“Shoulder impingement” is a familiar label for pain when lifting the arm, particularly during overhead activity. Clinicians may also use terms such as subacromial pain or rotator cuff-related shoulder pain because symptoms can often involve several structures rather than being just one tissue alone. Similar symptoms can occur with a rotator cuff tear, frozen shoulder, arthritis or a neck problem, so assessment is sensible when pain is severe or persistent.
The shoulder is the most mobile of all the joints in the human body. And whilst this incredible mobility enables us to perform a huge variety of arm movements: playing the guitar, a Mexican wave, handstands – to name just a few – it also comes with a sacrifice. Stability.
The anatomy of the shoulder is such that is has a shallow socket to support the top of the arm bone (the part that forms the “ball” in the “ball-and-socket” joint).
Instead, it relies, partially, on the strength of the numerous muscles around the shoulder to pull the arm up and into the socket and guide the movements of the arm.
When a trauma occurs to the shoulder – perhaps a fall or a rapid overhead movement to catch something – it can inflame the muscles, tendons and/or ligaments – putting pressure on the joints and affecting the free movement of the shoulder. This is what we mean when we say “impingement”.
Alongside the initial advice to rest and ice the shoulder in the initial stage of acute injury, progressive movement and strengthening are usually the first-line of management.
The examples below are gentle starting points rather than an individual prescription. Work within a comfortable range, begin with modest effort, and reduce or stop if an exercise causes sharp pain or leaves symptoms clearly worse.
Wall slides
Place your hands or forearms on a cloth against a wall. Slide upwards only as far as feels comfortable, then return slowly. Begin with 5–8 repetitions.
Outward press
Support the sore arm with the elbow bent. Press outwards into your other hand without allowing movement. Hold 10–15 seconds at about half effort, 4–6 times.
Pendulum Swings
Lean forward placing one hand on the back of a chair of a kitchen counter. Let the injured arm hang down and allow gravity to traction the arm away from the shoulder socket. Gently circle the hand clockwise for 8 rotations and then counterclockwise for a further 8 rotations.
When to seek help
Contact NHS 111 for sudden or very severe pain, inability to move the arm, deformity or marked swelling, persistent numbness, an arm that feels unusually hot or cold, pain after an injury, or fever and feeling unwell.
