Shoulder impingement

What is shoulder impingement?

This is the most common symptomatic shoulder condition, sometimes called ‘bursitis’ or ‘tendonitis’. No one really knows what causes impingement syndrome but it is thought that the supraspinatus tendon – one of the four tendons in the shoulder that make up the ‘rotator cuff’ – becomes inflamed. A fluid-filled sac, the ‘bursa’, overlies this tendon and this also becomes inflamed.

The supraspinatus tendon and the bursa run through a narrow bony canal, which can become narrowed in certain positions, such as when the arms are out in front of you and at or above shoulder level, and may impinge the tendon and bursa causing them to become inflamed.

Symptoms of shoulder impingement

Symptoms include:

• pain in the top and outer side of your shoulder
• pain that worsens when you lift your arm
• pain at night, which can wake you up
• arm weakness

How is shoulder impingement treated?

If initial physiotherapy or conservative treatment is unsuccessful, the next step on the treatment pathway is to have a steroid injection under ultrasound guidance. This procedure should be carried out by a consultant radiologist using ultrasound to ensure the steroid is injected where it does the most benefit – in the bursa. The radiologist will perform a thorough assessment of the shoulder tendons. The injection then takes only a few seconds to carry out. The steroid usually takes effect by one week. After the injection many patients find the greatest benefit is being able to sleep without being woken by pain.

Surgery can be offered for impingement syndrome if clinically necessary but it is usually kept to the end of the treatment pathway, used as a last resort when less invasive treatments have been unsuccessful.