Condition
Shoulder impingement and pain beneath the shoulder’s bony roof
When you lift your arm, one particular movement hurts while others feel almost normal. You put the shopping bag down differently, avoid the top shelf or leave the affected shoulder until last when getting dressed. After an examination, you may hear the term ‘impingement’.
Open individual sections or all the details on this page.
When you should have symptoms assessed promptly
If you can barely lift your arm after an accident or suddenly lose substantial strength, your shoulder should be examined by a doctor promptly. A hot, swollen shoulder with fever or new, pronounced changes in sensation are also reasons for urgent assessment.
If shoulder or arm pain occurs with chest pressure, breathlessness or circulatory problems, call 112 immediately. These symptoms must not be hastily attributed to known impingement.
Understanding
A closer look
This often describes pain in the area beneath the bony roof of the shoulder. The term sounds as though a tendon is definitely being pinched. However, the relationship is not always that simple. We want to work with you to establish which structures may be involved and how your shoulder can tolerate activity more reliably again.
Why the term alone does not determine treatment
The rotator cuff tendons and several bursae lie beneath the bony roof of the shoulder, among other structures. These structures allow the arm to lift and rotate. Symptoms in this area are also called subacromial shoulder pain. The term initially describes a location and a pattern of symptoms.
A visible bone spur, tendon change or calcium deposit does not necessarily explain the pain. Such findings also occur without symptoms. We therefore do not recommend a particular injection or surgery based on an image alone. Calcific tendinopathy, a larger tendon tear and frozen shoulder each need their own assessment.
Further information
What your movement and the examination tell us
Tell us which activity brings on the pain and how long it lasts afterwards. Is putting an object down difficult, working overhead, or mainly lying on your side? A change in activity at work, in the garden or during sport can also help the assessment, without in itself proving the cause.
We examine movement, strength and how the shoulder works as a whole. Individual movement tests provide clues, but not always a clear diagnosis. Ultrasound can show tendons and bursae and assess suitable movements in real time. X-rays or an MRI arranged externally add to the assessment when there is a specific question. You do not need to arrange new imaging yourself before the first appointment.
Adjusting activity so movement becomes possible again
Non-surgical treatment often begins by temporarily adjusting activities that particularly aggravate symptoms while continuing to move the shoulder appropriately. Exercise focuses on coordinated strength and movement control, not forcing through a suspected narrowed space.
We discuss which everyday activity should become easier first. Perhaps a task can be divided into shorter periods, or a load carried closer to the body. Exercises are built up according to your starting point and response. A lasting, marked deterioration after exercise is a reason to review the plan. One bad day, however, does not automatically mean that movement is harmful in general.
Which additional treatments may be considered
Painkillers may provide temporary relief if they are compatible with your other conditions and medicines. In suitable circumstances, a corticosteroid injection may help in the short term when irritation is pronounced. It does not replace building capacity for activity and is not a harmless routine treatment. Possible risks, such as infection, temporary rises in blood sugar, for example in people with diabetes, or tissue damage with repeated use, are considered in the decision.
Whether an additional procedure is useful depends on the condition actually present. Shockwave therapy for a particular form of calcific tendinopathy, for example, is not automatically appropriate for every pain beneath the shoulder roof. After a medicine injection at our practice, at least half an hour of observation is planned, longer if needed; advice on what to do afterwards is discussed separately.
What to expect and next steps
Why creating more space beneath the shoulder roof is not automatically the next step
For persistent subacromial pain without a tendon tear requiring separate treatment, the benefit of routinely operating to create more space beneath the shoulder roof has not been convincingly demonstrated. If non-surgical treatment has not helped yet, it is therefore worth first reviewing the diagnosis, activity levels and course so far.
A specific injury or another condition may call for a different decision. The question is then which problem an operation is intended to resolve. A general aim of ‘creating more space’ is not enough as a reason. We want you to understand the thinking behind any proposed next step.
Frequently asked questions
Does impingement always mean a pinched tendon?
No. The term is used for different symptoms beneath the bony roof of the shoulder. A mechanical narrowing may play a part, but it does not explain every course of symptoms or every imaging finding.
How long does it take for the shoulder to tolerate more activity again?
This depends, among other things, on how long symptoms have been present, the diagnosis and appropriate management of activity. Progress may be gradual. Giving a fixed recovery time without examining you would not be responsible.
Do I need an MRI every time symptoms return?
No. First, it matters what has changed. A new accident, substantial loss of strength or an unusual course may justify additional investigations. The investigation should answer a specific question.
Your next step
