Nonsurgical Treatments for Shoulder Impingement

In most cases of shoulder impingement, nonsurgical treatment options will be recommended first. The goals of nonsurgical treatments are to:

• Reduce inflammation of the affected soft tissues
• Improve range of motion
• Improve supporting muscle strength and posture to increase the shoulder’s subacromial space
• Restore joint function ¹ Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765-776.
• Reduce pain ¹ Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765-776.

Nonsurgical treatment options to relieve pain and improve joint mobility include:

• Rest. A person should avoid overhead activities and rapid movement, such as sports that require throwing or swinging. It is best to avoid frequent shoulder movement, however, total immobilization should be avoided. Immobilization can lead to weakness, stiffness, and worsening shoulder problems.
• Physical therapy. A licensed physical therapist can provide an individual treatment plan. A physical therapy treatment plan may focus on improving range of motion and strengthening weak muscles. A physical therapist may also recommend at-home stretches and exercises, which can help speed up recovery as well as prevent future shoulder problems.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Some research suggests that 1 to 2 weeks of daily over-the-counter NSAIDs, ² Khan Y, Nagy MT, Malal J, Waseem M. The painful shoulder: shoulder impingement syndrome. Open Orthop J. 2013;7:347-51. Published 2013 Sep 6. doi:10.2174/1874325001307010347 such as ibuprofen (Advil) or aspirin (Bayer, Ecotrin) may help to reduce pain. Prescription strength NSAIDs may be recommended to maximize anti-inflammatory effects.

See Acute Injury: Additional Treatment Considerations

• Corticosteroid injections. A corticosteroid injection contains a powerful anti-inflammatory drug called cortisone. Cortisone may be injected around the affected tendons to reduce inflammation and swelling that may be causing or contributing to the impingement. It is not recommended to receive more than 2 to 3 rounds of corticosteroid injections because, when administered repeatedly, tendon damage can occur. ³ Loitz D, Loitz S, Reilmann H. [The subacromial-syndrome. Diagnosis, conservative and operative treatment]. Unfallchirurg. 1999 Nov;102(11):870-87. Review. German. PubMed PMID: 10551935
• Regenerative medicine. A doctor may offer regenerative medicine treatments, such as platelet rich plasma (PRP) and stem cell injections. The goal of this type of treatment is to treat soft tissue problems, such as a rotator cuff tear, that is contributing to the impingement. Regenerative treatments are generally considered safe, but there is very little clinical research regarding whether they are effective in reducing shoulder impingement symptoms. One study of 62 patients suggests that PRP does not work better than physical therapy in treating shoulder impingement. ⁴ Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S, Mazaherinezhad A. Treatment of subacromial impingment syndrome: platelet rich plasma or exercise therapy? A randomized control trial. Orthop J Sports Med. 2017;5(5):2325967117702366. https://doi.org/10.177/2325967117702366.

See Regenerative Medicine for Sports Injuries

Generally, nonsurgical treatments will be used for 3 to 4 months before more invasive procedures are considered.

See The P.R.I.C.E. Protocol Principles