If it hurts to reach into a high cabinet, pull on a jacket or serve a tennis ball, shoulder impingement may be the reason. At Physical Medicine & Rehabilitation of NY & CT (PMR), shoulder impingement treatment is built on exercise that strengthens the rotator cuff and shoulder blade muscles, supported by hands-on care and activity changes. We treat it at our offices in Brewster, NY, and Danbury, CT.
What is shoulder impingement?
The top of your shoulder blade forms a bony roof, the acromion, over the shoulder joint. Beneath it sit the rotator cuff tendons and a small fluid-filled cushion called a bursa. When these tissues become irritated, lifting your arm can pinch or aggravate them.
Many clinicians now call this subacromial pain, since tendon irritation and muscle control usually matter more than the shape of the bone. See our shoulder pain overview for other causes.
Symptoms of shoulder impingement syndrome
- Pain at the front or outer shoulder that may spread down the outside of the upper arm
- A painful arc as you raise your arm partway out to the side, often easing higher or lower
- Pain reaching overhead or behind your back
- Night pain, especially lying on the affected side
- A tired or weak feeling with overhead work
What causes it?
Impingement usually builds when the load on your shoulder outpaces what it’s prepared for:
- Overhead work such as painting, drywall, electrical work and stocking shelves
- Overhead sports such as swimming, tennis, volleyball, and baseball or softball throwing
- Rotator cuff weakness or fatigue, which lets the ball of the shoulder ride up instead of staying centered
- Posture and shoulder blade control, since rounded shoulders and a stiff upper back change how the shoulder blade rotates
- Sudden spikes in activity, like a new gym program or a weekend of yard work
- Age-related changes in tendons, and sometimes bone spurs
When to get urgent care
Impingement comes on gradually. Get medical help quickly if something changes suddenly:
- A pop or tearing feeling followed by weakness, so you can’t lift your arm. See a doctor within a few days, since this may be a rotator cuff tear.
- Pain that spreads into your jaw, neck or chest, particularly with exertion, breathlessness or sweating. Call 911.
- Fever or chills along with a hot, swollen shoulder. Go to the ER to rule out a joint infection.
How PMR approaches shoulder impingement treatment
A movement-focused exam
Your clinician watches how your shoulder blade and arm move together, tests each rotator cuff muscle and finds which positions reproduce your pain. We also check your neck and upper back, since stiffness there changes how the shoulder moves. X-ray imaging is used when bone spurs or calcium deposits are suspected.
Physical therapy for strength and control
Exercise is the foundation of care, and physical therapy at PMR usually includes:
- Rotator cuff strengthening, starting with gentle holds and progressing to bands and weights
- Shoulder blade exercises to improve control of the scapula
- Mobility work for a stiff upper back and tight chest muscles
- Progression in our on-site gym toward the demands of your job or sport
Chiropractic mobilization of the neck and upper back, and massage for tight chest and shoulder muscles, can support the exercise plan.
Activity changes, not total rest
You rarely need to stop using your arm. We help you lighten the aggravating load for a while, with fewer overhead repetitions and adjusted technique, then build back up.
Care for athletes
For swimmers, throwers and racquet players, our sports medicine team adds sport-specific strength work and a graded return plan. In Brewster, Paul Ciatto, DC, has a special interest in rehabilitation and strength training of athletes.
Shoulder impingement exercises to start safely
Check with your clinician first, and stop anything that causes sharp pain. Mild discomfort that settles within a day is usually fine.
- Outward-rotation hold. Stand side-on to a doorframe, elbow bent at 90 degrees and tucked at your side, and gently press the back of your hand outward into the frame for 20 to 30 seconds. Repeat three to five times.
- Shoulder blade squeeze. Sit tall and draw your shoulder blades gently back and down. Hold for five seconds, ten times.
- Doorway chest stretch. With your forearms on the doorframe below shoulder height, step through until you feel a gentle stretch.
Frequently asked questions
Is shoulder impingement the same as a rotator cuff tear?
Not exactly. Impingement describes irritation of the rotator cuff tendons and bursa under the acromion, and it can happen with healthy, irritated or partly torn tendons. A full tear usually causes more obvious weakness, and your exam helps tell the two apart. Learn more about torn rotator cuff care.
Do I need surgery for shoulder impingement?
Most people don’t. Exercise-based rehab is the first-line shoulder impingement treatment and helps many people return to their usual activities. If pain blocks progress, a physician may discuss an injection. Surgery is generally considered only when significant symptoms continue after several months of good rehab, and an orthopedic surgeon makes that call.
How long does it take to feel better?
Many people notice some improvement within several weeks of consistent exercise. Building lasting tendon and muscle capacity typically takes a few months, especially with heavy overhead work or sport. Short flare-ups are common along the way, and results vary from person to person.
Book a shoulder impingement visit
You can also request a visit online.