Shoulder impingement, bursitis and rotator cuff pain

Clinical review by Kieran Cummins before publication Research checked: 10 November 2026 Reaching for a cup.

Putting on your coat. Turning onto your side at night. When your shoulder hurts, everyday movements can become uncomfortable and uncertain.

You may have been told you have shoulder impingement, bursitis or a rotator cuff problem. A scan might mention tendinopathy, degeneration or a tear. It can be difficult to know how these words fit together, or what they mean for your recovery.

Understanding the problem is a useful first step. The next is deciding what your shoulder needs, what you can work on and whether further advice would help.

HOW THE SHOULDER WORKS

Your upper arm meets a shallow socket in the shoulder blade. The collarbone connects the shoulder to the rest of your skeleton. The rotator cuff is a group of four muscles and their tendons. It helps support the joint and lift and rotate your arm. Above part of the cuff sits the acromion, a bony part of the shoulder blade.

A small fluid-filled sac, the subacromial bursa, helps the tissues glide as you move. [1] Assessment therefore needs to look beyond the spot that hurts.

At Redrock, we consider how you use your arm, your movement and strength, and whether the neck or other structures may be contributing.

WHAT DO THE DIFFERENT NAMES MEAN?

Shoulder impingement and subacromial pain “Shoulder impingement”, “subacromial impingement” and “rotator cuff impingement” are commonly used labels for pain around this region.

You may also hear “subacromial pain” or “rotator cuff related shoulder pain”. These terms overlap, but are not used consistently by every clinician. A label does not, by itself, establish precisely which tissue is causing your symptoms. [2]

Rotator cuff tendinopathy Tendinopathy describes a tendon problem associated with pain and reduced function. It is broader than “tendinitis”, which emphasises inflammation. A painful tendon needs assessment in the context of the demands placed on it and what it currently tolerates. [4]

Shoulder bursitis Bursitis means inflammation of a bursa. In the shoulder, the bursa can become painful alongside a rotator cuff problem. Movement or pressure on the area may hurt. However, symptoms overlap with other shoulder conditions, so soreness when lying on your side does not prove that bursitis is the only cause. [1,5]

Degenerative change and tendon tears “Degenerative change” describes changes in tissue over time. It does not automatically mean your shoulder cannot improve. A partial-thickness tear affects part of the tendon’s depth; a full-thickness tear extends through it. Tears may develop gradually or follow an injury.

The circumstances, weakness and effect on function matter when deciding what happens next. [1]

WHY DOES IT HURT WHEN I REACH OR SLEEP?

Rotator cuff related pain is often felt around the outside of the shoulder or upper arm. Lifting your arm, reaching behind your back or lying on the affected side may be uncomfortable. Similar symptoms can have different causes. [2,6] A change in activity, such as more gardening, decorating or gym work, may precede symptoms. Sleep, general health and stress can also influence how pain is experienced. Sometimes there is no obvious trigger. [7]

Your experience matters more than the terminology alone. We want to know which activities have become difficult, what you are avoiding and what you would like to do comfortably again.

DO I NEED A SCAN?

A clinical assessment can often guide initial care without an ultrasound or MRI. Imaging becomes more useful when it answers a specific question, particularly after injury, with significant weakness, diagnostic uncertainty or persistent symptoms. [3]

Scans can show tendon changes, tears or bursitis in people who do not have shoulder pain. That does not make your pain less real. It means the scan must be considered alongside your symptoms and examination, rather than treated as a complete explanation. [7]

IS EVERY PAINFUL SHOULDER A ROTATOR CUFF PROBLEM?

No. Frozen shoulder, arthritis, instability, fractures and pain arising from the neck can require different approaches. Marked stiffness, a feeling that the shoulder slips, or tingling and numbness need consideration during assessment. [8]

This is why we begin by listening and examining, rather than assuming everyone needs the same shoulder exercises.

WHAT PHYSIOTHERAPY CAN HELP YOU WORK ON

An active rehabilitation programme is recommended for rotator cuff tendinopathy. This can include exercises for movement, control and strength, supported by advice about symptoms, activity and self-management. Hands-on treatment may help pain in the short term when appropriate. [4]

At Redrock, we make that practical by agreeing a small number of goals with you. These might be putting on a jacket, sleeping more comfortably or returning to swimming and racket sports. We use those goals to decide what to work on and review whether the plan is helping.

GUIDED COACHING AND EXERCISE PROGRESSION

Knowing an exercise is useful is only part of the process. You may also need to understand how to do it, how much to do and how to respond when your shoulder feels different from one day to the next.

Our coaching aims to help you:

• Find a manageable starting point and practise it with feedback.

• Understand the response we are looking for during exercise and afterwards.

• Adjust resistance, repetitions or movement range when needed.

• Progress towards the actual demands of your work, hobbies or sport.

We can use the clinic’s rehabilitation space to work through these details together. For someone returning to tennis, that may eventually include reaching, speed and repeated effort. Someone returning to gardening may need confidence with lifting, pulling and sustained activity. Progression should fit the person.

There is no single exercise programme or loading level proven best for everyone. [4] Support should fit the person too. In the UK GRASP trial, up to six supervised sessions did not produce better average outcomes over a year than one high-quality advice session with a supported home exercise programme.

That study concerned a defined group with rotator cuff disorders, not every shoulder condition. [9] Some people need an explanation and a plan they can follow independently.

Others need further reviews to adjust the programme or resolve difficulties. Our aim is to give you useful support and growing independence, with a reason for each follow-up.

WHAT PHYSIOTHERAPY CANNOT PROMISE

Physiotherapy cannot promise to reverse all age-related tendon changes or reconnect a detached tendon.

Nevertheless, some people with rotator cuff tears improve their comfort and function without surgery. Treatment decisions depend on the individual and the tear. [1] Nor can we guarantee a fixed recovery date.

We can agree what progress should look like and reconsider the plan if it is not happening. Injections may provide short-term relief for some rotator cuff disorders, but they do not reliably improve longer-term outcomes. [9]

Surgery is not the automatic next step for an “impingement” diagnosis: decompression surgery has not shown meaningful benefit over placebo surgery for typical subacromial pain. This is a different question from repairing a traumatic tendon tear. [3]

WHEN SHOULD ANOTHER CLINICIAN OR CONSULTANT BE INVOLVED?

Referral is part of good care. We discuss further assessment when the diagnosis remains uncertain, significant weakness needs explanation, or symptoms are not improving despite an appropriate rehabilitation plan.

Current BESS guidance identifies lack of improvement after around 12 weeks of non-operative care as a reason for specialist referral. Earlier referral may be needed depending on the findings. [3]

At Redrock, our established relationships with shoulder consultants support onward advice when it is appropriate. With your consent, we can communicate the assessment findings, what has been tried and the question we want their opinion on.

A consultant review may help clarify the diagnosis or treatment options; it does not necessarily mean an operation.

WHEN TO SEEK URGENT HELP

Seek an urgent GP assessment or contact NHS 111 for sudden severe shoulder pain, inability to move your arm, deformity or marked swelling, persistent numbness, or shoulder pain with fever or feeling unwell. Pain following an accident or fall also needs prompt assessment, particularly if you cannot lift the arm. Do not wait for a routine rehabilitation appointment in these circumstances. [8]

HOW WE APPROACH SHOULDER CARE AT REDROCK

Our shoulder service brings together senior physiotherapists Anna Anders, Kieran Cummins and Simon Nicole. Simon has particular experience in complex shoulder instability and hypermobility, alongside his upper limb work at St George’s Hospital. [10] We allow time to hear your story, examine the problem and explain what we think is happening. Our private consulting rooms and rehabilitation space give us room to assess, practise and review.

You should leave understanding the next step: what you can do, how we can help and when we will review progress. If another professional’s input is needed, we will explain why.

GET SOME HELP, TALK TO AN EXPERT

Explore our shoulder service and choose an appointment with Anna, Kieran or Simon: https://www.redrockphysio.co.uk/shoulder-pain Not sure who to see?

Call 01727 309 915 or email info@redrockphysio.co.uk.

SOURCES AND FURTHER READING

[1] American Academy of Orthopaedic Surgeons. Rotator Cuff Tears. https://www.orthoinfo.org/bodypart/shoulder/rotator-cuff-tears/

[2] Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. Rotator Cuff Related Shoulder Pain. https://www.rjah.nhs.uk/our-services/therapy/supported-self-care/rotator-cuff-related-shoulder-pain/

[3] Pandey RA, Singh HP, on behalf of the BESS Subacromial Pain Working Group. BESS Patient Care Pathway: Subacromial Pain. Shoulder & Elbow. 2025;17(6):713–724. https://doi.org/10.1177/17585732251374282 Open guideline: https://bess.ac.uk/wp-content/uploads/2026/03/Subacromial-Shoulder-Pain-2025.pdf

[4] Desmeules F et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. JOSPT. 2025;55(4):235–274. https://doi.org/10.2519/jospt.2025.13182

[5] NHS. Bursitis. https://www.nhs.uk/conditions/bursitis/

[6] NHS. Shoulder impingement. https://www.nhs.uk/conditions/shoulder-impingement-syndrome/

[7] University Hospitals of Morecambe Bay NHS Foundation Trust. Shoulder pain. https://www.uhmb.nhs.uk/our-services/services/musculoskeletal-msk-physiotherapy/musculoskeletal-msk-pain/shoulder-pain

[8] NHS. Shoulder pain. https://www.nhs.uk/symptoms/shoulder-pain/

[9] Hopewell S et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP). The Lancet. 2021;398:416–428. https://doi.org/10.1016/S0140-6736(21)00846-1 [

10] Redrock Physio. Simon Nicole clinician profile. https://www.redrockphysio.co.uk/meet-simon-nicole