Understanding Shoulder Impingement Syndrome and Rotator Cuff Tears: Causes, Symptoms, and Treatment Options

Shoulder pain is one of the most common orthopedic complaints, especially among active individuals. While sports injuries can cause issues like dislocation, the most frequent culprit in adults is shoulder impingement syndrome.

Left untreated, this condition can progress to a partial or full rotator cuff tear, sometimes resulting in permanent damage. Understanding the causes of shoulder pain, how shoulder impingement develops, and the treatment options available is essential for protecting long-term shoulder health.

What Is Shoulder Impingement Syndrome?

Shoulder impingement syndrome is a common cause of shoulder pain that occurs when the acromion (the bone at the top of the shoulder) pinches or compresses the rotator cuff tendons or biceps tendon beneath it. This pinching creates irritation and inflammation, leading to pain, especially during overhead movements such as reaching, lifting, or throwing.

The biceps tendon runs through a narrow bony groove and attaches to the shoulder socket (glenoid). Over time, repeated irritation or compression in this space can cause tendinitis or tendon degeneration. Without early treatment, shoulder impingement may progress to a rotator cuff tear, resulting in more severe pain, weakness, and limited range of motion.

Why Rotator Cuff Tears Are Becoming More Common

In the past, rotator cuff tears were most often diagnosed in adults over the age of 60. Today, orthopedic specialists are increasingly treating younger patients, sometimes in their 30s or 40s. This happens due to higher activity levels, repetitive overhead movements, and sports-related injuries.

A large or untreated tear can eventually become irreparable, leading to chronic shoulder pain, weakness, and loss of mobility. This not only affects athletic performance but also makes everyday activities such as lifting, reaching, or sleeping on the shoulder painful. That’s why early diagnosis and rotator cuff tear treatment are critical for preserving long-term shoulder health.

How Doctors Diagnose Shoulder Impingement

When a patient presents with shoulder pain, an orthopedic shoulder specialist will perform a detailed exam to identify the cause. This typically includes:

• Evaluating range of motion and flexibility
• Checking for tenderness, swelling, or localized shoulder pain
• Assessing muscle strength to detect possible rotator cuff tears

In many cases, X-rays are used first to evaluate bone shape and identify potential impingement. If symptoms continue despite conservative care — such as NSAIDs (ibuprofen, meloxicam), rest, or corticosteroid injections — advanced imaging may be recommended. An MRI scan can provide clear detail and reveal:

• Partial or full rotator cuff tears
• Bone spurs or prominent bone causing shoulder impingement
• Arthritis in the acromioclavicular (AC) joint
• Rotator cuff tendinosis (degeneration and swelling of the tendon)

Treatment Options for Shoulder Impingement and Rotator Cuff Tears

Non-Surgical Treatments:

Most patients benefit from starting with non-surgical shoulder treatment. Conservative care can reduce pain, restore strength, and often prevent the need for surgery. Common options include:

• Oral anti-inflammatory medication (NSAIDs)
• Physical therapy for shoulder impingement to improve flexibility and strengthen the rotator cuff
• Corticosteroid injections to decrease inflammation and pain
• Activity modification to avoid repetitive overhead stress

Surgical Treatments:

If symptoms persist or imaging confirms a significant rotator cuff tear, bone spur, or arthritis in the AC joint, your doctor may recommend shoulder surgery. Surgical options include:

• Rotator cuff repair surgery to restore torn tendons
• Shoulder decompression surgery to remove bone spurs causing impingement
• Procedures to address acromioclavicular (AC) joint arthritis

When to See an Orthopedic Shoulder Specialist

If you have ongoing shoulder pain, weakness, stiffness, or difficulty lifting your arm overhead, it’s time to see an orthopedic shoulder specialist. Early diagnosis of shoulder impingement or a potential rotator cuff tear is critical for preventing long-term damage. Prompt treatment can restore mobility, relieve pain, and help you return to daily activities and sports without limitations.

Nebraska Hand & Shoulder specializes in diagnosing and treating shoulder conditions with both conservative and advanced surgical methods. Protect your mobility and quality of life by addressing shoulder pain before it becomes a long-term problem. Schedule your consultation today!