Shoulder Impingement

(Subacromial Impingement)

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What is the condition?

Subacromial impingement is a common shoulder condition where the rotator cuff tendons and the subacromial bursa become compressed or irritated as they pass beneath the acromion (the bony arch of the shoulder). This leads to inflammation, pain,and restricted shoulder movement, particularly during overhead activity.

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What are the symptoms?

· Pain at the front or outer side of the shoulder

· Discomfort when reaching overhead, behind the back, or across the body

· Pain that worsens at night or when lying on the affected side

· Weakness, catching, or a feeling of stiffness with shoulder use

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What are the risk factors?

· Repetitive overhead activity (e.g. swimming, throwing, manual labour)

· Poor posture or scapular muscle imbalance

· Age-related wear of the rotator cuff tendons or thickening of the bursa

· Bone spurs or structural narrowing of the subacromial space

· Previous shoulder injury or surgery

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How is it diagnosed?

· A clinical examination for signs of impingement

· X-rays may show acromial shape, bony spurs, or joint narrowing

· MRI is the gold standard and allows assessment of to rotator cuff

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What are the treatment options?

· Non-surgical treatment is first-line and includes activity modification, antiinflammatorymedications, and physiotherapy to restore normal shouldermechanics

· Cortisone injections may be used to reduce inflammation and pain in thesubacromial bursa

· Surgery may be considered if symptoms persist after 3–6 months of structured rehabilitation (arthroscopic subacromial decompression and acromioplasty)

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When is surgery required?

· When non-operative treatment fails to improve symptoms

· The surgical procedure typically involves arthroscopic subacromial decompression and bursectomy, with or without rotator cuff repair

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What happens if this condition is left untreated?

· Persistent pain and limited shoulder function

· Worsening inflammation may lead to a rotator cuff tear over time

· Chronic discomfort may impact sleep, work, and daily activities

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How long is the recovery following surgery?

• First 4-6 weeks:

· Focus on pain control and restoring gentle range of motion

· A sling may be used for comfort in the first few days

· Light hand and elbow use allowed

 

• 6 to 12 weeks:

· Physiotherapy shifts to active shoulder mobility and postural control

· Gradual return to normal activities as strength improves

 

• 3 to 6 months:

· Strengthening of the rotator cuff and shoulder stabilisers

· Most patients return to work and recreation

· Full recovery may take several months depending on pre-operative symptoms and any associated pathology

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What are the expected outcomes of surgery?

· Most patients experience significant pain relief and improved shoulder function

· Outcomes are best when combined with a structured post-operative rehabilitation programme

· Some patients may have residual stiffness or mild discomfort with high-demand use

· If rotator cuff repair is also performed, recovery time may be longer

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What does the rehabilitation/recovery involve?​

To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.