Question 1

What exactly is shoulder impingement?

Accepted Answer

Shoulder impingement (subacromial impingement syndrome) occurs when the rotator cuff tendons and bursa (fluid sac) get squeezed or 'impinged' between the ball of the shoulder joint (humeral head) and the bony roof (acromion) when you lift your arm. This squeezing causes inflammation, pain, and sometimes tendon damage. It's often due to a combination of factors: weak rotator cuff muscles, poor shoulder blade control, bone spurs on the acromion, thickened bursa, and poor posture.

Question 2

Why is physiotherapy the recommended first treatment instead of surgery?

Accepted Answer

Multiple high-quality studies, including large randomized controlled trials, show that intensive physiotherapy produces similar outcomes to surgery for shoulder impingement. Importantly, recent studies comparing arthroscopic decompression to sham (fake) surgery found no difference - suggesting surgery doesn't work better than placebo. Physiotherapy addresses the root cause (muscle weakness, poor mechanics) rather than just removing bone. It has no risks, costs less, and 70-80% of people improve. Surgery should only be considered after 6-12 months of proper physiotherapy has failed.

Question 3

How long does physiotherapy take to work?

Accepted Answer

Most people start noticing improvement in 4-6 weeks, with maximum benefit at 12 weeks. However, this ONLY works if you do the exercises daily and correctly. Doing exercises 2-3 times per week isn't enough. The exercises must be challenging enough to strengthen the muscles but not so aggressive that they cause severe pain. Your physiotherapist will progress the difficulty over time. After symptoms improve, you should continue maintenance exercises long-term to prevent recurrence.

Question 4

Should I get a cortisone injection?

Accepted Answer

Cortisone injections can be helpful for providing temporary pain relief (6-12 weeks) to allow you to engage better with physiotherapy. They're most useful if pain is severely limiting your ability to do exercises. However, injection alone is not a cure - symptoms almost always return unless you address the underlying mechanics with exercise. Limit injections to 2-3 per year maximum due to risk of tendon weakening. Injection should be combined with physiotherapy, not used instead of physiotherapy.

Question 5

Do I need an MRI scan?

Accepted Answer

Not always. MRI is useful if: your doctor suspects rotator cuff tear (severe weakness, inability to lift arm), symptoms haven't improved after 3-6 months of proper physiotherapy, or surgery is being considered. Many cases of impingement are successfully treated with physiotherapy alone without ever getting an MRI. X-rays are usually sufficient initially to check for bone spurs and arthritis. Your doctor will guide you on whether MRI is necessary.

Medical Disclaimer

Shoulder Impingement (Painful Shoulder)

📖What is Shoulder Impingement (Painful Shoulder)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention