Clinically reviewed by What is shoulder impingement
Shoulder impingement is pain from the rotator cuff tendons and the small fluid sac above them being squeezed under the tip of the shoulder blade. It hurts lifting the arm out to the side or reaching overhead.
In Urdu it is described simply as kandhe ka dard. The giveaway is the painful arc: pain appears partway through lifting the arm, roughly between shoulder height and overhead, and often eases again at the very top.
The space is usually not too small. More often the rotator cuff and the shoulder blade muscles are not controlling the joint well enough for the work being asked of them. That is why strengthening is the treatment and rest alone is not.
Symptoms you might have
- Pinching pain partway through lifting the arm out to the side, often easing at the top
- Pain reaching overhead, to a high shelf, or into a back pocket
- Pain lying on that side at night, which is what usually brings people in
- Weakness holding the arm out, or dropping it the last few inches
- Someone else can move your arm further than you can lift it yourself, which separates this from frozen shoulder
Why it happens
- A sudden increase in overhead work: painting, plastering, loading, whitewashing, cleaning fans and high shelves
- A weak rotator cuff and weak shoulder blade muscles
- Long hours rounded over a desk, a sewing machine or a phone
- Throwing and overhead sports, including cricket bowling
- A fall onto the shoulder or onto an outstretched hand
- Neck problems such as cervical spondylosis, which refer pain to the shoulder and are commonly mistaken for it
- Diabetes, which makes tendon problems more stubborn
When you should see a physiotherapist
Come in once the pain has lasted more than two or three weeks, or sooner if it is breaking your sleep. Shoulders left for months get stiff as well as sore.
Go to a hospital now if shoulder pain comes with chest pain or tightness, breathlessness, sweating, nausea, or pain spreading to the jaw or the left arm. Heart problems refer pain to the shoulder and that pattern is not a physiotherapy problem.
See a doctor the same day if you cannot lift the arm at all after a fall or a sudden heavy pull, or if the shoulder looks out of shape, because that can mean a significant rotator cuff tear, a dislocation or a fracture. Also see a doctor for shoulder pain with fever or unexplained weight loss. A shoulder becoming stiff in every direction may be frozen shoulder instead, and that is treated differently.
Al-Shama Physiotherapy Clinic
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How it is treated
Treatment is an exercise programme, with hands-on work and pain relief to make that exercise possible. Research on ordinary impingement has not shown surgery to beat a properly completed exercise programme, which is why we start here.
- Isometric holds first, pressing against a fixed resistance, which settles tendon pain without travelling through the painful arc
- Rotator cuff strengthening, outward and inward rotation against a band, progressed in small steps
- Scapular work for the muscles that set the shoulder blade: rows, wall slides, and overhead control once the cuff can hold
- Manual therapy to the shoulder, shoulder blade and upper back to restore movement
- Ultrasound and TENS for pain control in the early weeks, so the exercises can be done
- A graded return to overhead work, which is the part most people skip and the reason it comes back
Most people do not need surgery. Surgery is considered for a confirmed significant rotator cuff tear, or after a long and properly completed exercise programme has failed.
Exercises, and what to avoid
What helps
- Isometric outward rotation: elbow at your side, press the back of your hand into a wall, five ten second holds
- Band outward rotation and band rows, two sets of twelve to fifteen
- Wall slides, sliding the forearms up a wall only as high as stays comfortable
- Lifting the arm within the pain-free range, little and often, to keep the shoulder from stiffening
What to avoid
- Resting completely and waiting. Tendons do not get stronger with rest and the pain returns the day you lift again
- Overhead presses, upright rows and pulldowns behind the neck in the early weeks
- Pushing through sharp pain in the middle of the arc, which flares it for days
- Hard stretching into the pinch. Nothing useful is being stretched there
What you can do at home
Sleep with a pillow under the elbow of the painful arm so the shoulder is not hanging, and avoid lying directly on that side.
Heat for fifteen to twenty minutes before you exercise. Ice for ten minutes after a flare or a heavy day.
Keep work below shoulder height while it is settling. Lower the shelf, use a step rather than reaching, and split overhead jobs into short spells.
Carry loads in both hands or across the body rather than on the sore shoulder.
Do the exercises in short sessions twice a day rather than one long one. Five to ten minutes twice daily beats half an hour once a week.
How long it takes
Most people notice a clear change in four to six weeks of doing the exercises properly, and settle over about three months.
Longstanding cases, and people whose work is overhead all day, take four to six months. Diabetes slows tendon healing and adds time.
The first two weeks are usually about pain settling rather than strength, so judging the programme before then is premature.
The commonest reason it returns is stopping the exercises as soon as the pain goes. The cuff needs two sessions a week to hold what it gained, and that is a permanent change rather than a six week course.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
کندھے کے امپنجمنٹ میں بازو اٹھاتے وقت بیچ میں درد ہوتا ہے۔ رات کو اس طرف لیٹنے پر درد بڑھ جاتا ہے۔
صرف آرام کرنے سے یہ ٹھیک نہیں ہوتا۔ اصل مسئلہ کندھے کے اندر کے پٹھوں (روٹیٹر کف) اور کندھے کی ہڈی کے پٹھوں کی کمزوری ہوتا ہے، اس لیے ورزش ہی اصلی علاج ہے۔
بند کے ساتھ باہر کی طرف گھمانے والی ورزش، رووز، اور دیوار پر بازو سرکانے والی ورزش روزانہ تھوڑی تھوڑی کرنی ہے۔
اگر کندھے کے درد کے ساتھ سینے میں درد، سانس پھولنا، پسینہ، یا جبڑے اور بائیں بازو تک درد جائے تو فوراً ہسپتال جائیں۔ گرنے کے بعد بازو بالکل نہ اٹھ سکے تو اسی دن ڈاکٹر کو دکھائیں۔
Roman Urdu
Kandhe ke impingement mein bazu uthate waqt beech mein dard hota hai. Raat ko us taraf letne par dard barh jata hai.
Sirf aaram karne se ye theek nahi hota. Asal masla kandhe ke andar ke pathon (rotator cuff) aur kandhe ki haddi ke pathon ki kamzori hota hai, is liye warzish hi asli ilaj hai.
Band ke sath bahar ki taraf ghumane wali warzish, rows, aur deewar par bazu sarkane wali warzish rozana thori thori karni hai.
Agar kandhe ke dard ke sath seene mein dard, saans phoolna, pasina, ya jabre aur baien bazu tak dard jaye to foran hospital jayen. Girne ke baad bazu bilkul na uth sake to usi din doctor ko dikhayen.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Will rest fix shoulder impingement?
How long does shoulder impingement take to settle?
Is it impingement or frozen shoulder?
Do I need an MRI or surgery?
Is an injection better than physiotherapy?
Can I keep working with impingement?
Related conditions
- Neck pain and stiff neck treatment
- Cervical spondylosis treatment
- Rotator cuff tear treatment
- Frozen shoulder treatment
- Shoulder blade pain treatment