context: Rotator cuff impingement is most common in older adults and athletes, but 20% of all people will get it at some point in their lives. This shoulder problem can often be treated at home, but in severe cases you may need surgery. You're able to move your shoulder because of a group of muscles and tendons called the rotator cuff. An impingement happens when one of these tendons gets injured, causing it to swell and get pinched by the bony top of your shoulder joint. The âpinchingâ makes it hard for blood to flow through. Because of that, your tendon can start to fray and split like a piece of rope. People get a rotator cuff impingement for different reasons. In people younger than 25, it's often caused by using your shoulder too much, or by trauma. But if you're over 50, it's probably due to general wear and tear on your shoulder over the years. And the injury is more likely to go beyond a âpinchedâ tendon, and could end up as a partial or complete tear. Sometimes, an injury, like falling, can also cause an impingement. If you have a rotator cuff impingement, you'll notice pain in your shoulder. Reaching your arms behind your back or raising them overhead will make the soreness worse. So will twisting motions, such as trying to put on a coat. Some people wake up at night because of the pain. Your symptoms could come on quickly if an injury is to blame. If you're older, the signs could show up slowly over a period of time. Your doctor will ask about your symptoms. Then she'll have you move your shoulder in different ways to test your strength and range of motion. Because many other conditions share the same symptoms as impingement, your doctor will likely do an imaging test to see what's happening inside your shoulder. This may include an X-ray, ultrasound, or MRI. Most people are able to easily treat themselves at home by: Rest. You'll need to stop all physical activity that puts stress on your shoulder or causes you pain. This may include things you do at your job. Pain relievers. Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin, ibuprofen or naproxen can ease your pain. Ice. A cold pack applied 20 minutes, three times a day, can offer relief. You could also massage the area with an ice cube for 10 minutes at a time. Physical therapy. Your therapist can teach you exercises help strengthen the muscles of your shoulder. They'll also improve your strength and range of motion. Injection. A shot of numbing medicine and steroids in your shoulder joint can reduce soreness and swelling. Most people who follow these steps see their shoulder pain improve in 3 to 6 months. If your symptoms don't go away after 6 months, your doctor could suggest surgery. This may also be needed if one of your tendons is torn and can't heal on its own. The most common surgery to fix a rotator cuff impingement is called a subacromial decompression ( SAD). Your surgeon will remove any swollen tissue in your shoulder and bony growths that have occurred. This helps with healing and creates more room in your shoulder so your tendon isn't pinched any longer. The surgery often is done on an outpatient basis, meaning you shouldn't have to spend the night in a hospital. Afterward, your arm will need to be in a sling or splint. While recovery is different for everyone, it may take 3 to 4 months before your arm fully heals. During that time you'll need to do daily exercises to rebuild your strength. Because healing can take a while, talk to your doctor about whether surgery is the best option for you.