When Your Shoulder Starts Negotiating With You
It starts with something forgettable: reaching into the back seat, pulling on a jacket, or lifting a bag overhead. There’s a sharp pinch at the top of the shoulder that interrupts the motion. At first, it’s easy to ignore. Eventually, it becomes predictable. The arm lifts, hesitates, and stops just short of where it used to go. What used to be automatic is now a negotiation.
This pattern is a hallmark of shoulder impingement syndrome, one of the most common causes of shoulder pain. It affects athletes, people who sit at a desk all day, and anyone whose work or hobbies involve reaching or lifting. Many assume the pain means something is torn, but impingement is actually a problem of space. The shoulder is trying to move normally in a space that has become crowded.
The goal of treatment isn’t simply to numb the pain. It’s to understand the mechanical cause and restore motion so the shoulder can move confidently again.
The shoulder joint is structurally different from weight-bearing joints like the hip or knee. It’s built for freedom of movement, which means multiple structures must coordinate to create smooth motion. The joint involves the humeral head (upper arm bone), the scapula (shoulder blade), and the rotator cuff tendons, which wrap around the joint to keep it centered and stable. Above the rotator cuff is the acromion, a small shelf of bone extending from the shoulder blade.
Between the rotator cuff tendons and the acromion is the subacromial space, a small passageway that contains the tendons and the subacromial bursa—a fluid-filled cushion that helps reduce friction as the arm moves. During overhead motion, the tendons must glide through this space. When the space narrows due to inflammation, posture changes, or mechanical imbalance, the tendons become compressed. That compression is rotator cuff impingement.
Impingement does not mean something is torn. It means movement is happening in an environment with less room than the motion requires.
Symptoms can vary from a sharp pinch to a lingering ache. Most people describe pain at the top or outside of the shoulder that worsens when lifting or lowering the arm. Activities involving arm elevation—reaching into a cabinet, putting on a coat, or placing objects overhead—tend to be the most irritating. Some experience night pain, especially when lying on the affected shoulder. Others notice weakness, though the weakness often stems from discomfort and inflammation rather than loss of muscle power.
The inconsistency of symptoms can be misleading. Some days the shoulder feels normal, other days, simple movements trigger discomfort. The irregular timing leads many people to wait for it to resolve on its own. Rest may temporarily reduce irritation, but movement patterns that caused the impingement remain unchanged, which means the pain usually returns.
Shoulder impingement pain may be felt at the top of the arm, but the issue often originates elsewhere. The shoulder is dependent on the shoulder blade for support. If the shoulder blade doesn’t rotate properly or sits in a forward position—something that happens frequently with prolonged sitting or device use—the subacromial space narrows. Once that space narrows, the rotator cuff tendons must work harder to keep the humeral head centered during movement.
Other contributors include rotator cuff weakness, tightness in the chest muscles, decreased back mobility, and repetitive overhead movements. The pain shows up in one location, but the reason for the pain often involves several areas working inefficiently together. Once patients understand this, the treatment plan begins to make more sense. The goal is not just to relieve pain but to address the root cause of the friction.
The most common risk factors include repetitive arm elevation, sports that rely on overhead motion (such as swimming or tennis), and jobs or activities that require lifting. Age can also influence shoulder anatomy—bone spurs near the acromion are more common over time and can narrow the subacromial space. Posture plays an equally significant role. Forward rounding of the shoulders reduces space and increases the likelihood of tendon irritation. Prior shoulder injuries may also alter mechanics, making impingement more likely.
None of these factors implies permanent damage. They simply reveal areas where treatment can improve mechanics and restore movement.
Diagnosis begins with a physical exam that evaluates posture, the position of the shoulder blade, and how the shoulder moves through space. Specific tests help reproduce the symptoms, which assists in identifying the exact movement patterns causing the pain. Strength and range of motion are assessed to determine whether weakness is due to true muscular deficit or pain inhibition.
If structural changes need to be ruled out, imaging may be used. X-rays identify issues such as bone spurs or variations in shoulder anatomy that narrow the subacromial space. MRI or ultrasound may be recommended if a rotator cuff tear is suspected or if symptoms fail to improve. The goal is not to image the shoulder simply because there is pain, but to confirm the pattern causing the impingement.
Accurate diagnosis directs treatment toward correcting the movement problem rather than simply chasing symptoms.
The most effective treatment plans follow a clear progression: calm irritation, restore motion, rebuild strength, then prevent recurrence.
Many patients start with activity modification, targeted rest, and anti-inflammatory medications (nonsteroidal anti-inflammatory drugs). Temporary adjustment of overhead activities gives the irritated soft tissues time to settle. Ice and topical anti-inflammatory approaches may also help reduce discomfort.
Corticosteroid injections can decrease inflammation and provide pain relief, especially if the subacromial bursa is irritated. Injections are best used as a bridge to allow physical therapy to begin without significant pain. They are not the solution themselves; they simply reduce symptoms enough to allow meaningful progress to occur.
Physical therapy is the cornerstone of shoulder impingement treatment. Therapy focuses on improving scapular motion, strengthening the rotator cuff, and increasing mobility through the chest and upper back. A physical therapist will go over exercises that promote shoulder blade stability and improve how the shoulder moves in space.
Mobility work and strengthening exercises are also built into a personalized treatment plan that reflects how each person uses their shoulder. For someone who lifts weights, preventing re-aggravation during overhead lifts becomes part of the plan. For someone whose work requires repetitive motion, therapy incorporates postural awareness and specific strengthening to handle those demands.
Once motion improves, strengthening exercises deepen rotator cuff control and endurance so the gains are lasting. Preventing shoulder impingement involves continuing the exercises that improve posture, keeping the shoulder blade engaged during overhead lifting, and staying aware of repetitive arm movements that cause irritation.
Patients who finish physical therapy with improved movement patterns continue to feel better long after formal treatment ends.
Most patients see improvement with physical therapy and targeted mechanics, but not all. If symptoms persist despite treatment, surgery may be recommended. Subacromial decompression, the most common surgical treatment, involves removing bone spurs or tight soft tissue to create more space for the rotator cuff tendons. This minimally invasive procedure is performed arthroscopically through small incisions, typically as outpatient surgery.
If a rotator cuff tear is present, arthroscopic rotator cuff repair can be done at the same time. After surgery, the rehabilitation program resumes, focusing first on motion, then strength, and eventually a return to activity. Many patients notice meaningful improvement within one to two weeks, with continued progress over several months.
Surgery is about restoring space for movement when conservative care has failed. It’s a last resort, but it makes all the difference when done right.
Recovering from shoulder impingement is not about eliminating discomfort in a single moment. It is about restoring dependable movement so that everyday tasks no longer require thought or hesitation. Most patients notice that once they understand how their shoulder moves—and how to support that movement—they begin to reclaim confidence in what their body can do. The best measure of progress is simple: reaching overhead without thinking about it.
Shoulder impingement can shrink a person’s world. When motion begins to hurt, movements become restricted and routines change. Effective treatment focuses on rebuilding function. Pain relief is not the endpoint. Shoulder mobility—consistent, confident movement—is.
Dr. Mellano’s mission is to give his patients the freedom to keep doing the activities they love. If you are struggling with joint pain, arthritis, lack of mobility, or joint inflammation, contact Dr. Mellano for a consultation so he can help you get moving again.
