Shoulder impingement is the name for pain at the top and outside of the shoulder when you lift your arm, especially overhead. Many doctors and physios now call it “rotator cuff related shoulder pain” instead.
The best treatment is a strengthening program that gets progressively HARDER over at least 12 weeks. An injection can calm the pain enough to start.
Surgery to “make more room” in the shoulder did NO better than a fake operation in two trials, followed out to ten years. Guidelines now strongly advise against it for ordinary impingement.
Symptoms
- Pain lifting the arm, especially out to the side or overhead, and often on the way back down
- A “painful arc”: it hurts in the middle of the movement and eases higher up
- Night pain, especially lying on that side
- Trouble reaching a high shelf, doing up a bra or reaching a back pocket
- In longer cases, some weakness
Why the name is changing
- The old idea: the tendon gets pinched between the arm bone and a hook of bone above it, so shaving the bone should fix it
- The problem: most tendon damage is on the UNDERSIDE of the tendon, away from that bone
- And removing the bone didn’t beat a fake operation
- So the label now describes where it hurts, not a proven cause. US and UK clinicians may still use different words for the same thing
Impingement describes where it hurts. It doesn’t prove a bone is pinching anything.
Do you need a scan?
- Usually not at first. Most guidance says give exercise at least 12 weeks before scanning
- Scans find “damage” in people with no pain. About 1 in 4 people in their fifties have a cuff tear on a scan and no symptoms at all
- Get a scan sooner after a fall or injury with sudden weakness
What helps
- Exercise that gets harder: the best-supported treatment. In one trial of people already on a surgery waiting list, a progressive program cut the number who went on to surgery from about 6 in 10 to 2 in 10. See shoulder impingement exercises
- A steroid injection: can ease pain for a month or two so you can exercise. By three months, it’s no better than a placebo. More injections don’t add more
- Shockwave, laser, ultrasound and TENS: little or no meaningful benefit in the research
- Hands-on therapy: small benefit at best, alongside exercise
- Change what flares it for a while, rather than stopping everything
What about surgery?
- The operation (subacromial decompression) shaves bone and removes soft tissue to make more room
- Two trials compared it with a FAKE operation where surgeons only looked inside. Patients didn’t know which they’d had
- At six months, two, five and ten years, both groups did the same
- Guidelines now strongly recommend against it for ordinary long-term shoulder pain
- It may still have a place alongside a cuff repair, or for calcium deposits or large bone spurs. Those are different situations
How long it takes
- About 1 in 4 people are fully better within a month
- About half are fully better within a year to 18 months
- Slower recovery is more likely with neck pain as well, or severe pain at the start
- Still struggling after a year? That’s common, not a personal failure. It’s the moment to check the diagnosis, not repeat the same treatment
Get help today if
- You have shoulder pain with chest pain, breathlessness or sweating. Call emergency services
- You feel unwell with a fever and a swollen, painful shoulder
- Your shoulder looks deformed after a fall
- Your upper arm or chest suddenly swells or bruises
Get it checked within a week if
- You have a history of cancer, night sweats, weight loss or an unexplained lump
- Night pain never lets up, even with rest
- You suddenly can’t lift the arm after an injury
Related: rotator cuff tendinopathy · subacromial bursitis · rotator cuff tear · biceps tendinitis
Load it progressively, give it twelve weeks, and skip the operation that matched a fake one.