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Impingement

The rotator cuff is a group of four muscles that connect the upper arm (humerus) to the shoulder blade (scapula) to stabilise the shoulder. The tendons of these muscles pass directly under a bony prominence of the scapula (the acromion) through a tight space. If the tendons and their sac of fluid (a bursa) rub against this bony prominence, they can become inflamed and swollen.

Sameer Singh Impingement



Signs and Symptoms
As the tendons swell they become pinched in the tight space under the acromion. This leads to pain when the arm is raised. Sometimes this condition is caused by a single episode of trauma but more commonly it comes on over a period of a few weeks. Typically the pain begins when the arm is raised above the horizontal and is felt on the upper aspect of the shoulder and down the arm.

Diagnosis
After discussing your symptoms and examining you thoroughly, an X-ray is taken to exclude arthritis and other shoulder conditions. An ultrasound scan of the shoulder is then carried out to ensure the tendons are not torn and to examine them in motion. In our One-Stop Shoulder Clinic you will be scanned during your first appointment

Initial Treatment
This depends on the symptoms. Long-term relief can sometimes be achieved through anti-inflammatory medications and avoidance of aggravating activities. However, an injection of local anaesthetic and steroid into the shoulder may be necessary to settle the acute episode. As the inflammation subsides, physiotherapy exercises are encouraged to help strengthen the shoulder.

Further Treatment
If the inflammation persists despite the treatments above, or if the symptoms are particularly troublesome, arthroscopic (keyhole) surgery may be considered. During this procedure the whole joint is visualised so an exact technique to relieve the tendons can be used. Full details of these techniques will be discussed at your appointment.

Mr Sameer Singh's specialist areas