Patient education: Shoulder impingement (The Basics)

What is shoulder impingement? — 

This is a condition that causes shoulder pain. It happens when the bones that make up the shoulder squeeze another part of the shoulder, such as:

●A muscle

●A tendon, which is a strong band of tissue that connects a muscle to a bone

●A bursa, which is a small fluid-filled sac that sits near a bone

People can get shoulder impingement if they do a lot of work or a sport that involves stretching or lifting the arms overhead. Many daily activities, like getting dressed or working at a desk, can also increase a person's risk of shoulder impingement (table 1).

Shoulder impingement can lead to other problems, such as:

●Bursitis – This is when a bursa gets irritated or swollen.

●Rotator cuff injuries – The rotator cuff is made up of 4 shoulder muscles and their tendons (figure 1). These muscles move the shoulder.

What are the symptoms of shoulder impingement? — 

Most people have pain in the front or side of the shoulder, or down the outer part of the upper arm. The pain is usually worse when they try to move their arm over their head or lie on their shoulder.

Will I need tests? — 

Maybe. Your doctor or nurse will talk with you and do an exam. They might also do an imaging test of your shoulder, such as an X-ray or ultrasound. These create pictures of the inside of the body.

How is shoulder impingement treated? — 

Doctors are not sure of the best way to treat shoulder impingement. But certain exercises can help. It's important to work with an expert to learn which exercises to do and how to do them correctly. This usually involves seeing an exercise expert, such as a physical therapist or athletic trainer. They can also tell you when to start these exercises and how often to do them.

Some exercises help keep your shoulder from getting too stiff. One example is pendulum exercises (figure 2). To do these, let your arm relax and hang down. Move your arm back and forth, then side to side, and then around in small circles in both directions. Do these exercises for 5 minutes, 1 or 2 times a day.

Other exercises can help strengthen the shoulder muscles. Your physical therapist or athletic trainer can show you how to do these.

When you do shoulder exercises, it's important to:

●Warm up your shoulder first. You can do this by taking a hot shower or bath, putting a warm moist towel or heating pad on your shoulder, massaging the area, or doing gentle movements.

●Start slowly, and gradually make the exercises harder over time. Follow all instructions for how often to do the exercises and how many times to repeat each motion.

●Know that some soreness is normal. If you have sharp or tearing pain, stop what you're doing and tell your doctor or nurse.

Some doctors might try "kinesiology tape." This involves putting a special type of stretchy tape on certain parts of your shoulder. The tape is meant to support the shoulder and relieve pain. There is not a lot of good evidence this works, but some people think it helps.

What can I do on my own to feel better? — 

You can:

●Rest – Avoid doing things that cause pain or strain your shoulder, such as reaching up or across your chest, lifting, leaning on your elbows, or lying on your shoulder.

●Apply ice – Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time, as needed. Put a thin towel between the ice (or other cold object) and your skin. Ice can be especially helpful after you've been using your shoulder a lot for work, sports, or chores.

●Take pain medicines – Your doctor or nurse might recommend taking medicines such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve).

What if my symptoms don't get better? — 

Usually, doctors suggest trying physical therapy (exercise) for at least 3 months. If your symptoms do not get better after this, your doctor might suggest another treatment, such as getting a shot of medicine into your shoulder. This sometimes helps relieve pain for a short time and makes it easier to do physical therapy exercises.

If your doctor thinks you might have a tear or another type of shoulder injury, they might refer you to a surgeon. But in most cases, surgery does not work well for people who just have shoulder impingement without another injury.

How can I prevent getting shoulder impingement again? — 

To reduce the chances of getting shoulder impingement again:

●Try to take breaks if you are doing a repetitive activity, especially if it involves stretching or lifting the arms overhead. Examples include window washing, painting, construction, pitching a baseball, or swimming. Some people might need to completely avoid these activities for a time.

●Do not ignore or try to work through shoulder pain.

●Do exercises to keep all the muscles in your shoulder strong. Warm up your muscles before exercising to help prevent injury.

●Try to practice good posture. To do this, sit up straight and keep your shoulders back.

When should I call the doctor? — 

Call your doctor or nurse if your:

●Pain does not get better or gets worse

●Shoulder feels stiffer or harder to move

●Shoulder feels weaker

●Hand or arm becomes weak or swollen

●Hand feels cold

●Fingers are numb, tingly, blue, or gray

More on this topic

Patient education: Shoulder pain (The Basics)
Patient education: Bursitis (The Basics)
Patient education: Rotator cuff injury (The Basics)
Patient education: Rotator cuff repair (The Basics)
Patient education: Frozen shoulder (The Basics)
Patient education: Shoulder arthroscopy (The Basics)
Patient education: How to use a shoulder sling (The Basics)

Patient education: Shoulder impingement syndrome (Beyond the Basics)
Patient education: Rotator cuff tendinitis and tear (Beyond the Basics)
Patient education: Bursitis (Beyond the Basics)
Patient education: Frozen shoulder (Beyond the Basics)