift your arm between about shoulder height and overhead and feels better when your arm is below your shoulder or straight up
• Stiffness or tenderness in the front of the shoulder
• Shoulder pain at night, especially when lying on that side
• Weakness in the shoulder
• Limited range of motion
• Pain when reaching behind your back
• A catching or pinching sensation
• Crackling, popping or grinding when you move your shoulder

You should have your shoulder checked by a health care provider if you have: 

• Shoulder pain that does not improve with rest 
• Shoulder pain that lasts longer than a few weeks 
• Shoulder pain that keeps you from doing your usual activities  
• Shoulder pain that gets worse instead of better 
• Difficulty lifting or using your arm 
• Pain that affects sleep 
• Weakness or loss of function 
• Pain that starts after an injury  
• Pain along with swelling, warmth, redness or fever

Early treatment can help keep pain from getting worse and may help prevent a more serious injury, like a rotator cuff tear, chronic bursitis or frozen shoulder. 

Your provider may: 

• Review your symptoms and activity level 
• Ask about any injuries 
• Check your neck and shoulder blade movement  
• Examine your shoulder to see how strong it is and how well it moves 
• Perform specific tests to see exactly what causes pain 
• Order imaging such as X-rays or MRI if needed to look for bone spurs or arthritis 
• Check soft tissues with an ultrasound 

Non-surgical treatment

• Rest and activity modification, such as avoiding using your arm in motions that cause pain while still using it in a comfortable range
• Anti-inflammatory medications
• Physical therapy to build strength and flexibility in the rotator cuff and shoulder blade muscles, improve posture and help your shoulder move properly
• Ice or other cold packs for 15 to 20 minutes at a time, several times a day, to reduce inflammation
• A daily home exercise and stretching program, to help prevent stiffness and frozen shoulder 
• Modifications to work and sports so you can stay active without overloading your shoulder
• Sleeping on your back or on your other side, rather than with your arm under your head or pillow, since overhead positions can make impingement worse

Injections

• Ultrasound-guided corticosteroid injections to reduce inflammation and pain; however, you can usually only have three of these injections because too many can weaken tendons
• In some cases, other injections such as nonsteroidal anti-inflammatory (NSAID) injections or platelet-rich plasma (PRP) 

Surgical treatment for shoulder impingement 

Surgery may be an option if other treatments do not help after three to six months, when imaging shows a rotator cuff tear or another problem may need to be repaired.

A procedure called arthroscopic subacromial decompression removes the inflamed tissue and smooths or removes bone spurs to create more space for the rotator cuff. Your surgeon may also remove a tiny amount of your collarbone. 

Recovery time varies depending on your treatment. Many people improve within weeks to months and get good long term relief with non-surgical treatments when they follow their therapy, exercise and activity plan.

After surgery, you’ll need rehab with gentle motion at first, followed by several months of strengthening.

Strengthening and good posture can help keep shoulder impingement from coming back. Continuing your home program even after your symptoms improve lowers the chance that the pain will return. 

These steps can help you avoid shoulder impingement: 

• Strengthen and stretch the muscles in and around your shoulder and upper back 
• Practice proper posture by not slouching, keeping your shoulders relaxed and down and setting up your desk or workstation so you are not reaching overhead or forward for long periods 
• Avoid repetitive overhead strain when possible 
• Build in regular breaks and vary your tasks when you’re using your shoulders 
• Lift and carry items close to your body 
• Use proper technique if your job or sport involves repeated overhead motions 
• Warm up before physical activity 
• Maintain a healthy body weight 
• Avoid smoking 
• Prioritize sleep to support tendon and joint health 
• If you have pain, keep your shoulder moving with gentle range of motion exercises to help prevent stiffness, unless your provider tells you otherwise 

Shoulder impingement is a common cause of shoulder pain that can limit your movement and activities. When you treat it early, you’re more likely to improve without needing surgery, which will allow you to get back to your activities with less pain. 

At Banner Health, we offer: 

• An experienced team of orthopedic specialists that includes surgeons, sports medicine physicians, physical therapists and other providers 
• Advanced imaging and diagnostic tools 
• Personalized therapy and treatment plans that take you from diagnosis to rehab 
• Minimally invasive surgical options 

What does shoulder impingement feel like? 

It often feels like a sharp or aching pain when lifting your arm, especially overhead or behind your back.

Can shoulder impingement heal on its own?

Mild cases may improve with rest and therapy but ongoing symptoms may need treatment.

How long does shoulder impingement take to heal?

Recovery can take a few weeks to several months, depending on how severe it is and what treatment you need.

Is shoulder impingement the same as a rotator cuff tear?

No but impingement can lead to rotator cuff problems if it’s not treated. 

If shoulder pain is limiting your movement or daily activities, make an appointment with a Banner Health specialist.