Shoulder pain from tendon impingement: symptoms, assessment and exercise

The condition results from pinching of the bursa, the biceps tendon and the supraspinatus tendon under the outer bony projection of the shoulder, the acromion. It can come on acutely or gradually. Inflammation of the bursa and tendons and partial degenerative changes in the rotator cuff are often regarded as the same underlying condition [1].

Lægehåndbogen states that the condition accounts for roughly three quarters of shoulder disorders in general practice and is most common in people between 45 and 60 years. The cause is most often unknown, but overload and injury are common triggers. Work with the arms above shoulder height, vibrating tools and sports such as swimming, throwing sports and strength training are mentioned as risk factors [1].

Typical symptoms are shoulder pain, often radiating down the arm, and pain with lifting or work above shoulder height. Many have pain at night and have trouble lying on the shoulder concerned [1].

In acute cases the pain is often severe and the loss of function obvious. In long-standing cases the pain is more often moderate and linked to activity [1].

The examination is a systematic shoulder examination, in which the painful arc, Hawkins test and Neer's test are among those used. Pain in a particular part of the movement range, the so-called painful arc, is regarded as the main criterion. Active mobility is often reduced, while passive mobility and strength are often normal [1]. The tests are not very specific, so the findings must be assessed together [1].

Strength in the rotator cuff tendons is tested to rule out injury that may need surgical assessment [1]. X-ray can be used to show calcium deposits and rule out other disease, and ultrasound is useful for ruling out tendon injury [1]. MR is used by specialists, especially when a rotator cuff tear or frozen shoulder is suspected [1].

The Danish national clinical guideline gives a weak recommendation to consider supervised exercise for subacromial pain syndrome that has lasted at least one month. The exercise should include at least two supervised sessions, last at least three months, include strengthening of the shoulder blade muscles and rotator cuff, and gradually increase in intensity. Home exercise after instruction can be considered for those who prefer it, but dropout is probably higher than with supervised exercise [2].

Lægehåndbogen describes structured, supervised exercise therapy for at least three months as the first choice, and that you can use the arm within the pain limit. The patient should be told how lifting above shoulder height causes pinching and can maintain the irritation [1].

Injection into the shoulder can be considered for severe pain, night pain or a need for pain relief in order to be able to exercise. The guideline gives a weak recommendation against routine use because the effect is small and short-lived, and exercise should be offered at the same time [2]. Lægehåndbogen states no documented effect after six months [1].

Surgery is not offered for pain that has lasted less than six months. For pain lasting more than six months without effect from supervised exercise, surgery can be considered after careful deliberation, but the evidence is weak [1][2]. In a study described in Tidsskriftet, surgery did not give better pain or function than sham surgery after two years, and the difference from the exercise group was not regarded as clinically relevant [3].

The duration varies. Spontaneous improvement over time is common, but the course can become long. Possible complications are tears of the rotator cuff or biceps tendons, shoulder stiffness and chronic pain [1].

The GP can usually follow up the condition. There is reason to have the symptoms reassessed, possibly with referral to a specialist, if there is no effect after a properly carried out exercise programme, an uncertain diagnosis, suspected tendon injury or suspicion that the pain is caused by another disease [1].

Dr.Dropin is a supplement to your GP and the rest of the health service. A chiropractor can examine the shoulder, neck and upper back, and together with you plan how the shoulder can be loaded and trained. Where relevant, diagnostic ultrasound can be used. You can read more about chiropractors, about the rotator cuff and about shockwave therapy.

What is shoulder impingement?

Impingement, or subacromial pain syndrome, means pinching of the bursa and tendons under the outer bony projection of the shoulder. It gives pain particularly with lifting above shoulder height and at night [1].

Why does my shoulder hurt at night?

Night pain and trouble lying on the shoulder are common in subacromial pain syndrome [1]. Pain at night can also have other causes, and is a reason to have the shoulder examined.

How long should you exercise the shoulder?

The guideline recommends considering supervised exercise over at least three months, with a gradual increase in intensity [2]. Lægehåndbogen describes exercise therapy for at least three months, preferably longer [1].

Do I need surgery for shoulder pain?

Surgery is not offered for pain lasting less than six months. For longer duration without effect from supervised exercise it can be considered after careful deliberation, but the evidence is weak [1][2].

The pages about the rotator cuff, supraspinatus tendinitis and frozen shoulder describe related shoulder problems. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Olsen BS. Subacromielt smertesyndrom, afklemning skulder, impingement (Subacromial pain syndrome). Lægehåndbogen, sundhed.dk. Professionally updated 16 December 2021, edited 28 November 2025. Link

2. Sundhedsstyrelsen. National clinical guideline for treatment of patients with subacromial pain syndrome in the shoulder, Quick Guide. February 2021. Link

3. Slagstad K. Pasienter med subakromialt smertesyndrom bør som hovedregel ikke tilbys operasjon (Patients with subacromial pain syndrome should as a rule not be offered surgery). Tidsskriftet, 2018 (year taken from the web address). Link