Subacromial Impingement
What is Subacromial Impingement?
Impingement syndrome is pain due to pinching / compression of the rotator cuff tendon and burs on top of your shoulder beneath the acromion bone. This is the commonest cause of shoulder pain in patients over the age of 30, although can affect younger age group patients.
What Causes it?
We use our shoulder constantly and the resulting strain makes the rotator cuff weak although often a minor trauma or excessive repeated activity like overhead sports may precipitate the symptoms. Sometimes there is no specific triggering point. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible. Often the symptoms are associated with ACJ Arthropathy
What are the symptoms?
Initial symptoms may be mild. Minor pain that is present both with activity and at rest
- Pain radiating from the front of the shoulder to the side of the arm
- Pain with overhead, reaching/stretching movements
- Athletes who do overhead sports may have pain when throwing or serving a tennis ball
- As the problem progresses, there may be pain at night.
- Strength and motion may be lost. It may be difficult to do activities that place the arm behind the back, such as buttoning or zippering.
How is it diagnosed?
The diagnosis is usually based on a good clinical history and physical examination. Your doctor will also want to know how much your pain affects your daily tasks. There may be tenderness of the top of the shoulder joint.
Investigations:
The diagnosis of subacromial impingement is mainly based on history and physical examination. Plain radiographs, ultrasound and / or MRI scan may be requested to look for other pathologies around the shoulder.
Treatment:
- Conservative treatment comprising of rest, activity modification and non-steroidal anti-inflammatory may be helpful in the early stages and when symptoms are mild
- Physiotherapy: A rehabilitation programme may be directed by a physical or occupational therapist may be helpful in stretching the joint and preventing the loss of movements. The success depends on the level of pain and expectations. A focused rotator cuff strengthening programme will reduce the symptoms.
- Injections: An ultrasound or fluoroscopy guided injection in the subacromial space provides a decrease in inflammation and reduces pain.Cortisone’s effects are often temporary, but it can give very effective relief in the short term. It also aids in confirming the diagnosis.
- Arthroscopic Technique
If the non-operative treatment fails, then the commonest form of surgical intervention is called –arthroscopic subacromial decompression is performed in which the bony spur is removed from acromion. The inflamed bursa is also removed. A fibre-optic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon can perform the repair under video control.
After surgery, the arm will be placed in a sling for a short period of time. This allows for early healing. As soon as comfort allows, the sling may be removed to begin exercise and use of the arm.
- Open Technique:
This allows direct visualisation of the joint and is used in select cases, often revision cases when it is difficult to access it via keyhole.