Question 1

If I have shoulder impingement, will it eventually turn into a rotator cuff tear?

Accepted Answer

This is controversial. Traditional teaching suggested chronic impingement causes progressive tendon wear eventually leading to rotator cuff tears, but recent research questions this. Many people have bone spurs and impingement on imaging but no symptoms. It's more likely that impingement and rotator cuff tears are related but separate processes - both caused by age-related tendon degeneration rather than impingement directly causing tears. That said, if you have impingement symptoms and don't address them, you may develop muscle weakness and altered shoulder mechanics that could increase tear risk. The best prevention is maintaining strong, well-balanced shoulder muscles through regular exercise, not necessarily having surgery to remove bone spurs. Most studies show that people who do physiotherapy properly don't have higher rates of developing rotator cuff tears compared to those who have surgery.

Question 2

My doctor recommended physiotherapy first, but I've heard surgery is more effective - should I just have surgery now?

Accepted Answer

The evidence strongly supports trying physiotherapy first. While older studies showed surgery gave better outcomes than no treatment, high-quality recent trials (CSAW trial from UK, FIMPACT trial from Finland) found no difference between arthroscopic decompression surgery and physiotherapy alone at 1-2 years - both groups had about 75-80% improvement. This means surgery doesn't provide additional benefit over good physiotherapy for most patients. Surgery has risks (infection, stiffness, anaesthetic complications) and costs that physiotherapy doesn't. The Australian Orthopaedic Association now recommends at least 3-6 months of proper physiotherapy before considering surgery. However, surgery may be reasonable if you've genuinely tried physiotherapy properly (attending 8-12 sessions, doing home exercises for 3+ months) without improvement, or if you have severe symptoms significantly affecting work and quality of life. The key is 'proper' physiotherapy - one or two sessions without home exercises doesn't count.

Question 3

How long will it take for physiotherapy to work, and what should I expect?

Accepted Answer

Most patients notice initial improvement within 4-6 weeks of starting physiotherapy, but full recovery typically takes 3-6 months of consistent exercise. In the first 2-3 weeks, physio focuses on pain relief (techniques, modifying activities, gentle movements) and you may not notice much change - this is normal. At 4-6 weeks, you should start noticing less pain with daily activities and better sleep. By 8-12 weeks, you should have significant improvement in pain and function if treatment is working. If you've had no improvement whatsoever after 8-12 weeks of proper physiotherapy (2-3 sessions per week plus daily home exercises), discuss with your doctor whether to try a corticosteroid injection or consider surgery. Success requires commitment - expect to do 10-15 minutes of exercises daily at home, not just attending physio sessions. Most people who fail physiotherapy fail because they don't do home exercises regularly, not because physio doesn't work.

Medical Disclaimer

Shoulder Impingement (Subacromial Pain)

📖What is Shoulder Impingement (Subacromial Pain)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention