What is shoulder impingement?
Impingement happens when the rotator cuff tendons are compressed in the narrow space between the top of the arm bone and the bony arch of the shoulder blade (the acromion). Every time you lift the arm, that space narrows — and if it is too tight, the tendons are pinched and become inflamed.
Over time, repeated pinching irritates the tendon and the fluid-filled sac (bursa) that cushions it. Left unchecked, persistent impingement can contribute to a rotator cuff tear — which is why it is worth addressing early.
Signs and symptoms
- checkPain when lifting the arm especially in the mid-range and overhead.
- checkA painful arc with discomfort easing once the arm is fully raised.
- checkNight pain particularly when lying on the affected side.
- checkWeakness or reluctance to reach overhead or behind the back.
Causes & risk factors
- Repetitive overhead activity — sport, painting, construction.
- A bony spur narrowing the subacromial space.
- Weakness of the rotator cuff and shoulder-blade muscles.
- Poor posture altering the position of the shoulder blade.
How it is diagnosed
Specific tests load the shoulder in positions that reproduce the pinch, helping to confirm impingement and distinguish it from a cuff tear. Ultrasound or MRI assesses the tendons and bursa and rules out a tear, while X-rays can reveal a bony spur.
Treatment options
The great majority of cases improve with non-surgical care aimed at restoring movement and creating space for the tendons.
Physiotherapy
Strengthening the cuff and shoulder-blade muscles restores balanced movement and opens the subacromial space.
Anti-inflammatories
Medication and, in selected cases, a targeted injection settle inflammation so rehabilitation can progress.
Subacromial decompression
When pain persists despite full rehabilitation, keyhole surgery removes the spur and creates more room for the tendons.
Recovery & outlook
With consistent rehabilitation, most patients improve over several weeks to a few months and return to overhead activity. Where surgery is needed, a structured programme afterwards restores motion and strength, and outcomes are generally very good.