Subacromial Impingement Treatment

Subacromial Impingement TreatmentSubacromial impingement treatment can be either with or without surgery.  Fortunately, most of those who have isolated impingement syndrome get better with nonoperative treatment.  For those who don’t, operative subacromial impingement treatment is usually successful.

Subacromial Impingement Treatment:  Nonoperative Approach

As I discussed in an earlier post, the symptoms of impingement syndrome, not associated with some other disorder of the shoulder, may develop from routine aging of your rotator cuff but frequently arise from repetitive overhead activities. With these activities, the rotator is asked to work harder and the rotator cuff tendons and the  subacromial bursa may also get pinched by the undersurface of a bone on the top of your shoulder (acromion) and the top of your arm (humerus).  As a result, the tendon and bursa may thicken more, and the bursa may become inflamed (subacromial bursitis).  This process is often associated with some dysfunction of the shoulder.  Usually the dysfunction is a loss of motion due to tightness of the lining of the back of the shoulder.  As a result, nonoperative subacromial impingement treatment is directed at stopping and correcting these issues.

The main components of nonoperative subacromial impingement treatment are:

1. Relative rest

Absolute rest is often not required or desired. Our tendons “like” motion. However, too much activity for our “sick” tendons can make them sicker.

How much activity is too much?

Usually avoiding painful overhead activities is sufficient.  Essentially, you should avoid those activities that cause excessive pain during the activity or afterwards.  The goal is to avoid making the problem worse and to provide an opportunity for the tendon damage and bursal inflammation to settle down.

 2. Inflammation reduction

Inflammation is a large part of what is causing your pain.  So it must go away for you to feel better.  There are two ways to potentially accomplish this:

1. Oral Antiinflammatories (NSAIDs or Steroids)

2. Antinflammatory Injection(s)

NSAIDs (Nonsteroidal Antiinflammatory Drugs) and steroids are medications taken by mouth.  These don’t instantly remove the inflammation and therefore don’t instantly remove the pain.  They work slowly over time.  In many people, these may be effective in eliminating the inflammation.  In others, they may not.

When an oral medication is insufficient, an injection of an anti-inflammatory medicine directly into the bursa often can do the trick.  These can be given right in your doctor’s office. Although they have a bad reputation as being painful, for most patients this is not the case.  Usually patient’s are surprised at how little pain these injections cause.  The usual medicine injected is a mixture of a steroid, which is a strong anti-inflammatory medication, and lidocaine, a numbing medication.  This mixture is better known as cortisone.

3. Physical Therapy

Physical therapy is an important component of successful nonoperative subacromial impingement treatment. Tight tissue at the back of your shoulder as well as other shoulder dysfunction is usually present along with impingement syndrome.  If these issues are not cured, the problem usually persists. Even if the inflammation does resolve but the dysfunction is not corrected, the bursitis, along with the symptoms, often returns. Furthermore, when our shoulder hurts, we tend not to use it.  remember, our tendons “like” motion to remain, or become, healthy. Lack of complete use when we are having pain, often leads to further stiffness and weakness, and progressive shoulder dysfunction.

This is where physical therapy comes in. A skilled therapist will not only be able to identify and correct any existing shoulder dysfunction, but they will also encourage, and teach, you to use your shoulder more correctly when your brain is telling you to not use it at all.

Subacromial Impingement Treatment: Operative Approach

When nonoperative treatment fails, as it does in about 10% of patients, then surgery can often correct the problem. The operative approach to subacromial impingement treatment is an arthroscopic procedure. During this surgery, the inflamed bursal tissue is removed. Additionally, the space for the bursa and rotator cuff are sometimes narrowed. In these cases,  enlarging this space may be required. Although this is rarely needed, when it is this is accomplished by performing an acromioplasty.  An acromioplasty essentially “raises the roof” of the subacromial space by removing a spur on the undersurface of the acromion. This can reduce some of the sources of your pain. As a result, when this surgery is accompanied by postoperative therapy that helps get your shoulder functioning more normally, the combined treatment can often be very successful.

Impingement syndrome can be very painful.  It is one of the most common shoulder problems seen.  Fortunately, subacromial impingement treatment, whether nonoperative or operative, is usually very successful.  So if you suffer from this common problem, it is a good idea to see your Orthopaedic shoulder specialist and get on track to getting your shoulder better.



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