Shoulder Impingement Syndrome
Shoulder Impingement Syndrome (sometimes called subacromial impingement or swimmer’s shoulder) is one of the most common causes of shoulder pain. It occurs when the tendons of the rotator cuff or the fluid-filled sac (bursa) in the shoulder become pinched between the bones as the arm is lifted. This “impingement” can cause irritation, swelling, and ongoing discomfort that limits movement and strength.
For many people, the pain starts gradually and is linked to repetitive use of the shoulder, such as during swimming, tennis, gym training, or manual work that involves lifting overhead. It may also develop as part of the natural ageing process, when bone spurs or changes in the shoulder joint reduce the space available for the tendons to move freely. Shoulder impingement can be frustrating, as it often interferes with sleep, daily activities, and sport, but with the right treatment it is usually very manageable.
Causes
Shoulder impingement can happen for a number of reasons:
- Repetitive overhead activities such as swimming, throwing, tennis, or painting
- Age-related changes, including bone spurs that reduce the space in the joint
- Muscle weakness or imbalance around the shoulder and shoulder blade
- Poor posture, especially rounded shoulders that tilt the blade forward
- Wear and tear of the rotator cuff tendons
Signs and Symptoms
The most common symptoms of shoulder impingement are:
- Pain in the front or side of the shoulder, especially when lifting the arm overhead
- Pain at night, making it hard to sleep on the affected side
- Weakness when lifting or rotating the arm
- A “painful arc” of movement where pain is worst between shoulder height and above the head
- Stiffness or loss of movement in more severe cases
Diagnosis
When you see Mr Soong Chua, he will carefully examine your shoulder to understand what is causing your symptoms. This involves asking about how the pain started, what makes it worse, and checking your shoulder movements and strength. Special tests that reproduce the pain can help confirm whether impingement is the likely cause.
If further detail is needed, scans may be arranged. X-rays can show the shape of the bones and whether there are bone spurs contributing to the narrowing. Ultrasound or MRI scans can give a clearer picture of the rotator cuff tendons and bursa to see if they are inflamed or damaged. This thorough assessment ensures the diagnosis is accurate and that the best treatment plan can be made for you.
Non-Surgical Treatment
Most people with shoulder impingement improve with non-surgical care. Resting the shoulder and avoiding painful overhead movements are often the first steps. Physiotherapy plays a key role and focuses on stretching tight muscles, improving posture, and strengthening the rotator cuff and shoulder blade muscles so the joint moves more freely. Ice, anti-inflammatory medication, and activity modification can also help control symptoms.
In some cases, a cortisone injection into the space around the tendons may be used to reduce inflammation and provide relief, though this is usually considered only after other measures have been tried.
Surgery
If shoulder impingement does not improve with non-surgical treatment, surgery may be recommended. The most common procedure is Shoulder Arthroscopy, a minimally invasive keyhole surgery where the inflamed tissue and any bone spurs are removed to create more space for the tendons to move without being pinched. This is sometimes called a subacromial decompression or acromioplasty.
In some cases, impingement occurs together with a tear in the rotator cuff. If this is the case, Rotator Cuff Surgery may also be performed to repair the damaged tendon at the same time as relieving the impingement.
Surgery aims to restore smooth movement, reduce pain, and improve function. Recovery usually involves wearing a sling for comfort initially, followed by physiotherapy. Most people return to normal daily activities within several weeks, though full recovery for sport or heavy lifting may take longer.
FAQs
- Can shoulder impingement get better without surgery?
Yes. Many people improve with physiotherapy, rest, and activity modification. Surgery is usually only needed if symptoms do not improve after several months of non-surgical treatment. - How long does recovery take?
With non-surgical treatment, improvement may be noticed within weeks, although full recovery can take a few months. After surgery, most people recover gradually over three to six months, with physiotherapy playing a key role. - What activities make impingement worse?
Overhead movements like throwing, swimming, lifting weights, or even reaching into high cupboards can aggravate symptoms. Adjusting or limiting these movements can help reduce irritation. - When should I see a surgeon?
If shoulder pain is interfering with sleep, work, or your ability to lift and use your arm, it’s a good idea to see a specialist like Mr Soong Chua. Early treatment can prevent the problem from worsening and helps you return to your usual activities sooner.
