Impingement Syndrome

What is it?

Impingement syndrome is when the tendons of your shoulder or the bursa (fluid filled sac) of your shoulder become inflamed.

This gives you pain when you move your arm above shoulder height or twist your shoulder.

The reason being is the inflammation around your shoulder gets nipped against the roof of your shoulder (Acromion) in these positions causing pain.

How does it happen?

There are a number of reasons that this can happen including; poor posture, repetitive jobs, weak muscles, tight, tense or injured muscles.

Generally this problem occurs for no apparent reason and is a result of a build up of the above problems over years and months.

The pain is usually caused by the arm bone (humerus) nipping against the under surface of the top of the shoulder blade (the acromium). This is usually a fairly tight space, but due to changes due to wear and tear or due to the shape the bones have developed the space can be considerably reduced. Muscles that stabilise and move the shoulder get trapped and become initially painful, with swelling developing around them. Eventually these muscles may become damaged and the tendons that attach the muscles to the bone can tear (rotator cuff tears).

How can physiotherapy help?

Physiotherapy helps to bring down the inflammation around the tendons and the bursa. It also helps to correct the problems that instigated the pain and prevent the pain from returning. This is aided by loosening out the tight muscles, strengthening the weak muscles and correcting posture. Examining your lifestyle and work environment and adjusting these to eliminate the aggravating factors.

As the condition develops some people change the way they use the shoulder and start to put more force on the shoulder blade. This can cause complex shoulder problems and often needs corrected by physiotherapy. Physiotherapy can also help to strengthen the small muscles around the shoulder to reduce pain and improve function.

Physiotherapy alone may not control the symptoms of impingement and your specialist may arrange for you to have an injection of steroid (cortisone) into the inflamed area. This is to try to reduce the swelling, to allow both the pain to settle and to give the shoulder more freedom to move.

If these treatments do not improve symptoms sufficiently then you may be offered surgery.

Subacromial Depression

Surgery aims to remove the inflamed areas of bone and soft tissues, to allow the muscles around the shoulder not to be nipped and trapped. This is performed usually with a telescopic (arthroscope) technique. The wounds will be small (usually less then 1cm) and will be around the shoulder (usually no more than 3 wounds).

During the surgery spikes of bone are removed leaving an enlarged area around the muscles and tendons of the shoulder. Any inflamed soft tissues (bursa) are also removed. The tendons of the rotator cuff are checked and repaired if necessary.

Most patients will be given an anaesthetic block that will dull any pain for the initial few hours following surgery. After this time you will need to take significant painkillers that will be prescribed for you. It is important to take regular painkillers for the first few weeks as if your shoulder becomes too painful your exercises will suffer and the shoulder may become very stiff.

After an initial few days of rest your physiotherapist will then show you exercises to perform to try to build up the strength and range of movement in your shoulder. These exercises are very important to allow good co-ordinated strong movements to be regained.

It is very important for you to remember that this is significant surgery for your shoulder. Most people achieve excellent results; however it will take 6 to 9 months to achieve a good result with little pain.

Targets for recovery should be:

Washing unaided: 2- 3 weeks

Driving: 6 – 8 weeks

Golf: 12 weeks

Full return of function: 6 – 9 months