Patient information · Orthopaedics and physiotherapy
Shoulder impingement
the painful arc, and the exercises that fix it
Pain on lifting the arm to shoulder height, easing again as it goes higher, is the classic painful arc of subacromial shoulder pain. It is the commonest shoulder problem in adults, and a well-designed exercise programme produces results as good as surgery in the great majority of people.
Arrange prompt assessment if you have
- sudden weakness after an injury — unable to lift or hold the arm out
- shoulder pain with fever, redness or heat
- night pain with weight loss, or a history of cancer
- pins and needles or weakness in the hand
- a shoulder that looks deformed after a fall
- pain that came on with chest tightness, sweating or breathlessness
An acute rotator cuff tear after trauma, particularly in someone under 60, may need early surgical assessment — the window matters. Referred cardiac pain can present in the shoulder. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What is happening
The rotator cuff tendons pass through a narrow space beneath the bony arch of the shoulder. When those tendons become irritated or degenerate, or the muscles controlling the shoulder blade are not working well, the space becomes symptomatic. The result is pain on overhead and reaching movements, often worse at night when lying on that side.
- pain on the outer upper arm rather than the point of the shoulder
- a painful arc between roughly 60 and 120 degrees of lifting
- difficulty reaching overhead, behind the back, or into a back seat
- night pain, particularly lying on the affected side
- weakness that is due to pain rather than true loss of power — the distinction matters and needs examining
Treatment, and what the evidence shows
Multiple good-quality trials have compared subacromial decompression surgery with exercise, and with placebo surgery. The results consistently show no meaningful advantage for the operation. Exercise therapy is therefore the primary treatment, and it needs to be done properly and for long enough.
- Rotator cuff strengthening with a resistance band — external and internal rotation with the elbow tucked in.
- Scapular control work — the shoulder blade must move correctly for the shoulder to work; this is the part most home programmes miss.
- Progressive loading, increasing resistance as tolerated, three to four times a week.
- Modify, do not stop. Reduce overhead work temporarily rather than resting the arm completely.
- Expect twelve weeks before judging. Improvement is not linear.
Where injections fit
A subacromial corticosteroid injection can reduce pain substantially for several weeks to months. Its value is in creating a window in which rehabilitation becomes possible for someone too sore to exercise — not as a treatment in itself. Injection without a subsequent exercise programme reliably leads to the problem returning. Repeated injections into the same shoulder are best avoided.
Day to day
Helps
- Sleeping with a pillow supporting the arm, or propped up
- Keeping the elbow close to the body for heavier tasks
- Warmth before exercises
- Breaking up sustained overhead work
- Attention to desk posture and screen height
Avoid
- Complete rest or a sling, which stiffens the shoulder
- Repeated overhead lifting while symptomatic
- Pushing through sharp pain during exercises
- Carrying heavy bags on that shoulder
- Abandoning the programme at six weeks
If it does not settle
Ultrasound or MRI can define whether there is a partial or full-thickness cuff tear, calcific deposit or other pathology. Calcific tendinitis, which causes sudden severe pain, can be treated with barbotage — needling the deposit under ultrasound. Full-thickness tears in younger, active people may warrant surgical repair. These are decisions made on the scan plus the clinical picture, not on the scan alone — cuff tears are common in painless shoulders over 60.
Book an appointment if shoulder pain is waking you, has lasted more than six weeks, or is not responding to exercise. We perform ultrasound and ultrasound-guided injection on site, arrange MRI quickly through our CQC-registered imaging partners, and offer physiotherapy seven days a week without a referral.
Ultrasound-guided injection and physiotherapy
Same-day appointments most days, seven days a week, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.