Shoulder Impingement (Rotator Cuff Tendinitis)

What is shoulder impingement?

Shoulder impingement happens when the top outer edge of your shoulder blade (scapula) pinches your rotator cuff beneath it. Healthcare providers sometimes also call it impingement syndrome or shoulder impingement syndrome. Impingement is the medical term for pinching or rubbing together inside a joint. It causes pain, especially when you move.

Your rotator cuff is a group of four muscles that connects your shoulder blade to your upper arm bone (humerus). You use your rotator cuff to raise your arm overhead and to rotate your arm toward and away from your body.

The rotator cuff sits in a small space between your humerus and the acromion (the upper part of your shoulder blade). This makes your rotator cuff susceptible to being pinched between these bones. That pinching is shoulder impingement.

Visit a healthcare provider if you’re experiencing shoulder pain or can’t move your shoulder without pain.

Types of shoulder impingement syndrome

A healthcare provider might classify shoulder impingement as a more specific issue, including:

• Rotator cuff tendinitis: Rotator cuff tendinitis is exactly what its name sounds like — tendinitis that affects your rotator cuff. Tendinitis is swelling or irritation of a tendon. Four tendons support your rotator cuff and help it move your shoulder joint. Anything that irritates or damages your tendons can make them swell. This swelling causes shoulder impingement.
• Shoulder bursitis: Bursitis is inflammation of a bursa — one of the fluid-filled sacs that line some of your joints. A bursa between your rotator cuff tendons and acromion normally cushions the space between them. Swelling from bursitis can lead to shoulder impingement symptoms.
• Acromion deformity: The acromion is usually flat. If your acromion is curved or hooked, it can rub or pinch your rotator cuff and cause shoulder impingement. Some people are born with a differently-shaped acromion. You might also develop bone spurs on it as you age.

How common is shoulder impingement?

Experts estimate that shoulder impingement causes around half of all cases of shoulder pain. It’s especially common among athletes and people who do physically demanding work.

What are shoulder impingement symptoms?

Shoulder pain is the most common shoulder impingement symptom.

This usually feels like it comes from the front of your shoulder. The pain may also:

• Make your shoulder feel tender when you touch it.
• Spread (radiate) from the front of your shoulder to the side of your arm.
• Get worse at night. It might affect your ability to fall (or stay) asleep.

Shoulder impingement pain may get worse during certain movements or positions, including when you:

• Extend your arm up, above your head.
• Lift and lower your arm.
• Reach for something.
• Lay on the injured side of your body.
• Reach behind your back (like reaching into your back pocket or twisting to unzip a purse or backpack).

Rotator cuff tendinitis symptoms

You might experience different symptoms depending on which type of shoulder impingement you have. For example, in addition to shoulder pain, rotator cuff tendinitis can cause other symptoms, including:

• Stiffness.
• Swelling.
• Skin discoloration or redness.
• Hearing or feeling a cracking or popping sound when you move your shoulder.

What causes shoulder impingement?

Shoulder impingement is almost always an overuse injury. This means it happens over time when an activity or motion repeatedly puts too much stress on your shoulder joint and rotator cuff.

Healthcare providers call the kinds of movements that cause shoulder impingement overhead rotation motions — any repetitive motion that requires you to twist and turn your shoulders with your arms raised. Training for a sport or performing the same type of movement all day at work are the most common causes.

Some people develop shoulder impingement without an obvious cause (idiopathically). It’s also possible for trauma (like a fall, car accident or sports injury) to cause impingement suddenly.

Shoulder impingement risk factors

Anyone can experience shoulder impingement, but athletes and people who do physical work are more likely to. It usually develops slowly over weeks or months.

Sports that can cause shoulder impingement include:

• Swimming.
• Baseball.
• Volleyball.
• Tennis.

Any physical job that puts pressure on your shoulders can lead to shoulder impingement, including:

• Construction.
• Painting.
• Washing windows.
• Hanging wallpaper or drywall.

How is shoulder impingement diagnosed?

A healthcare provider will diagnose shoulder impingement with a physical exam. They’ll examine your shoulder and check your range of motion (how far you can move your shoulder without pain). Tell your provider what you were doing when you first noticed pain and other symptoms. Make sure to mention any sports, hobbies or work you do that use repetitive shoulder and arm motions.

Shoulder impingement tests

Your provider might use imaging tests to take pictures of your shoulder joint, including:

• X-rays.
• MRI (magnetic resonance imaging).
• Ultrasound.

Imaging tests will help your provider see the bones and tissue in your shoulder joint. They’ll also help your provider diagnose specific causes of impingement.

These tests may also help rule out other causes of shoulder pain, including:

• Rotator cuff tears.
• Biceps tendon injuries.
• Shoulder arthritis.

How do you fix an impingement in your shoulder?

Your provider will suggest treatments that manage your symptoms and help your shoulder heal and regain its usual function. The most common shoulder impingement treatments include:

• Rest: Taking a break from physical activity — especially the sport or activity that caused the impingement.
• Physical therapy: A physical therapist will give you stretches and exercises to strengthen your shoulder and improve its range of motion. As your shoulder heals, they’ll give you exercises to strengthen the muscles in your rotator cuff.
• Icing: Apply ice or a cold pack to your shoulder. Wrap ice packs in a thin towel to avoid putting them directly on your skin. Your provider will tell you how often (and for how long) you should ice your shoulder.
• Pain relievers: Over-the-counter (OTC) NSAIDs can relieve pain and reduce swelling. Don’t take NSAIDs for more than 10 days in a row without talking to your provider.
• Corticosteroids: Corticosteroids are prescription medications that reduce inflammation. You may need cortisone shots injected directly into your shoulder joint.

Shoulder impingement surgery

Your provider might recommend surgery if other treatments don’t relieve your symptoms. Your surgeon might perform an arthroscopic shoulder decompression. They’ll remove part of your acromion to create more space for your rotator cuff.

Your surgeon will tell you which procedure you’ll need and what to expect as you recover.

What is the best treatment for rotator cuff tendinitis?

Rotator cuff tendinitis treatments usually include all the same treatments for other types of shoulder impingement. Your provider will suggest the best ways to help your rotator cuff tendons heal.

How soon after treatment will I feel better?

Most people with shoulder impingement start feeling better a few weeks after they start treatment. Don’t resume playing sports or doing any intense physical activity before your provider says it’s safe, even if your symptoms improve.

How long does it take to recover from shoulder impingement?

How long it takes you to recover from shoulder impingement depends on which type you have and how severe it is.

People usually start feeling better a few weeks after starting treatment, but it can take a few months for your shoulder to heal completely. Some people may need treatment and rehab for up to a year.

Does rotator cuff tendinitis ever go away?

Yes, all types of shoulder impingement — including rotator cuff tendinitis — are very treatable. But don’t put off getting your shoulder examined by a healthcare provider. If it’s not treated, shoulder impingement can get worse and increase your risk of complications or a more severe injury.

Visit a healthcare provider as soon as you notice symptoms like pain, swelling or a decreased range of motion in your shoulder.

How can I prevent shoulder impingement?

The best way to prevent shoulder impingement is to avoid overusing your shoulders:

• Stop exercising or physical activities as soon as you feel pain. Never play through pain.
• Warm up and cool down before physical activities.
• Wear the right equipment for all sports and physical work.
• Follow an eating and exercise plan that’s healthy for you.
• Visit a healthcare provider as soon as you notice pain or other symptoms.

How do I take care of myself with shoulder impingement?

Don’t resume physical activities before your healthcare provider says it’s safe. If you stress your shoulder or rotator cuff again before it has time to heal, you’re more likely to reinjure it. This can increase your risk of more severe injuries like a torn rotator cuff.

When should I see my healthcare provider?

Visit a healthcare provider if you notice any new pain, stiffness or swelling in your shoulder — especially if the symptoms are getting worse or make it hard to move or use your shoulder and arm.

Go to the emergency room if you’ve experienced trauma, can’t move your shoulder or think you might have a dislocated shoulder. Never try to force your shoulder back into place on your own.

Which questions should I ask my healthcare provider?

Questions you can ask your provider include:

• Do I have shoulder impingement or another injury?
• Which type of impingement do I have?
• Which treatments will I need?
• Will I need surgery?
• How long should I avoid sports and physical activities?