Shoulder impingement & subacromial bursitis

The typical picture is pain on the outside of the shoulder or down the upper arm when reaching overhead, behind the back or out to the side — often with a painful arc partway through the lift. Night pain when lying on the affected side is common, and is frequently what brings patients in.

The bursa that cushions the rotator cuff becomes inflamed (bursitis), and the cuff tendons themselves can become irritated (tendinopathy). Because the same tendons are involved, impingement and early rotator cuff disease sit on a spectrum, which is why a careful examination matters.

Symptoms usually build gradually, though they can follow a single period of heavy overhead activity.

Impingement usually reflects how the shoulder is being loaded rather than a single injury. Weakness or fatigue of the rotator cuff and the muscles controlling the shoulder blade lets the ball ride upward; a hooked acromion shape or bone spur narrows the space further. Overhead work, swimming, throwing and gym programs are common triggers, and it is frequent in people whose work involves lifting.

It also appears alongside other shoulder problems — a stiff shoulder, a partial rotator cuff tear, or biceps irritation — which is one reason persistent pain deserves a proper evaluation rather than repeated rest.

Shoulder pain lasting more than a few weeks, night pain that disturbs sleep, or pain that keeps you from work, sport or the gym is worth evaluating. An early diagnosis separates simple impingement from a rotator cuff tear or frozen shoulder — conditions that are treated differently — and early treatment is generally faster treatment.

Examination reproduces the pain with specific maneuvers and tests rotator cuff strength and scapular control. X-rays show the acromion shape, any spur, and the joint itself. When the examination suggests a tear, or pain persists despite treatment, an MRI defines the rotator cuff and biceps.

Most impingement resolves without surgery. Treatment centers on a rehabilitation program restoring rotator cuff strength and the way the shoulder blade moves, alongside modification of the activities that load the shoulder. A subacromial cortisone injection is a useful adjunct when pain limits sleep or blocks progress in therapy.

Platelet-rich plasma is an option some patients ask about for rotator cuff tendinopathy; it is discussed on the PRP injections page, including candidacy and self-pay pricing. Structured post-treatment and post-operative programs are outlined in the rehabilitation protocols.

Surgery is reserved for impingement that has not responded to a full course of non-operative care, or where a spur or tear is clearly driving the pain. It is performed arthroscopically as an outpatient procedure, with subacromial decompression to open the space, and repair of the rotator cuff or treatment of the biceps if those are involved.

Recovery after isolated decompression is measured in weeks to a few months; if a rotator cuff repair is added, the timeline follows the repair rather than the decompression.

Dr. Horner is a board-certified orthopedic surgeon fellowship-trained in shoulder surgery and sports medicine at Rush University Medical Center. Surgery for impingement is recommended only after a genuine trial of non-operative care, and when it is needed the goal is a durable result rather than a quick one.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.