Shoulder impingement is one of the commonest reasons people see an orthopaedic surgeon. Above the ball of the shoulder sits a bony roof called the acromion. The rotator cuff tendons and a small fluid-filled cushion (the bursa) pass through the narrow space beneath it. When these tissues become irritated or swollen, they can catch against the bone as the arm is raised, causing pain and a pinching feeling.
Tendonitis of the shoulder and impingement: how they are linked
Tendonitis of the shoulder means irritation of a tendon, most often a rotator cuff tendon or the long head of the biceps tendon. The two problems usually occur together. One commonly described explanation is that a swollen tendon takes up more room, the space narrows, and the tendon is rubbed further. Doctors also use the terms cuff tendinopathy or subacromial pain syndrome for the same picture.
The cause is usually a mix of repeated overhead activity, poor control of the shoulder blade, tightness at the back of the shoulder and age-related change in the tendon. Sometimes the shape of the acromion or a bony spur adds to the problem.
Shoulder tendonitis symptoms
- Pain at the front or side of the shoulder, sometimes spreading down the upper arm.
- Pain when lifting the arm sideways or overhead, often in a middle "arc" of movement and easing at the top.
- Pain on reaching behind the back, for example into a back pocket.
- An ache at night, especially when lying on that side.
- Weakness that comes from the pain itself.
Stiffness is uncommon in impingement. If the shoulder stays stiff even when someone else moves your arm, frozen shoulder needs to be considered. Real weakness, or a sudden loss of lifting power after a fall, may point to a tear instead; the rotator cuff signs are worth reading.
Who is affected
It is common in people who work with the arms overhead (painters, electricians, packers), in racket and throwing sports, swimming and gym training, and in desk workers whose shoulders sit rounded forward. It is seen most often in adults, but age alone does not decide who needs treatment.
How the problem is assessed
Assessment starts with a conversation and an examination of movement, strength and specific provocation tests. The neck is checked too, as neck problems can refer pain to the shoulder. An X-ray can show the shape of the acromion, bony spurs, calcium deposits and arthritis of the collarbone joint. An ultrasound or MRI is added when a tear or another problem is suspected, or when symptoms do not settle.
Treatment without surgery
Most impingement settles without an operation. A usual plan, after assessment, includes:
- Changing the activity that aggravates it, while keeping the shoulder moving.
- Physiotherapy for the rotator cuff and shoulder blade muscles, with stretching of tight tissues.
- Pain-relieving medicines as advised by the doctor.
- Where indicated, a subacromial injection (into the space under the acromion) for short-term relief, so that exercises can progress.
Improvement commonly takes weeks to a few months, and steady exercise is the core of treatment.
Surgery for shoulder impingement: when is it discussed?
Large trials found that subacromial decompression, an operation that clears space under the acromion, gave little extra benefit over a good exercise programme or even a placebo operation. It is therefore not usually recommended for impingement on its own. Dr. Aman does subacromial decompression only for selected patients, and a proper trial of exercise comes first: Dr. Aman usually advises about three months of physiotherapy before surgery is discussed.
Surgery is still discussed when something else needs treating, such as a rotator cuff tear, a calcium deposit or arthritis of the collarbone joint. It is done by arthroscopy (keyhole surgery): small cuts, a camera and fine instruments. The surgeon inspects the whole joint and treats what is found, and where indicated, in selected patients, performs subacromial decompression, clearing inflamed bursa and smoothing part of the underside of the acromion. You can read about the arthroscopy service and about rotator cuff problems and repair.
When to see a doctor
- Shoulder pain that has not improved after a few weeks of sensible self-care.
- Night pain that keeps disturbing sleep.
- Weakness, or difficulty lifting the arm after a fall or injury.
- Numbness or tingling in the arm or hand.
Seek urgent medical care for a hot, red or swollen shoulder with fever, or for shoulder or arm pain that comes with chest pain or breathlessness, as shoulder pain can occasionally come from the heart.
Booking an OPD visit
When you message on WhatsApp, say how long the pain has been present and which movements bring it on. The clinic and hours page has OPD timings in Surat.