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Impingement Syndrome

What is impingement syndrome?

Impingement occurs when the rotator cuff gets irritated on the undersurface of the acromion.  The reason this begins in the first place is a source of some debate:  Some people are born with a "hooked" acromion that will predispose them to this problem.   Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff.  "Bursitis" is a an older term which we occasionally use to refer to this syndrome.  This means that the bursa - a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus - gets inflamed.

How is impingement syndrome diagnosed?

Your orthopaedic surgeon or primary care physician can have you perform various maneuvers to detect this problem.  In addition, plain x-rays can show a spur on the undersurface of the acromion.  An MRI is occasionally ordered if a rotator cuff tear is suspected.

 

What can be done to treat impingement syndrome?

Our first line of treatment is with the prescription of exercises to strengthen the rotator cuff.  These can be done by the patient independently or with a physical therapist.  We find that patients who do their exercises on their own, at home (in addition to physical therapy, if necessary) are the most likely to be able to avoid surgery. Anti-inflammatory medications (eg. Ibuprofen, Naprosyn) are prescribed.  An injection of a corticosteroid medication into the bursa may also be performed - this helps to decrease inflammation, and therefore, pain, within the bursa.   All these forms of treatment are called "conservative" - meaning they do not involve surgery.

What happens if impingement syndrome goes untreated?

Many people get mild impingement from time to time and it goes away on its own.  People also often respond to treatment with exercise and medicine, as detailed above. Some people will continue to have symptoms and progress to a rotator cuff tear.

What can be done if the "conservative" treatment fails?

The spur on the undersurface of the acromion can be removed, surgically.  There are two ways to do this: 1) Open decompression - an incision is made on the front of your shoulder and the spur is removed.  2) Arthroscopic decompression - two or three small incisions (about 1/2 an inch each) are made around your shoulder and an arthroscope is placed into the bursa - using specialized instruments, the spur is removed.I prefer the arthroscopic decompression because it is much less painful for the patient, the recovery time is less, and the scars are more cosmetic.   This type of surgery takes less than an hour to perform and is performed on a "same-day" basis - you go home the same day you have surgery - no need to stay in the hospital overnight.

What is the recovery after surgery?

For arthroscopic surgery, the recovery period is relatively short.  I encourage patients to move their shoulder immediately after surgery, although their arm is placed in a sling for comfort. Cryotherapy can be of help in reducing the pain post-operatively - you should check with your insurance company if they will pay for such a device. Strengthening exercises are prescribed.  For people who work at a "desk job", many can return to work within 1 week of surgery.   Heavy laborers may require a longer time off work.

 

- Laith A. Farjo, M.D. 

 

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