Signs and Symptoms
Impingement usually comes on gradually. Common symptoms include:
- Pain on the front or outside of the shoulder that may spread down the upper arm
- Pain when you lift your arm to the side or overhead, often in a middle range of motion
- Pain when reaching behind your back, such as tucking in a shirt or fastening a bra
- Night pain, especially when lying on that shoulder
- Mild weakness that is often caused by pain rather than a tear
What Causes It?
Impingement is closely related to rotator cuff tendonitis (inflamed tendons) and bursitis (an inflamed bursa). It often develops from:
- Repetitive overhead activity at work or in sports such as tennis, swimming, golf and pickleball
- Weak rotator cuff or shoulder blade muscles, or rounded posture, which change how the shoulder moves
- Age-related wear of the tendons
- The natural shape of the acromion or bone spurs that narrow the space
Left untreated, ongoing irritation can contribute to partial tearing of the rotator cuff over time.
How We Diagnose It at POPB
Your physician will examine your shoulder, test strength and motion, and use specific maneuvers that reproduce impingement pain. X-rays in our office look for bone spurs, arthritis and the shape of the acromion.
Diagnostic ultrasound, which Dr. Adelman uses at the point of care, can show bursitis and tendon changes during your visit. An MRI, also available on site, may be ordered if a tear is suspected or symptoms are not improving. Sometimes a numbing injection into the bursa is used as a test: if the pain eases, impingement is a likely source.
Non-Surgical Treatment Options
Non-surgical care helps most people with impingement:
- Activity changes to reduce overhead motions for a period, plus ice and anti-inflammatory medication if appropriate
- Physical therapy in our office to strengthen the rotator cuff and shoulder blade muscles, improve posture and restore normal shoulder mechanics
- A cortisone injection into the bursa, often ultrasound-guided, to calm inflammation so therapy can progress
- PRP for selected cases of ongoing tendon problems. Evidence is still developing, results vary, and insurance usually does not cover it.
Improvement typically takes several weeks to a few months of consistent therapy.
Surgical Options
If pain continues after roughly 3 to 6 months of well-done non-surgical care, surgery may be considered. Arthroscopic subacromial decompression is performed by Dr. Chalal or Dr. Wolfson through small incisions. The surgeon removes the inflamed bursa and, if needed, shaves bone spurs from the acromion to create more space for the tendons.
If a rotator cuff tear is found, it may be repaired during the same procedure. This surgery is usually done on an outpatient basis at an area surgery center.
Recovery
With therapy alone, many people notice improvement within 6 to 12 weeks. After arthroscopic decompression, you may use a sling for comfort for a few days to a couple of weeks and begin motion exercises early. Most people return to daily activities within a few weeks and to overhead sports in about 3 to 4 months, though timelines vary and are longer if a tendon repair was also done.
Your physical therapy can take place in our office, with your therapist and physician working from the same chart.
Insurance and Cost
Office visits, imaging, physical therapy, cortisone injections and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay. HMO and managed-care plans require a referral from your primary care physician before the visit.
PRP is usually not covered by insurance. Our staff verify your benefits when you call.
When to Be Seen
Make an appointment if shoulder pain lasts more than 2 to 3 weeks, disturbs your sleep, or keeps you from work, sports or daily tasks. See a physician sooner if you notice significant weakness or cannot lift your arm, since that can signal a rotator cuff tear.
