Shoulder impingement: symptoms, treatment, exercises and how long it takes to recover

Frimley Health describes sub-acromial shoulder pain as often felt around the shoulder and upper arm, and sometimes towards the neck and shoulder blade. It can feel worse when the arm is raised to shoulder height or above, or when reaching behind your back. Simple tasks such as reaching for items on shelves, driving or getting dressed may be painful.

Sherwood Forest Hospitals lists an ache or pain in the shoulder or upper arm, pain on movement above head height, reduced movement (for example reaching behind your back, putting your arm in a coat or reaching for a seatbelt), weakness or stiffness when lifting heavy items, and discomfort when lying on the painful side. Sleep can be affected.

Pain may come on gradually or suddenly, particularly if the shoulder has been used for something much more demanding than usual, according to Frimley Health. Arthritis UK says that tingling in the hand or arm alongside shoulder pain is likely to come from a problem in the neck.

• Pain when raising the arm, especially at or above shoulder height.

• Pain reaching behind the back, for example putting on a coat.

• Aching or pain when lying on the sore side, which can disturb sleep.

• Weakness or stiffness when lifting heavier items.

Arthritis UK says rest and physiotherapy are the main treatments for shoulder impingement, and that a doctor may recommend an injection of steroids and a local anaesthetic to help with the pain. Frimley Health says there is good evidence that physiotherapy focused on posture, movement and strength will improve many patients' symptoms and allow them to avoid surgery, and that physiotherapy is usually the first-line treatment.

Sherwood Forest Hospitals describes the self-help steps as relative rest from the activity that hurts (not stopping all shoulder movement), pacing, pain relief as recommended by your GP or pharmacist, keeping the shoulder moving, and exercises. Its leaflet suggests changing position every 30 minutes or so and notes that sedentary, inactive lifestyles increase the risk of developing pain and can delay recovery.

Steroid injections are described by Sherwood Forest as sometimes used to give a window of opportunity to take part in physiotherapy exercises, and only alongside physiotherapy. It says they go into the subacromial bursa, and it is not recommended to have more than two. Frimley Health says the risks of injection are extremely low and most patients enjoy significant pain relief.

Surgery is rarely needed according to Sherwood Forest. The operation aims to increase the space under the acromion and is a keyhole procedure called subacromial decompression. Arthritis UK says surgery may be considered if the pain does not settle or comes back within a few months of treatment.

The rotator cuff is a group of four muscles and their tendons that control shoulder movement and help hold the joint together, according to Sherwood Forest Hospitals. Arthritis UK says pain from a problem with the rotator cuff is often called shoulder impingement, with swelling, pain or damage to the tendons.

The older idea was that the tendons were being pinched. Arthritis UK says it is now understood that it is caused by overuse or age-related problems with the tendons themselves, although the name is still used. The condition may also be called painful arc syndrome.

Sherwood Forest says rotator cuff related shoulder pain as a condition does not cause any serious damage to the muscles and responds well to conservative treatment such as simple home exercises. It also explains that a scan finding does not always explain symptoms: tears can be found on ultrasound, but that does not mean the tears are responsible for the symptoms.

There is no single timescale. Frimley Health says it can take at least 6 weeks of strengthening and postural work before you notice improvement in pain and function, and that doing the exercises about 4 to 5 times a week can produce significant gains in strength. If exercises cause some discomfort at first, it suggests doing them on alternate days.

The NHS says you usually need to do self-care for 2 weeks before shoulder pain starts to ease, and that it can take 6 months or longer to recover from shoulder pain. It advises seeing a GP if pain is getting worse or does not improve after 2 weeks.

Sherwood Forest says approximately 80% of patients with the condition are treated successfully with non-surgical management, and that its clinicians can review your case if symptoms do not improve within an expected period.

There is rarely one cause. Frimley Health says sub-acromial pain is very common, most patients are between 40 and 65, and it is slightly more common in women. It can develop from age-related changes, repetitive strain, an increase in load you are not used to, injury, or sometimes for no apparent reason.

Sherwood Forest lists muscle weakness or imbalance, injury, shoulder stiffness, posture, age-related change of the muscles, tendons or joints, decreased activity, and stress, anxiety and poor sleep. It adds that regular overhead activity such as painting and decorating, or work with an outstretched arm, can contribute.

Frimley Health also mentions general health factors that can influence tendon health, including smoking, obesity, a high-fat diet, high cholesterol, low vitamin D levels and diabetes. Sherwood Forest notes that smoking, alcohol, weight, stress and general fitness can affect musculoskeletal problems and limit recovery.

Sherwood Forest says rotator cuff related shoulder pain can be diagnosed from the symptoms you describe and an assessment of the shoulder, neck and arm by a healthcare professional. Further investigations are often not needed. If the diagnosis is unclear, an X-ray or ultrasound can be performed to help.

It explains that investigations only provide information to support the clinical examination. An X-ray looks at the bones of the shoulder, while an ultrasound scan looks at soft tissues such as muscles, tendons and the bursa.

The NHS lists common patterns of shoulder pain and what may lie behind them. This is for orientation only: it says not to self-diagnose and to see a GP if you are worried.

The NHS says you can usually ease shoulder pain yourself. It suggests staying active and gently moving your shoulder, trying shoulder exercises for 6 to 8 weeks to stop pain returning, standing up straight with your shoulders down and gently back, and using painkillers such as paracetamol and ibuprofen so you can keep moving.

For heat or cold, the NHS suggests a pack of frozen peas wrapped in a tea towel for up to 20 minutes, 3 times a day, or a hot water bottle wrapped in a tea towel for up to 20 minutes, 2 to 3 times a day.

It advises not to completely stop using your shoulder, not to do things that seem to make it worse, not to make up your own strenuous exercises or use heavy gym equipment, and not to slouch. Sherwood Forest adds practical work tips such as arranging a computer workstation so frequently used items are within easy reach, and resting your arm on a pillow or armrest.

Impingement itself is not an emergency, but other causes of shoulder pain can be. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden or very bad shoulder pain, you cannot move your arm, your arm or shoulder has changed shape or is badly swollen, you have pins and needles that do not go away, there is no feeling in your arm or shoulder, your arm or shoulder is hot or cold to touch, the pain started after an injury like a fall, you have severe pain in both shoulders, or you feel feverish or unwell.

Arthritis UK says severe pain in both shoulders together with pain in the thighs, or feeling feverish or unwell, can be signs of polymyalgia rheumatica, which needs prompt treatment. See a GP if shoulder pain is getting worse or has not improved after 2 weeks.

The NHS says that in many areas you may be able to refer yourself for physiotherapy through NHS community musculoskeletal (MSK) services without seeing a GP. It also says physiotherapy is available on the NHS but waiting times can be long, and that you can pay for physiotherapy privately.

Frimley Health says you will probably be asked to do physiotherapy as a first-line treatment by your GP or the hospital upper limb team. Whichever route you use, ask what outcome to expect and over what timescale, and whether a scan will change the plan.