News | August 17, 2026
Many patients first notice the pain when moving their arms overhead. Later, the symptoms also occur when reaching behind them, during sports, or even at rest.
If you’d like to seek treatment for your shoulder impingement, an accurate diagnosis is crucial. At ROC Ortho in Aschheim, we therefore do not view shoulder problems as an isolated joint issue. We investigate why the space beneath the acromion has narrowed, which structures are affected, and which shoulder impingement treatment is appropriate for your specific condition, focusing on biomechanics and load-bearing capacity.
In this guide, you’ll learn how to recognize shoulder impingement, what causes it, how it’s diagnosed, and what conservative or surgical treatment options are available. We’ll also explain when physical therapy is recommended and when you can resume sports activities after shoulder impingement.
In shoulder impingement, soft tissues in the space beneath the acromion are compressed or irritated. This area is known as the subacromial space. Among other things, the rotator cuff tendons, bursae, and other important sliding structures pass through this area. When the arm is raised forward or to the side, the head of the humerus glides beneath the acromion. If this interaction is disrupted, pressure is exerted on sensitive structures.
The term “impingement syndrome” describes this mechanism very clearly. The shoulder functions as a finely tuned system of muscles, tendons, and joints. If a muscle is weakened, the scapula does not function optimally, or the joint’s alignment changes, friction and pressure result. Initially, this often leads to tendon irritation or bursitis. If the underlying cause persists, pain, loss of strength, and restricted movement may worsen.
However, shoulder impingement does not automatically mean a torn tendon. Rather, it indicates that the shoulder can no longer perform certain movements optimally. That is precisely why a thorough diagnosis of shoulder impingement is the foundation for successful treatment.
Many patients initially describe a pulling pain on the outside of the upper arm. Often, however, the actual cause lies in the shoulder itself. The pain often radiates from the front or side of the shoulder into the upper arm, but usually does not extend all the way to the hand.
Typical symptoms of shoulder impingement include:
There is one warning sign you should take seriously: If, after a fall, you are suddenly unable to actively lift your arm, notice a significant loss of strength, or experience numbness, you should have your shoulder examined by an orthopedist as soon as possible.
Similar symptoms may also be caused by a rotator cuff tear, calcific tendinitis, osteoarthritis of the acromioclavicular joint, frozen shoulder, or problems with the cervical spine. That is why a thorough evaluation is important before beginning treatment for shoulder impingement.
The cause of shoulder impingement is rarely attributable to a single factor. In most cases, several factors contribute. A bony spur on the acromion, an irritated supraspinatus tendon, a thickened bursa, or altered shoulder mechanics can all combine to reduce the space beneath the acromion.
Mechanical Causes
In some people, the natural shape of the acromion leaves less space for the tendons. Osteoarthritis of the acromioclavicular joint, calcium deposits, or bony spurs can also further narrow the subacromial space. In these cases, we at ROC Ortho check to see if there is what is known as “outlet impingement.”
Functional causes
Symptoms also frequently arise without significant bony changes. Often, the scapula, rotator cuff, and core muscles do not work together optimally. Prolonged sitting, primarily computer-based work, or one-sided strength training can also alter the shoulder’s range of motion and contribute to shoulder impingement.
Occupation, Sports, and Strain
Overhead movements also play an important role. Tradespeople, painters, tennis players, swimmers, golfers, and volleyball players regularly place strain on the area beneath the acromion. At the same time, a lack of recovery or repeated overexertion can prevent irritated tendons from healing properly.
That’s why at ROC Ortho, we don’t just ask about your pain. We’re also interested in your occupation, the sports you play, past injuries, your exercise habits, and the physical demands of your daily life. Only once we have the full picture can we recommend the right treatment for shoulder impingement.
For us, successful treatment of shoulder impingement begins with a thorough examination. We assess range of motion, strength, scapular movement, pain points, and the function of the cervical spine and adjacent joints. Only the combination of a consultation, physical examination, and imaging provides a complete picture.
Depending on the specific issue, we at ROC Ortho use a variety of diagnostic procedures:
Our open MRI in Aschheim is particularly suitable for cases of suspected tendon tears, severe tendon irritation, biceps tendon discomfort, or unexplained nighttime pain. In addition, an ultrasound examination provides valuable information because it allows us to assess the shoulder while it is in motion.
One thing is important to us: We don’t treat the MRI image—we treat your symptoms. Imaging abnormalities can also be found in people who have no symptoms. Conversely, even minor changes can cause significant pain. That’s why we consistently tailor every shoulder impingement treatment to your individual findings and personal goals.
For most patients, shoulder impingement can initially be treated without surgery. The goal of conservative treatment for shoulder impingement is to reduce pain, soothe irritated tissues, improve range of motion, and gradually restore the shoulder’s ability to bear weight.
At ROC Ortho, we focus on a personalized treatment plan. The most appropriate therapy depends, among other things, on the cause of your symptoms, the condition of your tendons, the physical demands of your job and sports activities, and your personal goals.
| Therapy Module | Goal | Suitable for |
|---|---|---|
| Load Adjustment | Reduce irritation | acute pain, nighttime pain, discomfort during overhead movements |
| Physiotherapy | Strengthen the Scapular Movement and Rotator Cuff | functional shoulder impingement, loss of strength, improper loading |
| Anti-inflammatory Infiltration | Reduce pain and enable active therapy | severe bursitis or intense pain |
| Shock wave therapy | Stimulating Tendons and the Healing Process | Tendon irritation, calcific tendinitis, chronic symptoms |
| PRP / Autologous Blood Therapy | Support the body's natural regeneration process | chronic tendon irritation and selected orthobiological indications |
Complete rest rarely helps with shoulder impingement. On the contrary: If the shoulder remains immobile for an extended period, strength, mobility, and coordination may continue to decline.
For this reason, physical therapy forms the basis of shoulder impingement treatment for most patients. The goal is to strengthen the rotator cuff, improve scapular control, and promote mobility in the thoracic spine. This allows the shoulder to function stably and with as little pain as possible.
At ROC Ortho, we tailor your treatment plan to your specific diagnosis and daily life. Someone who regularly works overhead as part of their job often needs a different exercise program than someone who experiences discomfort while playing golf or tennis. Together with our physical therapy team, we develop a training plan that fits your activity level and helps stabilize your shoulder over the long term.
If bursae or tendons are severely irritated, pain can make any active exercise difficult. In these cases, a targeted injection can be a useful addition to shoulder impingement treatment.
The treatment often helps reduce the inflammatory response and creates a therapeutic window during which physical therapy and muscle strengthening become possible again.
At ROC Ortho, we perform image-guided injections when medically indicated to treat the affected structures as precisely as possible. Our goal is not merely to provide short-term pain relief, but to lay the foundation for a lasting improvement in shoulder function.
Not every sore shoulder requires the same treatment. That’s why at ROC Ortho, we assess on a case-by-case basis whether regenerative therapies can effectively complement your shoulder impingement treatment.
In cases of chronic tendon irritation or calcific tendinitis of the shoulder, shock wave therapy can help promote healing and stimulate irritated tendon insertions.
Autologous blood therapy using PRP may also be an option for certain tendon conditions. In this procedure, growth factors are extracted from your own blood and precisely injected into the affected areas to support the body’s natural repair processes.
We do not decide whether shockwave therapy, PRP, or another treatment is appropriate based on a single MRI finding. We take into account, among other things, the condition of the tendons, the degree of inflammation, comorbidities, medications, and your personal goals in your career, daily life, and sports.
The right shoulder impingement exercises are among the most important components of successful treatment. However, it is crucial that the exercises are tailored to your individual condition.
A common mistake is to start too early with heavy weights or painful overhead movements. If the shoulder subsequently reacts with nighttime pain or more severe discomfort, the load was usually too heavy.
Depending on the findings, we at ROC Ortho rely on the following exercise modules, among others:
During an acute phase of muscle soreness, you should avoid heavy overhead presses, deep dips, wide lateral raises, or exercises performed behind the head as much as possible. Pain in these situations is not a sign of a particularly effective workout, but is usually an indication that the angle, load, or technique needs to be adjusted.
Many physically active patients ask us whether they can continue doing pull-ups despite having shoulder impingement. There is no one-size-fits-all answer. It depends on how severe the symptoms are and which structures are affected.
Pull-ups place high demands on the rotator cuff, scapular motion, biceps tendon, and shoulder joint. Especially in the lower position, significant forces act on the space beneath the acromion. If this area is already irritated, certain exercises—such as the full dead hang, kipping pull-ups, very wide grip variations, or the addition of weight—can exacerbate the discomfort.
Our goal, therefore, is not to ban exercise outright. Rather, we adapt the training to the healing process. Often, controlled pulling exercises with a neutral grip, rowing movements, or isometric holds are more appropriate at first. Only once the shoulder is stable again and can bear weight without pain do we gradually increase the intensity.
Nighttime pain or significantly more severe discomfort the day after a workout are good indicators of overexertion. In such cases, your workout routine should be adjusted. Together with our physical therapy team, we’ll develop a personalized exercise plan so you can return to your sport as safely as possible.
One of the most common questions is: “How long does shoulder impingement last?”
There is no one-size-fits-all answer. The duration of recovery depends, among other things, on the cause of the symptoms, the condition of the tendons, your occupation, your level of physical activity, and your consistent adherence to the treatment plan.
Guidelines are:
It is important to us that expectations are realistic. The shoulder rarely heals in a linear fashion. Good days and bad days often alternate. What matters is not any single day, but rather that pain, range of motion, and strength improve steadily over several weeks.
How long you will be unable to work due to shoulder impingement depends primarily on your occupation.
People who work primarily at a desk can often return to work sooner than those who regularly lift heavy loads or work overhead.
The following factors also influence the duration of sick leave:
That’s why at ROC Ortho, we discuss not only your diagnosis but also your specific work routines. The more precisely we understand the movements you perform on a daily basis, the better we can assess when a safe return to work is possible.
Many patients want to know when shoulder impingement surgery is truly necessary. In fact, surgery is rarely the first step in treatment.
First, we always assess whether the symptoms can be alleviated through targeted conservative treatment for shoulder impingement. Surgery may be appropriate only if these measures have been followed for a sufficiently long period and no satisfactory improvement has occurred, or if there is a significant mechanical problem.
Depending on the findings, the procedure may be aimed at,
At ROC Ortho, we generally take a joint-preserving approach. If non-surgical treatment for shoulder impingement is medically appropriate, we consistently explore all available options. At the same time, we’ll be open and honest with you if surgery is the better long-term solution.
At ROC Ortho, we don't view shoulder problems in isolation. Our goal is to understand the cause of your symptoms and work with you to develop the right treatment plan.
To this end, we combine modern orthopedic diagnostics with conservative and regenerative treatment options. Depending on the findings, we can combine, among other things, ultrasound, digital X-rays, open MRI, injections, shock wave therapy, PRP, and individually tailored physical therapy.
Many patients come to us because pain medication, occasional injections, or nonspecific exercises have not provided lasting relief. Often, the problem is not a lack of motivation, but rather the absence of a structured treatment plan.
That is why we develop a personalized treatment plan based on your diagnosis, your symptoms, and your personal goals. Our goal is to reduce pain, restore shoulder function, and help you return to your daily life, work, and sports.
If you’d like to find out which shoulder impingement treatment is right for you, please feel free to schedule an appointment at ROC Ortho in Aschheim. Please bring any MRI images, medical reports, and information about previous treatments with you. Together, we’ll discuss which treatment plan makes the most sense for your shoulder.
Dr. med. Daniel Filesch
Specialist in orthopaedics and trauma surgery
Martina Berger
Doctor for regenerative orthopaedic procedures
Dr. med. Edan Manos
Doctor for regenerative orthopaedic procedures
Patrick Heine
Specialist in orthopaedics and trauma surgery
ROC Ortho
Private Orthopedic Practice
St.-Emmeram-Str. 5
85609 Aschheim
Email: praxis@roc-ortho.de
Phone: +49 89 46259930
Opening hours
| Monday | 7:30 a.m. – 6:00 p.m. |
| Tuesday | 7:30 a.m. – 6:00 p.m. |
| Wednesday | 7:30 a.m. – 8:00 p.m. |
| Thursday | 7:30 a.m. – 6:00 p.m. |
| Friday | 7:30 a.m. – 3:00 p.m. |