Impingement describes pain felt as you lift your arm out and up, often in a particular arc of movement, easing again at the top. The name suggests something being pinched, and that picture has turned out to be far too simple. Current thinking treats it as pain arising from the rotator cuff tendons and surrounding structures under load, which is why the term subacromial shoulder pain is increasingly used instead.
This has changed recent approaches to treatment. If the problem were purely a mechanical pinch, making more room would fix it. The evidence has not supported that.
More information
Why exercise comes first
Multiple good quality trials have compared subacromial decompression surgery with exercise based treatment and with placebo surgery, and have not shown a clinically meaningful advantage for the operation. That has changed practice considerably, and it means a properly progressed exercise programme is now the first line treatment rather than the thing you try while waiting for a surgical opinion.
What treatment involves
Working out what your shoulder does not tolerate and why, settling the pain enough to load it, then a graded strengthening programme for the cuff and the muscles controlling the shoulder blade. Alongside that, a look at the activity that provoked it, whether that is a job overhead, a sport or a sudden burst of decorating.
Expect a programme measured in months. Shoulders are slow, and stopping when the pain goes is the most common reason it returns.
When to consider other options
If a well executed programme over several months has not helped, an injection or a surgical opinion is reasonable and we will write to your GP.
Frequently Asked Questions
What is shoulder impingement?
Do I need surgery for impingement?
How long will treatment take?
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