What is shoulder impingement?
Shoulder impingement, also called shoulder impingement syndrome, is a condition where tendons or other soft tissues become compressed between the upper arm bone and a bony projection of the shoulder blade. When the arm is lifted, the space in the shoulder joint decreases, which can cause the tissue to become pressed together.
The repeated compression often leads to irritation and inflammation in tendons or bursae in the shoulder. This can in turn cause pain, stiffness, and reduced mobility. Impingement is one of the most common causes of long-term shoulder pain and often affects active individuals and people who use their arms frequently at work, but it can also develop as a result of prolonged sedentary behavior.
Common causes of impingement
Shoulder impingement often develops gradually and is usually caused by a combination of strain, muscle balance, and posture. A common cause is repetitive movements where the arm is lifted above the head, which occurs in certain occupations, sports, or types of exercise. This type of strain can irritate the tendons of the rotator cuff and make them more likely to become compressed.
Weakness or imbalance in the muscles around the shoulder joint can also contribute to the condition. The rotator cuff and the muscles around the shoulder blade play an important role in stabilizing the shoulder. If these muscles do not function optimally, the upper arm bone may shift into a position where the space in the joint becomes smaller.
Posture also affects how the shoulder joint functions. A forward-leaning posture, which often develops during prolonged sitting in front of a computer, can change the position of the shoulder blade. This reduces the space in the shoulder joint and increases the risk of compression.
With increasing age, tendons and tissues become less elastic and more sensitive to irritation. For this reason, impingement is somewhat more common in middle-aged and older individuals. In some cases, the condition may also develop after an injury, such as a fall or a sudden overload of the shoulder.
Symptoms of impingement
The symptoms of shoulder impingement often develop gradually and may initially be mild. Over time, the pain can become more noticeable and affect both daily activities and sleep.
- Pain when lifting the arm: The pain often occurs when the arm is lifted to the side or above the head
- Shoulder pain at night: It may hurt to lie on the affected side
- Reduced mobility: The shoulder may feel stiff and difficult to move fully
- Weakness in the arm: You may notice reduced strength in the shoulder
- Dull aching pain on the outside of the shoulder
The pain is often located on the outside of the shoulder and may sometimes radiate down toward the upper arm. In some cases, even simple movements, such as putting on a jacket or lifting something from a shelf, can become difficult.
How is the diagnosis made?
The diagnosis of impingement is usually made through a clinical examination by a doctor or physiotherapist. During the examination, you will describe your symptoms and how the pain affects your daily life. The mobility, strength, and pain response of the shoulder are assessed through different movements. In some cases, imaging such as ultrasound or MRI (magnetic resonance imaging) of the shoulder may be used to rule out other causes of pain, such as tendon injuries or osteoarthritis.
Treatment for impingement
Most people with shoulder impingement improve without surgery. Treatment focuses on reducing pain, improving mobility, and strengthening the muscles that stabilize the shoulder joint.
The first step in treatment is often to reduce or pause activities that worsen the pain, especially movements where the arm is lifted above the head. By relieving the shoulder from strain, the irritated tissue can have time to recover. Physiotherapy is an important part of treatment. With individually adapted exercises, the muscles of the rotator cuff and around the shoulder blade can be strengthened. This improves shoulder stability and reduces the risk of the tendons being compressed in the joint.
If necessary, a doctor may recommend pain-relieving or anti-inflammatory medications to reduce pain and swelling. In some cases, a corticosteroid injection in the shoulder may be used to reduce inflammation and provide temporary pain relief. If symptoms do not improve after several months of treatment, surgery may sometimes be considered. During such a procedure, more space is created in the shoulder joint to reduce pressure on the tendons.
What can you do yourself?
There are several things you can do to reduce symptoms and prevent shoulder impingement. Regular exercise that strengthens the muscles stabilizing the shoulder is one of the most important measures. It is also helpful to pay attention to your posture, especially if you work a lot in front of a computer. A more upright posture can help create more space in the shoulder joint. If you exercise, it is wise to increase the load gradually and avoid sudden changes in training intensity. Warming up before physical activity can also reduce the risk of irritation in the shoulder.
When should you seek medical care?
You should seek medical care if you have shoulder pain that does not improve after a few weeks or if the symptoms affect your daily life. An early assessment can make it easier to start the right treatment. Seek urgent care if the pain occurs after an accident, if you suddenly lose strength in the arm, or if you have severely limited mobility in the shoulder.