Shoulder Impingement Treatment
Impingement is one of the most common causes of shoulder pain and one of the most commonly mislabeled. It describes a mechanical problem, the rotator cuff tendons being pinched in the narrow space beneath the acromion, and the same symptoms can come from a partial tear, from bursitis, or from a shoulder that is simply moving badly.
Impingement is regularly confused with a rotator cuff tear, and telling them apart on examination is what changes the treatment. Steven Struhl, MD is board certified in orthopedic surgery and holds separate board certification in sports medicine, has practiced in New York since 1991, and is a Fellow of the American Academy of Orthopaedic Surgeons. He serves on the faculty of NYU School of Medicine.
What Shoulder Impingement Is
The rotator cuff tendons pass through a narrow corridor between the top of the arm bone and the acromion, the bony shelf projecting from the shoulder blade. When that space narrows, the tendons and the bursa above them are compressed each time the arm is raised.
- Structural Narrowing: a hooked or spurred acromion reduces the space available to the tendons.
- Bursal Swelling: an inflamed bursa takes up room the tendons need.
- Poor Scapular Control: the shoulder blade failing to rotate properly closes the space during motion.
- Cuff Weakness: a weak cuff allows the humeral head to ride upward into the acromion.
The last two matter more than patients expect. Impingement is often a movement problem rather than a bone problem, which is why therapy resolves a great many cases without touching the anatomy.
Shoulder Impingement Symptoms
- Pain Reaching Overhead: discomfort in a specific arc of motion rather than throughout it.
- Night Pain: difficulty sleeping on the affected side, common as the condition progresses.
- Weakness With Elevation: difficulty holding the arm up, often more fatigue than true weakness.
- Pain Behind The Back: discomfort reaching for a seatbelt or a back pocket.
Impingement or a Rotator Cuff Tear
These two are confused constantly, including in referrals, and the distinction changes the treatment entirely.
Impingement produces pain in an arc, typically between sixty and one hundred twenty degrees of elevation, with strength largely preserved once the painful arc is passed. A rotator cuff tear produces genuine weakness against resistance that does not improve with a numbing injection. Imaging helps, but the examination usually gets there first.
Shoulder Impingement Treatment
- Activity Modification: reducing the overhead loading that provokes symptoms during recovery.
- Physical Therapy: restoring scapular control and cuff strength, which resolves most cases.
- Injection Therapy: a subacromial corticosteroid injection to break the inflammatory cycle.
- Subacromial Decompression: arthroscopic removal of bone to widen the space.
Surgery is the last option rather than the first, and it is most useful where a structural narrowing is genuinely present. Operating on an impingement that is really a scapular control problem tends to produce a disappointed patient.
Frequently Asked Questions About Shoulder Impingement
Will shoulder impingement go away on its own?
Sometimes, particularly when it follows a period of unusual overhead activity that has since stopped. More often it persists because the underlying mechanics have not changed, which is why therapy aimed at scapular control and cuff strength is the mainstay rather than rest alone.
How is impingement different from a rotator cuff tear?
Impingement is compression of intact tendons in a narrowed space, producing pain in a specific arc of motion with strength largely preserved. A tear is structural damage to the tendon producing genuine weakness against resistance. The two frequently coexist, since long standing impingement can lead to tearing.
How long does recovery take?
Most patients improve substantially over six to twelve weeks of consistent therapy. Improvement that stalls at three months, particularly with continued night pain, is worth reimaging, because a tear may be present that the initial assessment did not identify.
Do cortisone injections cure impingement?
No, and they are not intended to. An injection reduces inflammation enough to let therapy proceed comfortably, which is where the durable improvement comes from. Injections used repeatedly without addressing the mechanics tend to deliver diminishing returns.
What is subacromial decompression?
An arthroscopic procedure in which a small amount of bone is removed from the undersurface of the acromion to widen the space the tendons pass through. It is performed through small incisions on an outpatient basis and is generally reserved for patients whose symptoms persist despite appropriate therapy.
Can I keep exercising with impingement?
Usually yes, with modification. Overhead pressing and behind the neck movements typically provoke symptoms and are worth setting aside temporarily, while lower body work, cuff strengthening, and most other training can continue. Complete rest is rarely the right prescription.
Schedule a Shoulder Evaluation in New York City
Shoulder pain that hurts in a specific arc and wakes you at night is worth having examined properly, mostly to determine whether the tendons are being pinched or are actually torn, because those two answers lead to different treatment. Dr. Struhl evaluates impingement at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
