Shoulder Impingement

Impingement usually occurs as a result of the narrowing of the subacromial space, the area below the acromion. This can be due to:

• Repetitive overhead activities (swimming, throwing sports)
• Bone spurs on the acromion
• Inflammation of the bursa
• Age-related changes to the tendons

Shoulder impingement usually presents as pain in the shoulder that is exacerbated by overhead activities. The pain can be sharp when lifting objects, or a dull ache at rest. Other symptoms include:

• Pain that radiates from the front of the shoulder to the side of the arm
• Pain during nighttime, particularly when sleeping on the affected shoulder
• Weakness in shoulder muscles
• Difficulty reaching behind the back

The body’s ability to heal shoulder impingement naturally is limited. Although rest can help reduce inflammation and pain, without addressing the root cause of the impingement, symptoms may recur once normal activities are resumed.

Shoulder impingement is typically diagnosed based on a physical examination and your description of symptoms. As a specialist shoulder surgeon Dr. Mayo may ask you to perform various arm movements to identify any pain or discomfort. Imaging tests such as X-rays and MRIs can also be used to confirm the diagnosis and assess the extent of the impingement.

Treatment for shoulder impingement often begins with conservative approaches, including:

• Rest and activity modification
• Physical therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroid injections

If these measures don’t relieve symptoms, surgical options such as arthroscopic subacromial decompression may be considered.

Surgery for shoulder impingement is typically reserved for patients whose symptoms have not improved with conservative treatments over several months. The timing of surgery varies and depends on the severity of symptoms and the patient’s overall health. It is considered an elective procedure and can be done at the patients preference.

Surgery for shoulder impingement, known as subacromial decompression, involves Dr. Mayo removing or reshaping the part of the acromion that is causing the impingement. This creates more room for the rotator cuff tendons, reducing the likelihood of them being squeezed and becoming inflamed. This procedure is usually performed arthroscopically, resulting in less post-operative pain and a quicker recovery.

Following surgery, physical therapy is critical to restore shoulder strength and flexibility. Most patients can return to normal activities within 3-6 months after surgery, though this can vary based on individual healing rates and the extent of their condition prior to surgery.