Shoulder impingement: any advice on treatment welcome

[Sundayafternoonblues]

Following an ultrasound scan I have a diagnosis of the shoulder/upper arm pain I have been experiencing: subacromial impingement. But not much in the way of advice from GP about treatment: do I want a steroid injection? Don't know really. What are the pros and cons? In a month of using ice packs and taking ibuprofen, shoulder has possibly got slightly better, should I just be patient? Shoulder and arm not generally painful if still, but I have to be careful to avoid various everyday movements (or sharp pain) and minor twinges are unavoidable even when being careful (unless arm completely still).

Have tried googling and keep reading about getting pain under control and then proceeding to physio, but my shoulder got dramatically and rapidly worse after a physio session. Does that mean I should avoid physio or did I just pick the wrong physio?

If anyone knows anything about this subject, would really welcome some advice! TIA

I have had ongoing issues with shoulder resulting in 2 decompressions, second only necessary after review by a different surgeon which showed that initial surgeon did jack shit which is why I had ongoing pain. Post op my shoulder now feels like new.
The steroid injections only halted the pain for a matter of weeks. Physio, though was a life saver post op

Feldenkrais work for me. Hope you find what you need.

Thank you for the replies. Had to google Feldenkrais - had not heard of it. Grump, did you experience any side effects from the steroid injection? I am wondering whether if I had the steroid injection, that would get rid of the pain long enough to do some physio exercises which would help get rid of the underlying problem. But then I also worry that if the injection just kills the pain, I might do more damage when exercising, which might only become apparent once the painkilling effect of the injection wears off. My own experience of physio has made be pretty nervous of trying it again, but lots of stuff about shoulder impingement says physio should help. I am wondering whether it's all about finding the right physio, but don't really know how to do that. The physio I saw had been qualified for many years, and I had previously been referred to her (for a different shoulder problem) by my GP.

I had no effects from the steroid injection however I had to have several hefty steroid injections into shoulder and other joints for other ailments I have ended up with osteoporosis

My GP diagnosed me with impingement syndrome - though by just hauling my arm around, not by a scan or anything. He gave me a steroid injection, but I just found my whole arm started hurting immensely about half an hour after the injection, and lasted a few hours. Once that pain wore off, my shoulder felt the same as it had before. He gave me a couple of sheets of exercises to do, but in the end it just gradually improved. I had about 6 months of significant pain - now (another 6 months down the line) it's pretty much fine unless i put my arm out to the side and raise it up level with my shoulder... Sorry - none of that is much help!

I have had two episodes. The first did not respond to steroids, so needed surgery. Excellent outcome.
Five years later, a sudden flare up. Five months off sick. Physio made it worse. Three lots of steroids, injected under ultrasound, worked well. Regular Naproxen and Paracetamol helped. Took alot of time to gradually get better.

Phizzwizard, that is helpful because it's useful to know that a steroid injection won't necessarily help, and also that things may just improve on their own, even when they have got quite bad.

Grump, sorry to hear that. Thank you for replying.

Hedwig, thank you. Interesting to hear that you had at least one occasion where steroids did not work, and that you have also experienced physio making things worse. I am increasingly thinking that in my case sticking with ibuprofen and ice packs may well be the right approach for the time being.

I had a subacromial decompression two years ago. Totally sorted the problem and pain. Tried physio, analgesics / anti inflams and rest prior to the op but only thing that worked was the op. If I were you, I'd be asking for a referral to a consultant shoulder specialist and getting an MRI. A steroid injection is useful to confirm a diagnosis though - I had one and it initially made things much worse/ exaberated symptoms but then started to help. At that point my surgeon knew with the MRI evidence, physical symptoms and results of the steroid that an op would be the best option. Went for it, very painful recovery but so worth it.

Thank you for posting. All the posts taken together have been really helpful. Whilst a steroid injection may be the way to go at some point, I am happy that I am not being over-cautious in not just having one straightaway, given that they can be painful and don't always help. Have asked GP for stronger anti-inflammatories. I am also hoping that over a week off at Christmas will help, as I don't think sitting at a desk using a mouse is great for shoulder.

Ive had both my shoulders operated in for this issue in the last 2.5 yrs , I had immense continuous pain and very limited movement in both . On the left side I also had excision of the clavicle . Steroids did not work for me this time although I had steroid injections in the left shoulder several years ago and that did work . What I would say is if you do end up going down the surgical route ensure that you have a shoulder specialist and not a general orthopod . I had one done by each and the recovery was not comparable and I'm fairly certain that the left ,which was done by the General orthopod will need further treatment within a couple of years .

Thanks Floral. I am certainly hoping that my shoulder won't get to the point of needing surgery, but I'm sure your advice about only allowing a specialist to operate is very sound.

I had similar symptoms that I hoped would improve with rest. Didn't work. However, a physio helped me strengthen and mobilise my shoulder and it's now much better.

Mayhew, my shoulder deteriorated rapidly after second physio session, but I keep reading online that physio is supposed to help. Did you feel that your shoulder improved (or at least didn't get any worse) as soon as you started the physio, or was it initially a lot more painful and before getting better?

Sorry for typo. Meant to say "painful and less mobile".

I did lots of short bouts of exercise 3x a day as prescribed by physio. He told me to stop if it pain increased. He also did some painful massage to release adhesions. I saw him weekly for half an hour for 3 weeks then monthly for 2 months. I saw an improvement after 2 weeks.

Thanks mayhew. The physio I saw didn't give me any exercises to do between sessions. I am increasingly thinking that I picked the wrong physio...