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Shoulder impingement

What is shoulder impingement ?

This is a condition which causes pain over the shoulder joint, most commonly on the front area of the shoulder, due to tendon or bursa rubbing against the shoulder blade. It is also called ‘Swimmer’s shoulder’ as it is caused mostly when a person move the hand upwards as in swimming free style.

People may develop this injury during activities that involve moving the arms above the head, such as swimming, tennis, and other sports. The shoulder is a complicated joint comprising several connecting joints, tendons, and muscles, so it may be particularly vulnerable to injuries. In this article, learn more about shoulder impingement and how to treat it.

How does shoulder impingement cause pain?

Shoulder impingement causes pain due to inflammation in the shoulder. This inflammation results from repetitive use of the shoulder. Aging and injuries can make the issue worse. Additionally, a fluid filled sac called a bursa cushions the shoulder joint, preventing friction in the socket. The bursa allows free motion of the tendons when a person moves their shoulder, preventing sticking and friction.

Impingement occurs when inflammation causes the tendons, muscles, or bones to push into the bursa or against each other.

How does impingement present?

The classic symptom of shoulder impingement is difficulty lifting the arm past shoulder height. It will also hurt to reach the arm behind the back.

People with shoulder impingement usually experience general stiffness and throbbing in the shoulder. This type of pain may resemble that of a toothache, rather than the tearing pain of an injured muscle. The person may also see or feel swelling in their shoulder.

The shoulder will typically ache and be stiff when at rest and then hurt more when the person uses it.

These symptoms may get worse over time, with pain increasing and strength decreasing. The pain may get worse if the person tries sleeping on the affected side of their body. Putting the arm over the head or behind the back may become increasingly difficult.

Without treatment, the tendons in the rotator cuff may wear down or tear, which can lead to worse pain, shoulder weakness, and difficulty lifting or using the shoulder at all.

What are the causes of Shoulder impingement?

Overuse is the leading cause of shoulder impingement.

Over time, any activity that repeatedly requires a person to move the arm up above the shoulder and toward the back may put them at risk of impingement. Some activities that can cause shoulder impingement are swimming, badminton, overhead blackboard use, painting over head, packing, lifting or construction work.

Injuries, such as a dislocated shoulder, are other important causes of shoulder problems, including impingement and rotator cuff tears.

How do you diagnose shoulder impingement?

Diagnosing shoulder impingement early on is important, as treatment can help prevent symptoms from getting worse. Doctors move the shoulder in certain directions to detect those which reproduce pain. Stress testing of the rotator cuff is also done to detect rotator cuff dysfunction which can lead to a shoulder impingement.

In some cases, doctors may then order imaging tests, such as an X-ray or MRI scan, to rule out other possible causes of the pain. Other possible causes include bone spurs, injuries, and arthritis.

Can a rotator cuff tear cause shoulder impingement pain?

The rotator cuff also holds the top of the upper arm in place in the shoulder socket. Pain in the front of the shoulder might be a indicator of rotator cuff tear as the rotator cuff tendons cushion the shoulder ball (humerus) under the acromion bone of shoulder blade, and also helping to push the shoulder ball down when it contracts.

How does a rotator cuff dysfunction cause shoulder & neck pain?

If left untreated a rotator cuff tear can cause pain in the neck and back of the shoulder radiating to the outer aspect of the arm. There will be an increase in strain on the neck muscles and the deltoid muscle which are the secondary muscles which help to lift the arm. When the rotator cuff is not functioning, the shoulder and arm muscles tend to work more causing pain over the outer aspect of the arm. Some people develop swelling over that area with pain. 

Over working of the deltoid muscle can cause impingement of the shoulder ball (humerus) under the acromion and thereby injure the rotator cuff tendons, leading to an increase of the rotator cuff tear dimension.

Read more about Rotator cuff tear>>

How is shoulder impingement treated?

Conservative treatments are effective for many people. The authors of a 2017 clinical study note that 60% of cases respond well to conservative treatment within 2 years. Minor cases may resolve more quickly.

Conservative treatment for shoulder impingement can include rest, anti-inflammatory medications, warm fomentation, physical therapy and therapeutic kinesiotaping.

Physical therapy uses safe, gentle exercises to strengthen the muscles in the shoulder and restore the range of motion in this area of the body.

In cases where the body does not respond to these conservative treatments, there are arthroscopic methods (key-hole) to reconstruct the lost muscle balance inside the shoulder joint. The surgical procedure for shoulder impingement widens the space around the rotator cuff to prevent friction. If a person has a rotator cuff tear, surgical repair may also be necessary.

Part of the treatment for shoulder impingement is learning to prevent future injury. Physical therapists will show the person how to use the shoulder correctly and train them on specific movements relevant to their occupation or sport to avoid injury in the future.

Stretches and exercises

You will be given an exercise plan by the physical therapist which will allow return of muscle balance in the shoulder joint. You can see some possible stretching exercises which can help in this problem – Shoulder stretches.

It is important to keep in mind that rest is vital to help the body recover and to avoid pushing too hard or doing too many of these exercises. If any new symptoms appear or existing symptoms get worse, a person should stop the exercise immediately.


Shoulder impingement generally occurs due to a person overusing the shoulder. Swimmers, baseball players, and other athletes may be more likely to experience this type of injury.

People working in occupations that require a lot of lifting may also be more likely to experience shoulder impingement.

Preventing shoulder impingement by learning how to lift and move the shoulder correctly may be the best way to avoid injury. Most people respond well to simple treatments, such as rest and physical therapy. NSAIDs can also help reduce pain and inflammation.

Anyone uncertain about their symptoms or treatment options should talk to a doctor.

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