Understanding Shoulder Impingement: What You Need to Know
Shoulder impingement is a common shoulder condition in which soft tissues (such as the tendons of the rotator cuff and/or the bursa) become pinched between bones in the shoulder area. Frequently under the top bony plate of the shoulder blade (acromion). (Sports-health)
With the right diagnosis, rest, appropriate rehab, and awareness of risk factors and posture, you can often reduce pain, restore motion, avoid long-term damage (like rotator cuff tears) and get back to using your arm confidently.
Here’s a guide to what shoulder impingement is, how it occurs, what to watch for, how it’s diagnosed, what treatment options exist (both non-surgical and surgical), and tips to protect your shoulder going forward.
Why the Shoulder and Its Space Matter
The shoulder is a complex joint system: the upper arm bone (humerus) meets the shoulder blade (scapula) and collar-bone (clavicle). The rotator cuff (a group of muscles and tendons) wraps around the shoulder joint and helps lift and rotate the arm. (Hospital for Special Surgery)
A critical area is the subacromial space: the gap between the underside of the acromion (the top-outer edge of the shoulder blade) and the humeral head. When that space becomes narrowed (by bone shape, swelling, overuse, etc.), the soft tissues within (tendons, bursa) can become compressed (impinged) during arm elevation or overhead motion. (Sports-health)
When that space is compromised:
- Tendons or a bursa may get irritated or inflamed.
- Repeated compression can lead to tendon degeneration or tears.
- Motion becomes painful, limited, or weak, which can affect daily tasks and athletic activity.
How Shoulder Impingement Happens
There are multiple ways impingement can develop:
- Overuse / repetitive overhead activity: sports like swimming, tennis, baseball, occupations involving lifting overhead.
- Anatomical factors: a curved or hooked acromion, bone spurs, or a prominent coracoid may reduce the subacromial space.
- Postural or functional issues: poor posture (forward-hunched shoulders), muscle imbalances, inadequate scapular control.
- Previous shoulder injury or instability: prior rotator cuff issues, labral tears, or shoulder instability can predispose to impingement.
In short: when the shoulder mechanics are sub-optimal and the soft tissues are exposed to repetitive pinching, impingement may ensue.
Recognising the Symptoms
Common signs of shoulder impingement include:
- A “pinching” or catching sensation in the top/front of the shoulder, especially when raising the arm overhead, reaching behind the back, or during throwing/serving. (Sports-health)
- Pain that radiates from the front/side of the shoulder down the upper arm (but typically not past the elbow).
- Pain at night — particularly when lying on the affected shoulder, or when the shoulder is elevated above head level while sleeping.
- Decreased range of motion and difficulty lifting the arm, especially overhead or behind the back.
- Feelings of weakness in the shoulder, even without major motion, or a sensation that the shoulder may give way under load.
- In some cases: tenderness when touching the top of the shoulder, swelling, or a “painful arc” when moving the arm between ~60-120° of elevation. (Peak Physio)
Because symptoms may start mildly (only with certain movements) then gradually worsen, it’s important to catch them early to avoid progression.
Diagnosing Shoulder Impingement
Diagnosis typically involves:
Patient History:
- Description of pain (when, how, what movements).
- Activity/work/sport history (especially overhead use).
- Prior shoulder injuries. (Sports-health)
Physical Examination:
- Range of motion assessment, strength testing.
- Special tests: e.g., Neer test (raising the arm to provoke pain) or Hawkins‑Kennedy test (arm at shoulder height, internal rotation) may help identify impingement. (Sports-health)
- Examination of posture, scapula mechanics, etc.
Imaging (as needed):
- X-rays: may show bone spur, acromion shape, arthritis — but not soft-tissue itself. (Sports-health)
- MRI: best for visualising soft tissues (rotator cuff tendons, bursa inflammation). (Sports-health)
- Sometimes ultrasound may also be used.
Diagnosis is important because other conditions (rotator cuff tear, labral tear, arthritis) can mimic impingement.
Treatment Options
Conservative (Non-Surgical)
Most cases of shoulder impingement are managed non-surgically first. Goals: reduce inflammation, restore motion, strengthen support, correct mechanics.
Key components include:
- Rest/modification: avoid or reduce overhead tasks, throwing, or reaching behind the back until pain reduces.
- NSAIDs: short-term use of non-steroidal anti-inflammatory drugs to reduce pain/swelling.
- Physical therapy: tailored rehab focusing on range of motion, strengthening rotator cuff and scapular stabilisers, posture correction.
- Corticosteroid injections: around the affected tendons/bursa, typically if symptoms persist after initial conservative steps.
- Addressing biomechanics and posture: correcting muscle imbalances, improving scapula control, optimising sleeping and work positions.
If the above are successful (typically over 3–4 months) full recovery is achievable without surgery.
Surgical
If conservative treatment fails, and the impingement source is structural (e.g., hooked acromion, significant bone spur, rotator cuff tear), surgery may be considered. (Sports-health)
Common surgical options include:
- Subacromial decompression / acromioplasty: removing part of the acromion or bone spur to expand the subacromial space.
- Bursectomy: removal of inflamed bursa.
- Rotator cuff repair (if a tear is present).
Recovery timelines vary: sling/inactivity initially, then progressive physiotherapy. Full return to pre-injury activity may take a few months to a year depending on severity. (Sports-health)
Risks of surgery include persistent pain/stiffness, nerve or vessel injury, delayed recovery; so careful decision-making is needed.
Protecting Your Shoulder Long-Term
To reduce the risk of shoulder impingement (or re-injury), consider these strategies:
- Warm up properly before overhead or throwing activities.
- Strengthen the rotator cuff and scapular stabiliser muscles (e.g., external rotation, scapular retraction, serratus anterior work).
- Maintain good posture: avoid forward-hunched shoulders and slouched chest-forward positions.
- Avoid excessive overhead loading, especially with poor technique or fatigued muscles.
- Sleep and rest position matters: avoid lying on the affected shoulder or sleeping with arm overhead. Using back-sleeping with pillow support under arms may help. (Sports-health)
- Gradually return to overhead tasks after pain has settled; avoid immediate full-intensity overhead or throwing without good mechanics.
- Pay attention to early warning signs (pain when lifting overhead, night pain) and act early rather than push through.
We’re Here to Help
If you’re experiencing persistent shoulder pain: especially when lifting overhead, reaching behind your back, or lying on that side, our team is ready to help. We offer detailed assessment, targeted rehabilitation plans, and if needed, referral for specialist surgical evaluation.
📞 Call us at (02) 9817 2005 or Book Online to schedule an appointment and get expert help today.
