Medicines for Shoulder impingement

What it is

Shoulder impingement is a common cause of shoulder pain, in which the tendons of the rotator cuff (the muscles and tendons that stabilise and move the shoulder) are compressed or "impinged" as they pass through a narrow space in the shoulder, particularly when the arm is raised. This can cause pain and inflammation of the tendons (and the fluid-filled sac, the bursa, that cushions them). It is often related to repeated overhead activities or arm movements (for example in certain sports, jobs, or activities), to the shape of the shoulder bones, to age-related changes in the tendons, or to weakness or poor control of the shoulder muscles. The main symptom is shoulder pain, which is typically felt at the top and outer side of the shoulder and upper arm, and is characteristically worse when raising the arm — particularly in a certain range of movement (a "painful arc"), such as reaching overhead or out to the side, or with activities like putting on a coat or reaching behind the back. The pain may also be worse at night, particularly when lying on the affected shoulder, and can disturb sleep. There may be weakness or difficulty with certain movements. Shoulder impingement is usually not serious and often improves with conservative treatment over time, though it can be persistent and troublesome. The mainstays of treatment are relieving the pain, modifying activities that aggravate it, and — importantly — exercises and physiotherapy to strengthen and improve the control of the shoulder muscles, which addresses the underlying problem. Most people improve with these measures, though it can take time; for persistent cases, other treatments (such as steroid injections) or, occasionally, surgery may be considered. The key messages are that shoulder impingement is a common, usually not serious cause of shoulder pain, that it often improves with rest, activity modification, and exercises/physiotherapy, and that persistent cases should be assessed.

How it is treated

Shoulder impingement is usually managed with conservative treatment, centred on relieving pain and, importantly, exercises and physiotherapy, and most people improve over time. The mainstays include: modifying or temporarily avoiding activities that aggravate the pain (particularly repeated overhead movements), while keeping the shoulder gently moving to avoid stiffness (rather than resting it completely); pain relief and anti-inflammatory measures for the pain (a pharmacist or GP can advise), and, for some, using ice or heat for comfort; and, most importantly, a programme of exercises and physiotherapy to strengthen the rotator cuff and shoulder-blade muscles and improve the control and movement of the shoulder — this addresses the underlying problem and is central to recovery, and a physiotherapist can guide it. Improving posture and technique in relevant activities or sports also helps. Most people improve with these measures, though it often takes time (weeks to months), and continuing the exercises is important. For pain that is not settling with these measures, a corticosteroid injection into the shoulder can help reduce inflammation and pain in some people, often to allow rehabilitation to progress. If symptoms remain persistent and troublesome despite good conservative treatment, further assessment (including imaging) and specialist review may be arranged, and, in some cases, surgery (for example to create more space for the tendons, or to address associated problems such as a rotator cuff tear) may be considered. It is worth seeing a GP or physiotherapist if shoulder pain is persistent, significantly affecting activities or sleep, or not improving, so it can be assessed and managed, and to distinguish it from other shoulder problems. The reassuring messages are that shoulder impingement is common and usually not serious, that it often improves with activity modification, pain relief, and — crucially — strengthening exercises and physiotherapy, and that other treatments are available for persistent cases.