Subacromial shoulder pain (impingement) rehabilitation

NHS inform defines it as a general term for pain that originates from the shoulder and can spread towards the neck or down the arm. It involves the rotator cuff tendons, which help control the ball-and-socket joint. Causes include age-related change, repetitive strain, injury, and sometimes no obvious reason.

The NHS uses the term shoulder impingement alongside tendonitis and bursitis in its list of causes of shoulder pain. The characteristic symptom is pain in the upper arm when lifting the arm above shoulder height or reaching behind the back, such as putting on a jacket, and many people find lying on the affected side uncomfortable at night.

A clinician examines range of movement and strength, and may carry out other tests to rule out other conditions. Arthritis UK highlights that severe pain in both shoulders, thigh pain with shoulder symptoms, or feeling feverish can point to polymyalgia rheumatica and needs prompt assessment.

The NHS lists frozen shoulder, arthritis, shoulder instability, dislocation, broken bones, torn tendons and acromioclavicular joint problems among other causes. Sudden severe pain, being unable to move the arm, or a visible deformity needs urgent medical help through 111 or emergency services.

NHS inform states that targeted stretching and strengthening exercises encourage movement and improve pain. For new shoulder problems it advises reducing activity but moving as much as symptoms allow for the first 24 to 48 hours, moving the shoulder gently for 10 to 20 seconds every hour while awake, and then using the shoulder more.

The NHS says to try shoulder exercises for 6 to 8 weeks to stop pain returning. Neither page lists the exercises, so the programme comes from a physiotherapist. Arthritis UK names physiotherapy as the primary professional treatment, including strengthening, stretching and posture correction.

• Avoid long periods in one position, and move the shoulder gently at regular intervals.

• Limit overhead movements for a while if they strongly provoke pain, then reintroduce them gradually.

• Use trolleys rather than carrying heavy bags, and check desk set-up, as Arthritis UK suggests.

NHS inform says painkillers make movement more comfortable and so support recovery. Heat or cold can be used for comfort, and the NHS gives cold packs for up to 20 minutes up to three times a day and heat two to three times a day. Arthritis UK advises not using simple painkillers beyond two weeks without medical guidance.

If painkillers are not enough, NHS inform describes corticosteroid injections reducing pain and inflammation without curing the condition or reducing stiffness. Arthritis UK recommends no more than two or three injections into a shoulder because repeated use risks joint damage. Injections are usually used to make exercise possible, not as a replacement for it.

NHS inform says time off depends on the demands of the job, and that returning gradually when possible aids recovery. Staying at or returning to work is described as part of recovery for new shoulder problems.

The same page lists smoking, obesity, a high-fat diet, high cholesterol and diabetes as factors that can compromise tendon health and healing. Addressing them is a long-term gain even though the shoulder itself may be the immediate focus.

Arthritis UK says surgery, often keyhole, may be considered when conservative treatment fails, including for rotator cuff tears. The NHS pages used for this guide do not describe surgery for impingement, so the decision is made with an orthopaedic or shoulder specialist after exercise-based treatment and sometimes imaging.

The related surgical page on this site, on subacromial decompression, covers that procedure. Rehabilitation after any shoulder procedure follows the surgeon's protocol, which is stricter than the general advice above.