Shoulder Impingement

 

Introduction

Shoulder pain is one of the most common musculoskeletal problems that can affect daily activities, work performance, and overall quality of life. Among the many shoulder conditions, shoulder impingement syndrome is particularly significant due to its frequency and its impact on mobility. Individuals experiencing shoulder impingement often describe discomfort when lifting their arm, reaching overhead, or even lying on the affected side at night.

At Joint Injections, we recognise the importance of understanding the shoulder joint, the underlying mechanisms of pain, and the treatment options available. This blog explores shoulder impingement in detail — covering its anatomy, pathology, symptoms, diagnostic process, and management strategies. We also discuss the role of ultrasound-guided steroid injections, which are one of the services offered at Joint Injections to support the management of shoulder conditions.

Anatomy of the Shoulder

The shoulder joint is one of the most mobile joints in the human body, allowing a wide range of motion. However, this mobility comes at the cost of stability, which makes it vulnerable to injury.

The shoulder is composed of:

  • Bones: The humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone).
  • Joints: The main shoulder joint is the glenohumeral joint, where the head of the humerus articulates with the glenoid cavity of the scapula. Additional joints include the acromioclavicular joint and sternoclavicular joint.
  • Soft tissues: Ligaments, tendons, muscles, and bursae that provide stability and smooth movement.
  • Rotator cuff: A group of four muscles and their tendons (supraspinatus, infraspinatus, subscapularis, and teres minor) that stabilise the humeral head within the socket during movement.

Subacromial Space

Central to shoulder impingement is the subacromial space. This narrow passage is located between the acromion (a bony projection of the scapula) and the humeral head. Within this space lies the subacromial bursa and the supraspinatus tendon.

When the arm is raised, the humeral head moves upwards, reducing the available space. If this space becomes too narrow, structures such as the bursa or rotator cuff tendons may become compressed, leading to irritation, inflammation, and pain.

What is Shoulder Impingement?

Shoulder impingement, also referred to as subacromial impingement syndrome, occurs when the tendons of the rotator cuff and/or the subacromial bursa are compressed during shoulder movements.

This compression can lead to:

  • Inflammation of the bursa (subacromial bursitis).
  • Tendon irritation or microtears within the rotator cuff.
  • Pain particularly when lifting the arm above shoulder height or performing overhead activities.

Shoulder impingement is not a single disease but rather a syndrome that describes a collection of symptoms resulting from mechanical compression.

Causes of Shoulder Impingement

Several factors may contribute to the narrowing of the subacromial space and the onset of impingement:

  1. Structural Causes
  • Variations in the shape of the acromion (flat, curved, or hooked).
  • Bone spurs at the acromioclavicular joint.
  1. Functional Causes
  • Weakness or imbalance of rotator cuff or scapular muscles.
  • Poor posture, such as rounded shoulders or forward head position.
  • Repetitive overhead activities (e.g., painting, swimming, or racquet sports).
  1. Degenerative Changes
  • Age-related wear and tear.
  • Degeneration of rotator cuff tendons leading to thickening.
  • Osteoarthritis of the acromioclavicular joint.

Symptoms of Shoulder Impingement

Symptoms can vary in intensity and duration. Common features include:

  • Pain on lifting the arm above shoulder level.
  • Night pain, particularly when lying on the affected shoulder.
  • Weakness in the arm or reduced range of motion.
  • Clicking or catching sensations during movement.
  • Painful arc: pain typically occurs between 60 and 120 degrees of arm elevation.

Diagnosis of Shoulder Impingement

A diagnosis is often made following a detailed clinical assessment.

Clinical Evaluation

A clinician will typically:

  • Take a history of symptoms (onset, duration, aggravating factors).
  • Perform a physical examination, which may include:
  • Neer’s test: pain when the arm is passively lifted while internally rotated.
  • Hawkins-Kennedy test: pain when the shoulder is flexed and internally rotated.

Imaging

  • Ultrasound: useful for assessing rotator cuff tendons and bursae.

Management of Shoulder Impingement

Treatment for shoulder impingement often depends on the severity of symptoms and the underlying causes.

  • Pain management: use of simple analgesics as advised by a clinician.
  • Manual therapy: stretching and mobilisation techniques.

Ultrasound-Guided Steroid Injections at Joint Injections

At Joint Injections, we offer ultrasound-guided steroid injections as part of the management pathway for shoulder conditions.

These injections are performed by a clinician using real-time ultrasound imaging to precisely guide the needle into the subacromial space. This accuracy helps in targeting the area of inflammation, such as the bursa or rotator cuff tendons.

The aim of the injection is to:

  • Deliver steroid medication directly to the inflamed area.
  • Reduce irritation in the subacromial space.
  • Support participation in physiotherapy and rehabilitation programmes.

Living with Shoulder Impingement

For many people, shoulder impingement can be a long-term condition, particularly if not addressed early. Simple adaptations can help in daily life, such as:

  • Using the opposite arm for repetitive overhead tasks.
  • Modifying sleep positions with supportive pillows.
  • Incorporating posture correction exercises into routine activities.

Why Choose Joint Injections for Shoulder Impingement?

At Joint Injections, we focus on accurate diagnosis and targeted treatments for musculoskeletal conditions. Our clinicians utilise ultrasound-guided techniques to deliver steroid injections with precision. By tailoring management to each individual, we aim to support improved mobility and reduced discomfort, helping patients return to everyday activities.

Conclusion

Shoulder impingement is a common yet complex condition influenced by structural, functional, and degenerative factors. Understanding the underlying anatomy and mechanisms is vital for effective management.

At Joint Injections, we provide a comprehensive approach, with clinicians offering ultrasound-guided steroid injections alongside guidance for rehabilitation and ongoing care.

By combining precision, expertise, and patient-centred care, our aim is to support individuals in managing shoulder pain and restoring function in their daily lives.

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