Shoulder Impingement:
Causes, Symptoms & Treatment
Also known as
- Impingement syndrome
- Shoulder bursitis (subacromial bursitis)
- Rotator cuff tendinitis (or tendinopathy)
Shoulder impingement is a common source of pain when reaching, lifting, or sleeping on the affected side. It typically occurs when the rotator cuff tendons and the nearby subacromial bursa become inflamed and irritated beneath the bony arch of the shoulder (the acromion), especially with overhead activity.
What is the rotator cuff and the subacromial bursa?
Your rotator cuff is a group of four muscles and tendons that stabilise the shoulder and power lifting and rotation. Without a healthy rotator cuff, the ball of the shoulder (humeral head) will not sit or glide properly in the socket (glenoid).
A bursa is a small, fluid-filled cushion that reduces friction between tendons and bone. The key structure for impingement is the subacromial bursa, which lies above the rotator cuff tendons and below the acromion. When the bursa becomes inflamed (bursitis) and the tendons are irritated (tendinopathy), the space tightens and pain increases—especially during overhead reach.
Common Symptoms
- Achy pain over the outer shoulder/upper arm, worse with overhead reach or behind-the-back
- Pain when lifting, throwing, or prolonged repetitive work
- Night pain, difficulty sleeping on the affected side
- Weakness or fatigue with repeated shoulder use
- Painful arc between ~60–120° of shoulder elevation
Typical Causes & Risk Factors
- Repetitive overhead activity (sport, trades, gym)
- Postural factors (rounded shoulders, thoracic stiffness)
- Age-related tendon changes (tendinopathy)
- Bone spurs, acromial shape, or reduced subacromial space
- Rotator cuff weakness or scapular muscle imbalance
How we Diagnose Shoulder Impingement
Diagnosis is clinical—based on history and examination (including specific impingement and rotator cuff tests). Imaging helps when needed:
- X-ray to assess acromial shape, bony spurs, joint space, and arthritis
- Ultrasound for bursal inflammation and dynamic impingement; can identify cuff pathology
- MRI if symptoms persist or to evaluate suspected rotator cuff tears
Treatment of Shoulder Impingement
Most patients improve with non-operative care. We tailor treatment to your goals, activity level, and examination findings.
Evidence-Based Non-Operative Treatment
- Targeted physiotherapy: rotator cuff and scapular strengthening, postural correction, thoracic mobility, and graded return to overhead activity (typical program 6–12 weeks).
- Activity modification: temporarily reduce aggravating overhead or repetitive tasks; optimise ergonomics.
- Analgesia/anti-inflammatories: short-term use as advised by your GP.
- Ultrasound-guided corticosteroid injection: for persistent pain limiting rehab; settles bursitis to enable more effective physiotherapy.
When to Consider Shoulder Arthroscopy
If pain persists beyond 6 months despite high-quality physiotherapy and (where appropriate) injections, arthroscopic surgery may be recommended. During a keyhole procedure we can:
- Debride inflamed bursa (bursectomy) and address thickened tissues contributing to impingement
- Assess and, if required, treat partial rotator cuff tears or other intra-articular problems
- Perform acromioplasty selectively when bony spurs or acromial morphology meaningfully reduce the subacromial space
Non-operative Care vs Arthroscopy — What to Expect
| Aspect | Non-operative Care | Arthroscopic Surgery |
|---|---|---|
| Goal | Reduce pain/inflammation; restore strength, control and range. | Remove inflamed tissue; address mechanical narrowing; treat associated lesions. |
| What it involves | Physiotherapy (6–12 wks), activity modification, short-term meds, +/- guided injection. | Day procedure (keyhole); bursectomy ± selective acromioplasty; treat cuff pathology if present. |
| Recovery timeline | Commonly improves within 6–12 weeks. | Daily activities ~6–12 weeks; overhead/heavy sport often 3–6 months (case dependent). |
| Best for | First-line management; many patients recover without surgery. | Persistent symptoms >6 months despite quality rehab / injections; structural contributors. |
| Key success factor | Consistent, progressive rehabilitation and load management. | Post-op rehabilitation and graded return to overhead loading. |
Good to know: Whether you choose non-operative or operative care, a structured, progressive rehab program is the strongest predictor of long-term success.
Ready to plan your recovery? Book an assessment or learn more about our physiotherapy approach.
Prevention & Self-Care Tips
- Warm up shoulders before overhead tasks; pace and vary activities
- Maintain thoracic mobility and scapular control
- Strengthen the rotator cuff and posterior chain regularly
- Optimise workstation and lifting technique; avoid prolonged end-range overhead positions initially
Further Reading and References
- Specific or general exercise strategy for subacromial impingement syndrome—does it matter? A systematic review & meta-analysis. BMC Musculoskelet Disord. 2017;18:158.
- British Journal of Sports Medicine — shoulder tendinopathy clinical updates.
Shoulder Impingement FAQs
Frequently Asked Questions
How do I know if it’s impingement or a rotator cuff tear?
Both can cause pain with overhead reach. Impingement often presents with a painful arc but preserved strength, while a significant tear may cause objective weakness. Examination and, if needed, ultrasound/MRI distinguish the two.
Do I always need an injection?
No. Many patients recover with targeted physiotherapy and activity modification alone. Injections can be helpful if pain is too severe to progress rehab.
Will surgery fix the problem long-term?
Surgery can reduce pain by addressing inflamed tissue and mechanical factors. Long-term success still depends on rehabilitation, rotator cuff conditioning, and gradual return to overhead loads.
How long until I’m back to sport or heavy work?
Non-operative care commonly improves symptoms in 6–12 weeks. After arthroscopy, most return to usual activities by 6–12 weeks, with higher-demand overhead sports often taking 3–6 months.
When should I seek a specialist review?
If pain persists beyond a few weeks, disturbs sleep, or limits work/sport despite appropriate rest and GP-guided care, a specialist assessment helps clarify diagnosis and optimise treatment.
