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Shoulder Impingement

Dr. Lingaraju A P - Consultant Orthopaedic & Joint Replacement

Shoulder Impingement/ Rotator Cuff Tendinitis Subacromial Decompression (SAD)

What are the common causes for shoulder pain?

The Rotator cuff is a common source of pain in the shoulder. Pain can be due to:

  1. The rotator cuff tendons can be irritated or damaged.
  2. The bursa can become inflamed and swell with more fluid causing pain.
  3. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.
Shoulder Impingement

What is Shoulder Impingement?

When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain. You will find difficulty in doing above the shoulder activities.

Shoulder Impingement Syndrome is commonly seen in?

Shoulder impingement is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.

What are the symptoms of shoulder impingement?

The common symptoms include,

  1. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.
  2. Pain radiating from the front of the shoulder to the side of the arm
  3. Sudden pain with lifting and reaching movements
  4. Athletes in overhead sports may have pain when throwing or serving a tennis ball
  5. Difficulty doing activities that place the arm behind the back, such as buttoning or zippering
How the Shoulder Impingement /Rotator Cuff Tendinitis treated?

The goal of treatment is to reduce pain and restore function. In planning your treatment, we will consider your age, activity level, and general health

Most initial stages can be managed nonsurgically

Nonsurgical Options:

Options may include,

  1. Rest and activity modification, such as avoiding overhead activities.
  2. Nonsteroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
  3. Physiotherapy: physiotherapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.
  4. Local steroid (depomedrol) injection
  5. Platelet rich plasma (PRP)

Surgical options:

Subacromial decompression is the surgical option.

The two techniques commonly used subacromial decompression are,

  1. Mini-open subacromial decompression
  2. Arthroscopic subacromial decompression
What is Subacromial Decompression?

Subacromial decompression is a surgical procedure on the shoulder to treat shoulder impingement. Subacromial decompression is also called ‘acromioplasty’. The goal of surgery is to create more space for the rotator cuff by removing the bursa and removing the bony spur under the acromion process.

How is Arthroscopic Subacromial Decompression done?

Usually done under the combined brachial block and general anesthesia. The surgeon makes two small key holes in the shoulder to insert an arthroscope into the joint. At first complete visualization of the shoulder joint done to assess the structures.

Decompression is done by removing the subacromial bursa, shaving the bony bridge in under the surface of the acromion to increase the space for the free movement of the rotator cuff. Any rotator cuff tears will be repaired.  The entire surgery performed through a minimally-invasive arthroscopic procedure and all-inside technique.

How long do I need to stay in the hospital after the Subacromial Decompression surgery?

Many subacromial decompression surgeries are done on a day-care basis and do not require you to stay overnight in the hospital.

How will be my recovery after Subacromial Decompression?

You will be advised simple shoulder exercises immediate post-surgery and shoulder immobilizer for 3 weeks followed by shoulder exercises as per the protocol. You can return to all normal activities and sports by 3 months

What will happen if shoulder impingement not treated?

If you have a shoulder impingement and you keep using it despite increasing pain, you may cause further damage to the Rotator cuff. A large rotator cuff tears can happen. 

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