Rotator Cuff Impingement

Medically Reviewed by Tyler Wheeler, MD on November 17, 2022
Written by WebMD Editorial Contributors
3 min read

A rotator cuff impingement is a type of injury that causes shoulder pain. It affects the muscles and tendons between your arm bone and the top of your shoulder. You use this group of muscles and tendons, called the rotator cuff, to move and lift your arms.

An impingement happens when one of these tendons is injured, causing it to swell and get pinched by the bony top of your shoulder joint. The “pinching” makes it hard for blood to flow through. Because of that, your tendon can start to fray and split like a piece of rope.

Doctors sort these injuries into three grades based on your symptoms and how much damage the impingement causes:

  • Grade 1: swelling and inflammation
  • Grade 2: tendinopathy, or weakened tendons in the shoulder
  • Grade 3: tears in the rotator cuff or changes in the shoulder bone, such as the growth of bony spurs called osteophytes

Rotator cuff impingement is most common in older adults and athletes, but 20% of all people will get it at some point in their lives. This shoulder problem can often be treated at home. In severe cases, you may need surgery.

If you have a rotator cuff impingement, you’ll notice pain in your shoulder. It will be worse when you reach your arms behind your back, raise them overhead, or make twisting motions, such as trying to put on a coat.

Some people wake up at night because of the pain.

Your symptoms could come on quickly if an injury is to blame. If you’re older, the signs could show up slowly over time.

People get rotator cuff impingements for different reasons. In those younger than 25, it’s often caused by using your shoulder too much or by an injury.

But if you’re over 50, it’s probably due to general wear and tear on your shoulder over the years. And the injury is more likely to go beyond a “pinched” tendon and could end up as a partial or complete tear.

Your doctor will ask about your symptoms. They’ll have you move your shoulder in different ways to test your strength and range of motion.

Because many other conditions share the same symptoms as impingement, your doctor will probably do an imaging test to see what’s happening inside your shoulder. This may include an X-ray, ultrasound, or MRI.

Most people can treat the problem at home or at the doctor’s office with:

  • Rest. You’ll need to stop all physical activity that puts stress on your shoulder or causes you pain. This may include things you do at your job.
  • Pain relievers.Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin, ibuprofen, or naproxen can ease your pain.
  • Ice. A cold pack applied for 20 minutes, three times a day, can offer relief. You could also massage the area with an ice cube for 10 minutes at a time.
  • Physical therapy. Your therapist can teach you exercises to help strengthen the muscles of your shoulder. They’ll also improve your strength and range of motion.
  • Injection. A shot of numbing medicine and steroids in your shoulder joint can ease soreness and swelling.

Most people who follow these steps notice that their shoulder pain is better in 3 to 6 months.

Surgery

If your symptoms don’t go away after 6 months, your doctor could suggest surgery. You may also need it if one of your tendons is torn and can’t heal on its own.

The most common surgery to fix a rotator cuff impingement is called a subacromial decompression (SAD). Your surgeon will remove any swollen tissue in your shoulder and bony growths that have happened. This helps with healing and makes more room in your shoulder so your tendon isn’t pinched.

The surgery often is done on an outpatient basis, meaning you shouldn’t have to spend the night in a hospital.

Afterward, you’ll need to keep your arm in a sling or splint. Recovery is different for everyone, but it may take 3 to 4 months before your arm fully heals. During that time, you’ll need to do daily exercises to rebuild your strength.

Because healing can take a while, talk to your doctor about whether surgery is the best option for you.