Treatment - How can I help

Impingement Syndrome

Other popular names

Why does it happen?

There are a number of reasons why this happens. Pain is experienced when the arm is elevated or rotated inwards:

One of the rotator cuff tendons, the supraspinatus tendon, and the sac (bursa) above it become trapped between the part of the shoulder blade (acromion) and the top most part of the humerus (greater tuberosity)

Arthritis in the acromioclavicular joint (AC joint) or bony spurs (osteophytes) from the AC joint can result in impingement and mechanical irritation to the rotator cuff tendons;

Fractures of the ball part of the upper humerus can cause impingement.

Nerve problems in the neck

Thickening of the subacromial bursa and rotator cuff tendons.

The throwing athlete may have a different kind of impingement (internal impingement). This is less common.

Symptoms

Patients usually complain of pain over the outer aspect of the shoulder when the arm is lifted above shoulder height. It may be painful to lie on at night time. Sleep may be disturbed. Reaching forwards, backwards or rotating the arm inwards may also cause pain.

Diagnosis

The diagnosis is usually made following taking the history and examining the shoulder. It is usually necessary to take some x-rays. An ultrasound is also carried out to rule out other problems in the shoulder. Sometimes an MRI scan is carried out to confirm the diagnosis or rule out other causes of the symptoms.

Non-surgical treatment

Pain killers and anti-inflammatory medication can be helpful in controlling the symptoms. Physiotherapy can also be useful in managing the pain. Sometimes a cortisone injection is carried out. All these measures are usually tried before surgery is offered for this condition.

Surgical treatment

This procedure is performed under a general anaesthetic. It is usually performed as Day Case surgery. Two small cuts measuring about 3-4mm allow insertion of a camera and a burr to shave away some bone are used. At the end of the operation the arm is placed into a sling, for comfort.

Post-surgery rehabilitation and return to normal routine

I usually advise patients to remove the sling as soon as possible. More often than not, this is before they leave hospital on the day of the operation. My advice is to start moving and using the arm as soon as the discomfort from the operation allows. It is important to take the painkillers that you are prescribed regularly, especially in the first couple of weeks. By doing so, a return to normal everyday activities is possible. In the first three weeks, if you feel that your shoulder is comfortable enough when doing a particular activity, then you are encouraged to do that particular activity. This even includes sports such as golf. Tennis usually takes a bit longer to return to, usually ten to twelve weeks.

You are usually seen in the Out-Patient clinic after about three weeks following your surgery. I would expect to find that the shoulder is still a little uncomfortable. I would expect that there would be a good range of movement in the shoulder. If not then a course of physiotherapy will be organised.

Return to driving:

You are advised to avoid driving for at least 7 days. You will be advised about this at the time of your operation.

Return to work:

You can return to work as soon as your shoulder feels comfortable enough to allow you to work. This is usually one week to ten days after your operation.
I would expect you to have approximately 80% recovery by three months after the operation. You may feel some discomfort in the shoulder for up to 12 months after the operation.

Risks

Overall over 97% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).

Specific risks:

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