What is shoulder impingement and bursitis?

Above the shoulder joint and below the acromion, a projection of your scapula is an area called the subacromial space. Within this place lies the subacromial bursa, a cushion of tissue lying between the tendon and the bone. The bursa can become fluid-filled and inflamed leading to bursitis. This can be secondary to exercise and repeated activities, however, it can also happen secondary to impingement. This is when the acromion itself can impinge into the underlying bursa and tendon. In some cases, an arthritic acromioclavicular joint can also be the case of impingement.

What are the symptoms of shoulder impingement and bursitis?

The commonest symptom is usually pain and in some cases pain-related weakness and stiffness. Pain is most commonly felt with the arm held out to the side at shoulder height. Holding shopping or any weight at this level can exacerbate symptoms. Patients also describe pain in putting on their seatbelts and reaching behind their back.

How is it diagnosed?

It is diagnosed by taking a careful history and performing a detailed examination. It is important to exclude other potential causes, in younger patients instability should be excluded. Further assessment of rotator cuff strength and for acromioclavicular joint pain is performed. X-ray, ultrasound and MRI scans are extremely important to exclude rotator cuff tear and other intra-articular pathology.

How is it treated?

Treatment begins with symptomatic management using pain killers and physiotherapy to work on strengthening and range of movement exercises. Subacromial steroid injections can be extremely useful as a diagnostic and therapeutic measure and can allow the patient to engage thoroughly with their physiotherapy regime. 

For more prolonged cases failing to respond to these measures, a careful discussion with the patient regarding the options will be undertaken. Arthroscopic subacromial decompression has been shown to be an effective treatment option leading to improvement in patient-reported outcomes. However, some studies have shown that these cases need to be carefully selected in order to prevent the use of this surgery as a blanket treatment. In our practice this is typically performed in conjunction with other arthroscopic procedures to treat co-existing conditions, to ensure that the patient has the optimal long-term result.

If you or someone you know has suffered an injury or is experiencing pain in their shoulder or difficulty with moving the shoulder, arm or elbow and would like a consultant-led review, please contact us. Grosvenor Orthopaedics have extensive experience in the treatment of ACJ injuries with excellent patient outcomes.


Grosvenor Orthopaedics have extensive experience in the treatment of should & elbow -related injuries with excellent patient outcomes.


If you would like to learn about other shoulder & elbow conditions click the button below to find out more


If you would like to learn about other shoulder & elbow treatments click the button below to find out more

our specialist shoulder and elbow consultants

Shoulder and Elbow care at Grosvenor Orthopaedics is led by our consultant surgeons Mr W James White and Mr David Butt, both graduates of London medical colleges. They bring extensive experience to Grosvenor Orthopaedics having worked across Guys NHS Trust and the world renowned Royal National Orthopaedic Hospital.

Our team have broad experience in the successful treatment of a range of shoulder and elbow problems, addressing both young and sports related injuries as well as those relating to trauma, disease process and genetics.

Patients who choose Grosvenor Orthopaedic Partners for their treatment will receive some of the best care available in the UK. Our team are leading consultants across London’s shoulder and elbow clinics and offer specialist care to our private patients through King Edward’s Hospital, HCA Lister and other major private hospitals in central London.

Our team are well placed to manage and treat a diverse range of shoulder and elbow problems utilising cutting edge diagnostic technology and treatment approaches, both surgical and conservative. Below is an overview of some of the conditions we treat but for a more thorough understanding please contact our team here


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MBBS, BSc(Hons)
James is a Consultant Shoulder and Elbow Surgeon, practising at Guy’s and St Thomas’ Hospital NHS Foundation Trust, King Edward VII’s, The Lister Hospital Chelsea and HCA Chiswick Outpatient Clinic. His practice encompasses all aspects of shoulder and elbow surgery including arthroscopy, arthroplasty and trauma. He has a reputation as a thorough clinician, effective communicator and skilled surgeon. Through joint decision-making with the patient and utilising non-operative techniques where possible, he achieves the best possible outcomes for patients. When surgery is required, James has excellent outcomes based on his precise and prepared approach to operating.


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MSc, MBBS, BSc(Hons)
David is a Consultant Shoulder and Elbow Surgeon, practising at the world-renowned Royal National Orthopaedic Hospital Stanmore, King Edward VII’s Hospital and One Hatfield. His practice involves all aspects of shoulder and elbow surgery, from minor injuries to complex reconstructive procedures. He strongly believes in shared decision making and a patient-centred approach to treatment. He is a meticulous surgeon using up to date and evidence-based techniques to treat every patient’s individual needs.

What some of our patients say

Mrs MA

Thank you for taking care of me. You went above and beyond and I am so touched and grateful. My knee feels fine now