What is it?
Shoulder impingement syndrome is a condition where the tissues in the subacromial space become inflamed causing pain. It is common in patients above the age of 40 years and is associated with overhead sports and activities. The bursa / fluid filled sac become inflamed causing bursitis. The rotator cuff tendons lie in a small space and they become‘pinched’ on arm elevation.

What are the signs and symptoms?
The symptoms may be related to overuse or single episode of trauma. In many cases the symptoms gradually increase over a few weeks. Pain is worse on arm elevation and dressing may become difficult. Due to the pain there may be limitation in movement.

The pain is often felt at the upper aspect of the arm and may travel down to the shoulder.

The pain usually starts when the arm reaches the horizontal level.

How is the diagnosis made?
The doctor will listen to the description of the symptoms and examine the shoulder. X-rays will be taken to look at the joints of the shoulder and ACJ arthritis can contribute to impingement. X-Rays help exclude other disorders of the shoulder. An ultrasound scan is required to look at the rotator cuff tendons to make sure there is no tear and to examine the shoulder tendons in motion. The ultrasound scan can often be performed at the time of examination in the 1 Stop Shoulder Clinic provided by shoulderelbowhand.

What is the initial treatment?
Symptoms can range from a minor annoyance to crippling and your specialist will outline the treatment options for you depending on your symptoms. Anti-inflammatory drugs and avoidance of aggravating activities may be all that is required. A local injection of local anaesthetic and steroid often settle the acute episode. After the inflammation subsides, the patient should practice shoulder strengthening exercises with the aid of physiotherapy.

If initial treatment doesn't work, what's next?
If the symptoms persist despite conservative treatment and the symptoms are troublesome, arthroscopic surgery may be considered. This involves placing small instruments around the shoulder to shave away bone to allow the tendons to move freely. This is called an arthroscopic subacromial decompression and may be combined with an arthroscopic ACJ excision. The advantage of arthroscopy is that it allows visualisation of the whole joint and rotator cuff. It is performed through small incisions the recovery is quicker and complications reduced when compared to open surgery.