Shoulder impingement

Painkillers and anti-inflammatories may be prescribed by your GP if your pain is constant and is disturbing your sleep. Recent evidence would suggest these medications are only useful in the early stages and it is not advised to take these for shoulder pain for prolonged periods. This is due to the effect they have on the rotator cuff muscles and possible side effects.

It is unlikely that medication alone will cure or relieve your pain totally which is why we use the terms pain relief or pain management medications.

Some people find that heat and cold application helps. For heat, you can try a hot water bottle. For cold, try an ice pack or ice wrapped in cloth. Please be careful not to apply hot or cold packs directly to the skin as they can damage your skin if not used correctly.

Many people with shoulder pain are worried that exercise will cause further damage to the area. However, shoulders are designed to move. Inactivity is harmful to the tissues around the joint and can cause stiffness and weakness, so maintaining movement within the limits of your pain is important.

Exercise will also have a positive effect on general fitness. This is best done in liaison with your physiotherapist or GP.

It has also been found that exercising other areas of the body can improve the function of your painful shoulder, so general exercise such as walking, swimming or cycling is encouraged in addition to your specific shoulder exercises.

It is important to get your pain under control and to keep as much movement in the shoulder as possible. This keeps the muscles strong and nourishes the joint surface.

Initial treatment focuses on improving your pain levels. The stage which has been shown to be most important in physiotherapy treatment is the gradual introduction of strength work which will prepare your shoulder for the increasing demands as your pain improves.

The British Elbow and Shoulder Society (BESS) have produced an online guide with exercises to treat your subacromial shoulder pain. We would encourage you to try the exercises daily to strengthen your shoulder and help settle down the pain. Although the exercises aren't exactly the same as the ones we advise, if you find their videos helpful please feel able to use their exercise regime.

These exercises are a good starting point, but sometimes additional physiotherapy is required. The majority of shoulder problems get better if you complete the exercises daily. However, it should be appreciated that it can take a number of months of regular exercise to improve.

Raised levels of body fat can increase shoulder pain due to an increase in levels of inflammatory chemicals within the body. High fat diets have also been shown to have a negative effect on muscle tissue which can impair recovery from injury.

If you are overweight, try to lose weight through healthy eating and regular exercise activity. See NHS Highland information on maintaining a healthy weight.

The health benefits of stopping smoking are well known. The chemicals from smoking impair recovery in tendon tissues and can increase wear in the tendons as we age which can have a direct impact on your shoulder. Stopping or reducing smoking can improve your recovery from shoulder pain. Stopping smoking will also improve your long term health.

See information about NHS Highland's Smoke-Free service.

UK guidelines recommend that injections can be used in the management of subacromial shoulder pain. Local anaesthetic and steroid (cortisone) injections into the space around the inflamed shoulder tendons can be tried, though it is difficult to predict how much this might help. Your GP or physiotherapist may be able to offer this. Steroid injections should always be used in conjunction with exercise.

If you have seen little improvement following initial treatment, a steroid injection may provide pain relief to allow a greater range of shoulder movement and tolerance of physiotherapy. It is advised that no more than two injections should be administered for subacromial shoulder pain due to the possible negative effects steroid can have on the condition of the tendons.

It is very rare for patients to undergo surgery due to subacromial shoulder pain if there is no history of injury. Historically, decompression surgery which tidies up inflamed tissue and creates more space in the shoulder may have been performed but evidence shows that there was no great additional benefit when compared to physiotherapy and injection.

Scans are used in order to see the structures inside the body to help understand the cause of a problem. There are many different types of tests available including X-ray, ultrasound and MRI.

We are very fortunate to have these tools to help assist in providing patients with a diagnosis. The most important questions to ask before deciding on a scan are:

• Will this scan provide information which will change how we try to improve this problem?
• If there is something found on the scan, is this a normal finding which is present for most people?
• Will this patient be a candidate for surgery, which makes a scan more useful for future planning?

Scanning is not initially required for most people with subacromial pain. An X-ray can be beneficial initially to rule out other shoulder problems if symptoms fail to improve, but further scanning is very seldom required.

A recent study demonstrated that in 96% of people scanned there was evidence of conditions such as bursitis or tendon irritation - these people had no pain. It is therefore difficult to decide whether findings on scan have any influence on your current pain. Pain is a complex problem and a scan is very seldom the solution.