What is shoulder impingement and bursitis?
Shoulder impingement and bursitis often occur together because both involve irritation and inflammation in the structures around the rotator cuff. In shoulder impingement, the tendons of the rotator cuff and sometimes the bursa (a small fluid-filled sac that reduces friction) get pinched (impinged) between the humeral head (upper arm bone) and the acromion (a part of the shoulder blade). This usually happens when lifting your arm overhead or behind your back. Bursitis means inflammation of the bursa. In the shoulder, the subacromial bursa is most commonly affected. It often occurs together with impingement, because repeated pinching irritates the bursa, making it swollen and painful. Both cause painful shoulder movement, especially when lifting the arm.
Causes
Shoulder impingement and bursitis are commonly caused by repetitive overhead movements, poor posture, and structural narrowing of the space within the shoulder joint, which compresses the rotator cuff tendons and the bursa. Activities such as frequent lifting, throwing, or prolonged reaching—often seen in sports or certain occupations—can irritate these tissues over time. Muscle imbalances, particularly weakness in the rotator cuff or scapular stabilisers, can further contribute by altering normal shoulder mechanics. Age-related degeneration, inflammation from overuse, or previous injuries may also reduce the space in the joint, increasing friction and leading to pain, swelling, and restricted movement. Shoulder dislocations, fractures, or sudden trauma can lead to inflammation and impingement.
Symptoms
- Shoulder pain (dull or aching): A persistent pain felt on the outer part of the shoulder, often caused by irritation of the rotator cuff tendons or inflamed bursa
- Pain with overhead movement: Discomfort increases when lifting the arm above shoulder height due to compression of soft tissues in the joint
- Painful arc of motion: Pain is most noticeable when raising the arm between roughly 60–120 degrees, where impingement is greatest
- Tenderness to touch: The shoulder may feel sore when pressed, especially over the top or side, indicating inflammation
- Swelling: Inflammation of the bursa can lead to mild swelling, contributing to tightness and discomfort
- Night pain: Symptoms often worsen at night, particularly when lying on the affected shoulder, due to sustained pressure and reduced space in the joint
- Reduced range of motion: Stiffness and pain limit how far the arm can move, especially in overhead or behind-the-back positions
- Weakness in the shoulder: Muscle inhibition or tendon irritation can reduce strength, making lifting or carrying objects difficult
Diagnosis
Your surgeon will have a discussion with you about the history of your shoulder issues including the pain location and triggers, functional limitations and onset. There will also be a physical examination and review of your imaging.
The physical examination will include inspection and palpation, range of motion and specific tests which help to determine the pathology.
Imaging
Your GP should have already arranged an Xray and Ultrasound before your visit. Your surgeon may order an MRI quite frequently depending on what has been determined from your other images. An MRI can detect bursal inflammation, tendon tears, or impingement-related changes.
Treatment
Conservative (non-operative)
Conservative treatment of shoulder impingement and bursitis focuses on reducing pain and inflammation while restoring normal movement and strength. This typically begins with rest and activity modification, avoiding repetitive overhead movements that aggravate symptoms. Applying ice and using anti-inflammatory medications such as Ibuprofen can help manage pain and swelling. A structured physiotherapy program is central to recovery, aiming to improve posture, strengthen the rotator cuff and scapular stabilising muscles, and restore range of motion. Stretching tight structures and correcting movement patterns also help reduce compression in the shoulder. In some cases, a healthcare provider may recommend corticosteroid injections to reduce persistent inflammation, allowing more effective participation in rehabilitation exercises.
Surgical treatment
Surgical treatment of shoulder impingement and bursitis is typically considered when symptoms persist despite extensive conservative management. The most common procedure is arthroscopic subacromial decompression, a minimally invasive surgery in which a surgeon uses small instruments and a camera to remove inflamed bursal tissue and shave or reshape parts of the acromion to create more space in the shoulder joint. This reduces pressure on the rotator cuff tendons and helps relieve pain. In some cases, associated issues such as bone spurs or rotator cuff damage may also be addressed during the procedure. Following surgery, a structured rehabilitation program is essential to restore range of motion, rebuild strength, and ensure a gradual return to normal activities.
Recovery
When can I return to daily activities?
Most people can:
- Return to office or light duties – 5 – 14 days
- Light work – 2 weeks
- Heavy work – 3 months
- Driving – 2 weeks (when you feel confident that you are in control of the vehicle)
When can I participate in leisure activities?
- Walking for exercise – 1 week
- Exercise bike – 2 – 3 weeks
- Road bicycle – 6 weeks
- Gardening – 3 – 4 months
- Gym – 3 months
- Swim – 2 – 3 months
- Tennis / Golf – 3 – 4 months
- Contact sports – 3 months