Back to Home
Shoulder Condition

Shoulder Impingement Syndrome

One of the most common causes of shoulder pain — accurately diagnosed and treated with targeted, evidence-based care.

Book a Consultation Call 020 7770 8185
Overview

What is Shoulder Impingement Syndrome?

Shoulder impingement syndrome — also known as subacromial impingement — is one of the most common causes of shoulder pain. It occurs when the soft tissue structures within the subacromial space (the gap between the top of the humerus and the undersurface of the acromion bone) become compressed or irritated during movement of the arm.

The subacromial space contains the rotator cuff tendons and the subacromial bursa — a small fluid-filled sac that acts as a cushion for these structures. When the space is reduced, the tendons and bursa can be pinched as the arm is raised, causing pain, inflammation, and over time, potential damage to the underlying tendon.

Causes

What Causes Shoulder Impingement?

Impingement can arise from a combination of structural and functional factors:

The natural shape of the acromion — a hook-shaped or curved acromion reduces the available space

Inflammation and swelling of the subacromial bursa (bursitis)

Rotator cuff weakness or imbalance, causing the humeral head to ride upward

Repetitive overhead activities — common in swimmers, tennis players, painters, and manual workers

Age-related changes to the tendons, including thickening or partial tearing

Poor posture, particularly forward head and rounded shoulder positions

In many patients, more than one of these factors is present simultaneously.

Symptoms

Symptoms

The hallmark of shoulder impingement is pain that is provoked by lifting the arm — particularly between roughly 60 and 120 degrees of elevation (the so-called painful arc). Other common symptoms include:

Pain in the shoulder and upper arm, often radiating toward the deltoid

Discomfort at night, especially when lying on the affected shoulder

Pain when reaching overhead or behind the back

Weakness or fatigue of the shoulder with sustained activity

A gradual worsening of symptoms if the underlying cause is not addressed

Diagnosis

Diagnosis

Shoulder impingement is a clinical diagnosis, meaning a thorough clinical examination is the cornerstone of assessment. Professor Kochhar uses a series of specific clinical tests alongside a careful history to identify the impingement pattern, assess rotator cuff strength, and identify any associated pathology.

Imaging supports the clinical assessment. Plain X-rays can reveal the acromial morphology and any calcification. Ultrasound allows dynamic assessment of the rotator cuff and bursa. MRI is used where a rotator cuff tear or other intra-articular pathology is suspected.

Accurate diagnosis matters because shoulder impingement is a descriptive term, not a final diagnosis. Understanding what is driving the impingement — bursitis, a partial cuff tear, acromial morphology, or rotator cuff dysfunction — determines the most appropriate treatment.

Treatment

Treatment Options

Physiotherapy and Exercise

The mainstay of treatment for shoulder impingement is a structured physiotherapy programme focused on restoring normal shoulder mechanics, strengthening the rotator cuff and scapular stabilisers, and correcting any postural or movement pattern contributions. Most patients with true subacromial impingement respond well to an appropriate rehabilitation programme, and this is always the starting point for management.

Subacromial Injection

Ultrasound-Guided

Where pain is severe enough to limit engagement with physiotherapy, a subacromial corticosteroid injection can provide a meaningful window of relief that allows rehabilitation to proceed effectively. Professor Kochhar uses ultrasound guidance for injection procedures to ensure precise placement and maximise both safety and efficacy.

It is important to note that injections treat the inflammatory component of impingement — they do not address the underlying mechanical cause. They are most effective when combined with a concurrent physiotherapy programme rather than used in isolation.

Activity Modification

Identifying and temporarily modifying activities that provoke symptoms can prevent the cycle of repeated irritation from perpetuating the problem. This is particularly important in patients whose work or sport involves sustained overhead activity.

Subacromial Decompression

Arthroscopic Keyhole Surgery

For patients in whom conservative measures have not provided adequate or sustained relief, arthroscopic subacromial decompression is a well-established and effective procedure. Performed as keyhole surgery under general anaesthetic, it involves removing the inflamed bursal tissue and smoothing the undersurface of the acromion to increase the available space for the rotator cuff tendons.

The procedure is typically performed as day surgery and is associated with a good outcome in appropriately selected patients. Recovery involves a period of physiotherapy to restore movement and strength, with most patients returning to full activity within three to four months.

FAQ

Frequently Asked Questions

With appropriate treatment, many patients see significant improvement within six to twelve weeks of starting physiotherapy. Persistent cases, particularly where there is an underlying structural contribution such as a hooked acromion, may take longer or ultimately require surgical intervention.

Mild cases may settle with rest and activity modification, but the underlying factors that contributed to the impingement — rotator cuff weakness, poor scapular control, or acromial morphology — will not resolve without a targeted programme. Without addressing these, symptoms frequently recur.

No. The majority of patients with shoulder impingement do not require surgery. Professor Kochhar's approach is to exhaust appropriate non-surgical options before considering any operative intervention. Surgery is considered when conservative treatment has been properly tried and has failed to provide adequate relief.

Not necessarily, though the two frequently coexist. Impingement refers to the mechanical compression and irritation of structures within the subacromial space. A rotator cuff tear is a structural disruption of the tendon itself. Chronic impingement can contribute to tendon degeneration and tearing over time, which is one reason early assessment and appropriate management matters.

Why Choose Professor Kochhar

Expert Care You Can Trust

Professor Tony Kochhar is a specialist shoulder and upper limb surgeon with a reputation for accurate, prompt diagnosis and evidence-based, patient-centred care. He sees patients privately at London Bridge Hospital and across the West Kent area. His team includes specialist physiotherapists and anaesthetists, ensuring seamless care from first consultation through to full recovery.

Whether your symptoms are newly onset or have been affecting you for months, an expert assessment with Professor Kochhar will give you a clear picture of what is happening and what can be done about it.

Book a Consultation Call 020 7770 8185

Ready to Move Without Pain?

Call us on 020 7770 8185 or complete our contact form and we'll arrange an appointment at a clinic near you.

Book a Consultation Call 020 7770 8185