Shoulder impingement occurs when the rotator cuff tendons in the shoulder become irritated or pinched, typically by the acromion (a part of the shoulder blade). This condition often leads to pain and discomfort and is one of the most common causes of shoulder pain. It is especially prevalent in athletes or individuals who perform repetitive overhead motions, such as swimmers, baseball players, tennis players, or workers in occupations requiring frequent lifting.

Request an Appointment

Causes of Shoulder Impingement

Shoulder impingement is typically caused by one or more of the following factors:

  • Aging: As a person ages, the rotator cuff tendons can weaken and become more susceptible to irritation.
  • Rotator Cuff Injuries: Direct injury to the rotator cuff can cause the muscles to weaken or tear, leading to impingement.
  • Tendonitis: Inflammation of the tendons, often due to overuse, can cause swelling and lead to impingement.
  • Bursitis: Inflammation of the bursa (a fluid-filled sac that cushions the shoulder joint) can also contribute to impingement.
  • Overuse: Repetitive overhead activities, such as lifting or throwing, can stress the rotator cuff and lead to impingement.
  • Structural Abnormalities: In some cases, the shape or alignment of the shoulder may predispose a person to impingement, especially if the acromion is angled in a way that reduces the space for the rotator cuff.

Some individuals may experience impingement without a clear cause, though repetitive motion and weakness in the rotator cuff are often contributing factors.

Symptoms of Shoulder Impingement

The symptoms of shoulder impingement typically develop gradually and may worsen over time if left untreated. Early symptoms may include:

  • Mild pain in the shoulder, particularly when lifting the arm or reaching overhead.
  • Radiating pain from the front of the shoulder down the side of the arm.
  • Pain that becomes more intense during overhead movements, such as lifting or throwing.
  • Swelling and tenderness in the shoulder area.
  • Loss of strength and mobility, making it difficult to perform tasks that require shoulder movement.

As the condition progresses, pain and stiffness may increase, and it can become difficult to lift or lower the arm. If untreated, shoulder impingement can lead to frozen shoulder, where movement becomes severely restricted.

Diagnosis of Shoulder Impingement

A doctor will typically diagnose shoulder impingement through a combination of:

  1. Review of Symptoms: The doctor will ask about the patient’s symptoms, including pain location, intensity, and activities that aggravate the pain.
  2. Physical Examination: The doctor will assess the range of motion, strength, and tenderness in the shoulder. Specific tests may be conducted, such as the Neer test or Hawkins-Kennedy test, where certain movements may provoke pain and help pinpoint impingement.
  3. Imaging:
    • X-rays: To check for structural issues, such as bone spurs or arthritis, that could contribute to impingement.
    • MRI scan: Provides detailed images of the soft tissues, including the rotator cuff, allowing doctors to identify tears or inflammation.

Treatment of Shoulder Impingement

Treatment for shoulder impingement aims to relieve pain, reduce inflammation, and restore mobility. Initial treatment typically includes:

  1. Rest: Limiting activities that cause pain or strain on the shoulder, especially overhead movements.
  2. Anti-inflammatory Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and swelling.
  3. Steroid Injections: In more severe cases, a corticosteroid injection into the shoulder may provide temporary pain relief by reducing inflammation.
  4. Physical Therapy: Specific exercises to strengthen the rotator cuff and improve shoulder mobility, along with stretches to relieve tightness, are crucial for recovery. Physical therapy also helps prevent recurrence by improving the shoulder’s function and stability.

Surgical Treatment

While surgery is rarely necessary for shoulder impingement, it may be considered if conservative treatments fail to provide relief, or if the impingement is severe and has caused structural damage. Surgical options include:

  • Arthroscopic Surgery: A minimally invasive procedure in which small incisions are made, and a tiny camera (arthroscope) is inserted into the shoulder to remove or repair damaged tissue, such as inflamed bursa or tendon tissue that is irritating the rotator cuff.

Surgery is typically reserved for severe cases or if the condition leads to chronic pain and limited mobility despite non-surgical treatments.

Recovery and Rehabilitation

After treatment, especially if surgery is involved, rehabilitation plays a crucial role in recovery. This often includes:

  • Physical Therapy: To restore strength, flexibility, and range of motion to the shoulder.
  • Gradual Return to Activity: Depending on the severity, the patient may need to modify their activities for several weeks or months before returning to full function.

With proper treatment, most people with shoulder impingement can return to their regular activities and sports without long-term issues. However, continued care and exercise are important to maintain shoulder health and prevent recurrence.

Additional Resources