Shoulder impingement is a clinical condition that happens when the rotator cuff is compressed or irritated by the overlying scapula bone during certain motions. This pain occurs when the rotator cuff and the bone over top of it—the acromion part of the shoulder blade—develop clinical findings that suggest a mechanical irritation, although often the real cause is related to a problem of a rotator cuff tendon itself.
In overhead athletes, like swimmers and baseball players, the rotator cuff can become fatigued, preventing the shoulder from staying in the center of the shoulder socket (glenoid) and allowing it to move upwards towards the acromion, causing pain. In these cases, the problem is not the acromion but rather the overuse of the shoulder and rotator cuff. However, if the problem is not corrected, a rotator cuff tear can occur, which can be a partial tear at first, then progress to a full tear. In general, shoulder impingement causes low-grade, persistent pain aggravated by overhead activities during the day and is often worse at night. It may also cause weakness in the shoulder or arm.
Shoulder Impingement FAQ
Is impingement sometimes misdiagnosed?
Yes, frequently. Many conditions—such as calcific tendonitis, bicep tendonitis, arthritis, early frozen shoulder, and overuse of the shoulder—can mimic impingement syndrome. The most effective way to get the right diagnosis is a careful history, a good physical exam, x-rays, and sometimes an MRI. This diagnostic term “impingement syndrome” made sense when first used more than 50 years ago. Since then, we have a better understanding of the shoulder and realized that the term “impingement syndrome” is a general term that simply describes patients who have pain when they raise up their arm. When a patient presents with this diagnosis, Dr. Romeo carefully examines the shoulder and reviews the radiology studies to better define the real cause of the pain and limited function.
This diagnostic term “impingement syndrome” made sense when first used more than 50 years ago. Since then, we have a better understanding of the shoulder and realized that the term “impingement syndrome” is a general term that simply describes patients who have pain when they raise up their arm. When a patient presents with this diagnosis, Dr. Romeo carefully examines the shoulder and reviews the radiology studies to better define the real cause of the pain and limited function.
Is surgery an option?
Yes, in severe cases. If therapeutic exercises, medications, and injections fail to resolve the problem, then Dr. Romeo will perform a surgical procedure to widen the space above and around the rotator cuff, as well as debride the inflamed tissues and bursa. In most cases, this procedure is combined with another surgery to treat the area near the symptoms that is also responsible for the pain, such as repairing the rotator cuff or treating a damaged bicep tendon.
Subacromial Decompression Surgery
Subacromial decompression surgery, also called acromioplasty, is performed arthroscopically. Subacromial decompression surgery relieves pressure by making more room for the soft tissues around the rotator cuff.
During surgery, a tiny camera is used to guide the insertion of a small tube and surgical instruments through a small incision. The inflamed bursa located above the rotator cuff tendon is removed and some of the undersurface of the acromion is shaved off. This gives room to perform a full range-of-motion without catching on the bone or rubbing against it.
Some patients develop a spur on the undersurface of the acromion, causing a spike pinching down on the rotator cuff. This is also removed as part of the procedure. In severe cases, your surgeon may need to schedule more complex surgery to repair damage or a tear to the rotator cuff.
Subacromial Decompression Recovery
After surgery, you will be sent home with a sling to wear for a few days after surgery. Reduce swelling and discomfort by applying ice packs to the shoulder several times a day. Dr. Romeo will give you specific instructions for post-op pain management. After a few days, physical therapy begins. Physical therapy includes range-of-motion exercises and light strengthening exercises (below shoulder level) for the first few weeks.
You will typically be able to return to normal everyday activities within four to six weeks, if you follow your doctor’s advice to avoid motions that would put stress on the joint and tendons. This includes any activities that involve throwing or lifting activities above shoulder level. Swimmers will need to stay out of the pool during this time
After six weeks, a moderate strengthening program will be implemented, including exercises above the shoulder level. Shoulder impingement treated with an acromioplasty surgery usually takes about three to six months to heal completely. Advanced cases can require up to a year for full recovery.
For more information about shoulder impingement and treatment options, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. He is also experienced and skilled at taking care of patients who have had surgery for impingement syndrome but did not achieve the outcome that they expected. Call or email our office today to schedule your visit.
Anatomy of the Shoulder as it relates to Surgery
Animations of Shoulder Surgery
Additional Links on Shoulder Impingement
If you would like to learn more about impingement and the surgical management, here are a few of the articles Dr. Romeo has written over the years:
- Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015.
- Arthroscopic Subacromial Decompression and Acromioplasty
- Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.
- The role of acromioplasty for rotator cuff problems.
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.