Shoulder impingement

Impingement of the shoulder is a syndrome common in active adults as they age. It is typically due to repetitive overhead activity over an extended period of time. It can occur in combination with shoulder bursitis and rotator cuff tendonitis, which are closely related conditions.

Smiling male swimmer at edge of poolSmiling male swimmer at edge of poolWoman in water exercise class

Symptoms and classification of shoulder impingement

Shoulder impingement rarely goes away on its own, but treatment is usually very effective. Symptoms include:

  • Difficulty reaching up behind the back and shoulder blades.
  • Pain when the arms are extended above the head, especially during overhead activities such as tennis, swimming or baseball. Pain can be worse at night due to pressure on the shoulder from sleeping positions.
  • Shoulder weakness. If the rotator cuff has also torn completely, patients experience significant weakness and can’t raise their arm above shoulder height.

We diagnose and classify shoulder impingement into three grades:

  • Grade I. Inflammation of the bursa and tendons.
  • Grade II. Progressive thickening and scarring of the bursa.
  • Grade III. Rotator cuff degeneration and tears are evident.

Treatment for shoulder impingement

Nonsurgical treatment

We can treat most cases with a nonsurgical approach, which can take several weeks to a few months:

  • Ice. Apply to the shoulder for 20 minutes twice a day.
  • Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen.
  • Physical therapy. The most important treatment for shoulder impingement. A physical therapist will teach you strengthening and stretching exercises.
  • Rest. Avoid “overhead” activities.
  • Steroid injection. Cortisone injected it into the bursa beneath the acromion can relieve pain.

If this does not relieve pain and restore range of motion, your doctor may recommend surgery to create more space for the rotator cuff.

When surgery is called for

If you are young and an athlete, we might recommend surgery as the first choice. With surgery, your doctor removes the inflamed portion of the bursa, and may also perform an anterior acromioplasty, or subacromial decompression, to remove part of the acromion.

We do this in two ways:

  • Open surgery. Your doctor makes a small incision in the front of your shoulder to see the acromion and rotator cuff directly.
  • Arthroscopic surgery. Your doctor inserts thin surgical instruments into two or three small puncture wounds around your shoulder, and examines your shoulder and removes bone and the front edge of the acromion along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery.

Your recovery

Non-surgical treatment typically works well in several weeks, and surgery typically takes two to four months to achieve complete relief of pain.

Your personalized treatment plan will help you heal every step of the way, and your orthopedic team will diligently handle your case until you’re healed, pain-free and doing the activities you love.


Orthoinfo: American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendinitis (–conditions/shoulder-impingementrotator-cuff-tendinitis)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Shoulder Impingement Syndrome (