Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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The goal of treating shoulder impingement is to open up the subacromial space and reduce inflammation. The vast majority of patients—about 70% to 80%—can be treated successfully without surgery. The key is patience; tendons have poor blood supply and heal slowly. Recovery is a process of retraining the shoulder to move correctly so the pinching stops.
This section outlines the treatment ladder. We start with the “calm it down” phase using ice and meds, move to the “build it up” phase with therapy, and finally discuss surgical options for stubborn cases. We also cover the recovery timeline so you know when you can return to sports or lifting.
You cannot rehab a hot, angry shoulder. The first step is to stop the pain cycle. This involves “relative rest.” You don’t need a sling, but you must stop the activities that cause pain, especially overhead reaching and heavy lifting.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are standard. They reduce the swelling in the bursa, which physically creates more room in the joint. Ice is also powerful; apply ice packs to the front and side of the shoulder for 20 minutes, 3 times a day, to numb the area and decrease blood flow to the inflamed tissue.
If oral meds and ice aren’t enough, a cortisone injection into the subacromial bursa is a powerful next step. Cortisone is a potent anti-inflammatory steroid.
It doesn’t “fix” the bone spur or strengthen the muscle, but it shrinks the swollen bursa rapidly. This chemical decompression breaks the pain cycle, allowing you to sleep and perform physical therapy exercises without agony. Doctors typically limit these to 3 per year to avoid weakening the tendon.
The injection is a mix of steroid and numbing medicine. The numbing works instantly but wears off in a few hours.
The steroid takes 2-3 days to kick in. You might feel a flare-up of pain the first night (“steroid flare”) before the relief begins. This relief can last for weeks or months.
While effective, steroids can slightly weaken collagen fibers. Repeated injections into the same spot can increase the risk of tendon rupture.
This is why doctors use them judiciously—as a bridge to therapy, not a permanent cure on their own.
Physical therapy is the definitive treatment for impingement caused by weakness or poor mechanics. The therapist focuses on two things: strengthening the rotator cuff and stabilizing the scapula.
Cuff strengthening (using bands) pulls the humeral head down, centering it in the socket. Scapular strengthening (rows, retractions) ensures the shoulder blade rotates upward to clear the acromion. Stretching the tight posterior capsule (sleeper stretch) also helps the ball sit better in the socket. For most patients, 6–12 weeks of dedicated therapy resolves the issue.
If 3-6 months of conservative treatment fails, or if a large bone spur is visible on X-ray, surgery is considered. The procedure is called Arthroscopic Subacromial Decompression (ASD) or Acromioplasty.
is a minimally invasive surgery. The surgeon inserts a camera (arthroscope) and a motorized shaver through tiny incisions. They remove the inflamed bursa (bursectomy) and shave down the underside of the acromion bone to make it flat and smooth. This technique physically widens the space, giving the tendon room to move without rubbing. It is often a permanent cure for primary impingement.
The surgery takes about an hour and is done as an outpatient procedure (you go home the same day).
The surgeon uses the camera to inspect the rotator cuff. If a tear is found, it can be repaired at the same time. The bone shaving is precise, removing only the spur and leaving the main bone intact.
Arthroscopy causes much less trauma to the muscles than open surgery. The deltoid muscle does not need to be detached.
The result leads to less pain, a lower risk of infection, and a much faster return to movement and daily activities.
In distal clavicle excision, arthritis at the AC joint (where the collarbone meets the shoulder) causes the impingement. Bone spurs from this joint hang down into the space.
During the decompression surgery, the surgeon may also remove the end of the collarbone (distal clavicle excision). This removes the arthritic spurs and widens the space further. It does not affect shoulder function or strength once healed.
Because no muscles are cut and no tendons are repaired (unless a tear is found), recovery from decompression is relatively fast.
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It is rare for the spur to grow back significantly after it has been surgically shaved down. The recurrence rate of impingement after surgery is low if the diagnosis was correct.
It varies. Some people get relief for a few weeks; others get permanent relief if the shot allows them to rehab the shoulder successfully. It is not a guaranteed permanent fix on its own.
Yes. Surgery creates room, but it doesn’t strengthen the weak muscles that allowed the problem to happen. PT after surgery ensures you regain motion and retrain the mechanics to prevent future issues.
You can drive once you are off narcotic pain meds and are comfortable steering. Since you don’t need a sling for a long time, many patients drive within 3–7 days.
Failure is often due to an incorrect diagnosis (e.g., the pain was from the neck or a labral tear) or failure to rehab properly. Sometimes, “impingement” is actually early arthritis, which requires a different approach.
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