Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Shoulder Impingement Syndrome
Shoulder impingement syndrome is a common cause of shoulder pain, particularly when lifting the arm overhead. It occurs when structures within the shoulder become irritated during movement, leading to pain and reduced function.
Although the term “impingement” is widely used, it does not refer to a single condition. Instead, it describes a group of shoulder problems that may involve the rotator cuff tendons, the subacromial bursa or other surrounding structures.
Most patients improve with appropriate rehabilitation and do not require surgery.
What is Shoulder Impingement?
The rotator cuff tendons and the subacromial bursa pass through a narrow space beneath the acromion (part of the shoulder blade).
When these tissues become irritated or inflamed, lifting the arm may become painful.
Several different conditions can contribute to impingement symptoms, including:
- Rotator cuff tendinopathy
- Partial rotator cuff tears
- Subacromial bursitis
- Calcific tendinitis
- Shoulder muscle imbalance
Understanding the underlying cause is important because treatment differs depending on the diagnosis.
Pain often occurs because irritated tissues become compressed during shoulder movement rather than because of a single structural problem.
What Causes Shoulder Impingement?
Several factors may contribute, including:
- Repetitive overhead activities
- Rotator cuff tendinopathy
- Muscle weakness
- Poor shoulder blade control
- Calcific tendinitis
- Partial rotator cuff tears
- Age-related tendon degeneration
Rather than a single cause, impingement usually results from a combination of tendon health, muscle function and shoulder mechanics.
Symptoms
Patients commonly report:
- Pain when lifting the arm
- Pain reaching overhead
- Pain reaching behind the back
- Pain when dressing
- Pain lying on the affected shoulder
- Shoulder weakness
- Night pain
- Painful arc of movement
Symptoms often develop gradually.
Conditions Commonly Associated with Impingement
Several shoulder conditions can produce impingement symptoms.
Rotator Cuff Tendinopathy
Degeneration or irritation of the rotator cuff tendons is one of the most common causes of impingement symptoms.
Related page: Rotator Cuff Tendinopathy
Rotator Cuff Tear
A partial or full-thickness rotator cuff tear may present with symptoms similar to impingement.
Related page: Rotator Cuff Tear
Subacromial Bursitis
Inflammation of the bursa can contribute to pain during shoulder movement.
Calcific Tendinitis
Calcium deposits within the rotator cuff tendon can cause severe pain and impingement symptoms.
Related page: Calcific Tendinitis
How is Shoulder Impingement Diagnosed?
Diagnosis begins with a careful clinical assessment.
Your orthopaedic surgeon will evaluate:
- The location of pain
- Shoulder movement
- Muscle strength
- Rotator cuff function
- Shoulder blade movement
- Neck examination when appropriate
Special examination tests help identify the source of pain but are interpreted alongside your history and imaging findings.
Imaging
X-rays
X-rays may identify:
- Calcific tendinitis
- Arthritis
- Bone spurs
- Other structural abnormalities
Ultrasound
Ultrasound is useful for assessing:
- Rotator cuff tendons
- Bursitis
- Calcific tendinitis
It also allows dynamic assessment during shoulder movement and can guide injections when appropriate.
MRI
MRI is recommended when:
- A rotator cuff tear is suspected
- Symptoms persist despite treatment
- Surgery is being considered
MRI evaluates the tendons, muscles, labrum and surrounding soft tissues.
Non-Surgical Treatment
Most patients improve without surgery.
Treatment may include:
- Activity modification
- Physiotherapy
- Rotator cuff strengthening
- Scapular stabilisation exercises
- Anti-inflammatory medication
- Ultrasound-guided corticosteroid injection in selected cases
- Gradual return to activity
Rehabilitation focuses on improving shoulder mechanics rather than simply relieving pain.
When is Surgery Recommended?
Surgery is considered only when:
- Symptoms persist despite appropriate rehabilitation
- A significant rotator cuff tear is present
- Pain continues to interfere with daily activities
- Conservative treatment has been unsuccessful
The choice of surgery depends on the underlying diagnosis rather than the term “impingement” alone.
Surgical Treatment
Depending on the underlying condition, surgery may include:
- Rotator cuff repair
- Removal of calcium deposits
- Treatment of associated biceps or labral pathology
Routine subacromial decompression is not appropriate for every patient with shoulder impingement. Current evidence suggests that careful patient selection is important, and treatment should address the underlying cause of symptoms rather than relying on decompression alone.
Recovery
Recovery depends on the underlying condition and the treatment performed.
Typical recovery includes:
| Activity | Approximate Time |
|---|---|
| Daily activities | As symptoms allow |
| Physiotherapy | Begins early |
| Strengthening | 6–12 weeks |
| Return to sport | Varies according to the diagnosis and treatment |
Frequently Asked Questions
Is shoulder impingement the same as a rotator cuff tear?
No. Shoulder impingement describes a pattern of symptoms, while a rotator cuff tear is a specific tendon injury. Some patients with impingement have a rotator cuff tear, while many do not.
Do I have a bone spur?
Not necessarily. Although bone spurs can contribute to shoulder pain in some people, many patients develop impingement symptoms because of tendon problems, muscle weakness or altered shoulder mechanics.
Will I need surgery?
Most patients improve with physiotherapy and non-surgical treatment. Surgery is generally reserved for those with persistent symptoms or associated structural injuries.
Can physiotherapy cure shoulder impingement?
Many patients experience significant improvement with a structured rehabilitation programme that focuses on shoulder strength, movement and muscle control.
Why Choose Dr Puah Ken Lee?
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose practice focuses on shoulder, elbow and sports injuries. He believes that understanding the underlying cause of shoulder pain is essential before recommending treatment. Rather than treating all shoulder impingement in the same way, management is tailored to each patient’s symptoms, examination findings and imaging results, with surgery considered only when it is likely to provide meaningful benefit.
Related Conditions
- First Orthopaedic Consultation
- Shoulder Surgery
- Biceps Tenodesis
- Ultrasound-guided Shoulder Injections
- Sports Injuries
- Return to Sport After Injury
For a full overview of shoulder conditions, visit Shoulder Specialist Singapore
Dr Puah is regularly invited to teach shoulder surgery internationally
Specialist Care for Shoulder Injuries in Singapore
Dr Puah is an orthopaedic surgeon specialising in shoulder, elbow and sports injuries. He provides personalised care tailored to each patient’s condition and activity level.
Consultations are available at Mount Elizabeth Novena.
If you are experiencing shoulder pain that is affecting your daily life or sports, early assessment can help guide appropriate treatment.
Book a consultation or contact the clinic to discuss your condition.
Book a Consultation
Book a consultation or contact the clinic via WhatsApp to get started
Book a consultation at 360 Orthopaedics, Mount Elizabeth Novena
Shoulder impingement is common but treatable once the underlying cause is identified. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent shoulder pain are encouraged to seek specialist evaluation.