Shoulder Impingement: Causes, Symptoms & Treatments

You feel pain and weakness in your shoulder, making it difficult to raise your arm above your head or twist it behind your back.

You may ask friends or look online to try to work out what the problem is. You will probably take some over-the-counter medication to reduce the pain and swelling. You may use ice to calm it down.

You know that resting an injury is what you need to do. But for how long? And what if the pain comes back when you return to your activity? Do you stop and rest it all over again, or just start popping pills and altering your movement to avoid the pain?

Almost everyone who comes into my clinic with shoulder pain will have been through most, if not all of those stages. They may have been to see a physiotherapist or consulted with their GP. The chances are, you’ve had your condition for a number of weeks, months or maybe even years.

Listen to your body

Pain in any of your joints always needs to be addressed rather than masked or simply endured. And here’s why:

Your joints respond to damage in a few typical ways.

• More blood: when there is damage to a joint, your body sends more blood to the area, carrying red blood cells, chemicals and oxygen to stimulate healing.
• More fluids: your shoulder joint is encased in a fluid-filled sac. Designed to help with smooth movement, this synovial fluid also delivers nutrients to your joint. Your body produces more of this in response to damage.
• More fluid and blood in your joint also mean swelling and heat. Swelling makes it harder to move your joints – naturally encouraging you to rest while your body gets on with its job of healing. Heat also helps to stimulate healing.
• The chemicals in the fluid and your blood, along with the pressure caused by swelling, stimulate your nerves to send messages to your brain: ‘stop doing that’.

What is shoulder impingement?

Your shoulder is made up of three bones – the ball-like top of your arm bone (humerus), the top of your shoulder blade (acromion) and the end of your collarbone (clavicle). You can move your joint thanks to stretchy tendons connected to your muscles, and it is all held together by tough, fibrous ligaments. The bones are coated in smooth cartilage, and a gel-filled sac called a bursa acts as a cushion in the joint.

Every time you lift your arm, there is some compression or natural impingement of the tendons in your joint.

If the soft tissues inside your joint get repeatedly trapped or pinched, it can lead to a reduced range of movement, along with pain and swelling.

There are actually a number of conditions that can cause shoulder impingement – you can find more information here.

What are the symptoms of shoulder impingement?

Typical symptoms of shoulder impingement include:

• Pain in your shoulder, particularly when you raise your arm above your head, out to the side or twist
• your arm behind your back
• Muscle weakness in your shoulder
• Pain when you lie on your side to sleep

Over a period of time, you may start to feel stiffness in your joint – a common sign of rotator cuff injury or arthritis.

What causes shoulder impingement?

Repetitive and intensive activities are the most common causes of the conditions that lead to impingement. Those who play sports with overarm actions (such as tennis players) or people who work above their heads (such as decorators) are most at risk.

A few typical conditions include:

• Rotator cuff tear: the inner tube of tendons and muscles in your shoulder are known as the rotator cuff. Repetitive and intensive overhead activity can cause tears which lead to swelling and impingement.
• Bone spurs: damage to the bones in your shoulder (often due to degenerative conditions like arthritis) can lead to bony growths. These can cause pressure, catch on soft tissues, restrict movement and lead to tendon damage.
• Bursitis: damage to your joint can cause the gel-filled sac to thicken and get pinched in the joint.
  Tendinitis: the tendons of your rotator cuff can get swollen and inflamed, causing impingement.
• Labral tear: the cartilage that lines the dish in your shoulder blade can get damaged due to degenerative bone conditions or direct impact. The uneven surface can cause impingement.

How is shoulder impingement treated?

With rest, many of the causes of impingement syndrome can get better on their own. But (there’s always a but), you need to be clear about what has caused the pain before you can treat it.

This means seeing a sports medicine professional or an orthopaedic consultant for a diagnosis. Ongoing shoulder pain can be caused by many conditions, and you will usually need an MRI or ultrasound scan to work out what that might be.

A physical therapy programme of stretching and strengthening exercises is usually necessary for complete recovery. Injection therapy may be necessary.

More serious conditions, such as bone spurs, or severe cartilage or rotator cuff tears may need to be treated surgically.

Simon Moyes is an internationally renowned orthopaedic surgeon and leader in the field of arthroscopic (keyhole) surgery. His Capital Orthopaedics team works at Basinghall Clinic in London, with its state-of-the-art diagnostic and surgical equipment, and top sports medicine professionals. Contact Simon Moyes for an expert diagnosis and treatment of shoulder injuries.

Shoulder Impingement Tests

In this instructional video below, we demonstrate how to perform shoulder impingement tests.