Impingement is a common shoulder condition that causes pain as a result of pressure on the rotator cuff from the acromion, or roof of the shoulder. There frequently is a bone spur that is rubbing on the rotator cuff, causing a pinching feeling as the arm is lifted overhead.
The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. When impingement occurs and the arm is lifted, a bone or ligament can rub against the rotator cuff, producing pain and limiting movement. Shoulder impingement typically worsens over time.
Initially, individuals with a shoulder impingement may feel mild pain in the shoulder, which often radiates from the front of the shoulder to the side of the arm. The pain may worsen upon lifting the arm, reaching for something or throwing, and there may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until the patient may not be able to lift or lower the affected arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the arm becomes difficult to move at all.
Initial treatment of shoulder impingement includes conservative measures such as resting the arm, non-steroidal anti-inflammatory medications, corticosteroid injections and a regimen of physical therapy. However, if these techniques do not provide adequate pain relief, surgery will most likely be recommended.
THE SUBACROMIAL DECOMPRESSION PROCEDURE (ACROMIOPLASTY)
Severe cases of impingement may require surgery to remove the pressure and create more space for the rotator cuff. The most common procedure for treating impingement is subacromial decompression. This surgery involves the removal of some of the affected tissue and part of the bursa, which is the small sac that has become inflamed due to the impingement. In some cases, the front edge of the shoulder blade must be removed as well. Either general or local anesthetic will be administered prior to the start of the procedure.
A subacromial decompression (Acromioplasty) can be performed through an all arthroscopic technique. Three tiny incisions are made in the shoulder area. The arthroscope and specialized surgical tools are inserted into the incisions and the surgeon uses a video monitor to view the damaged area and excise the bone spurs and bursitis, as needed. Once sufficient space has been created to allow for free movement of the tendons of the rotator cuff, the surgeon will withdraw the instruments and suture the incisions closed.
RECOVERY FROM SUBACROMIAL DECOMPRESSION
The length of recovery from a subacromial decompression procedure will usually be 1-2 months. However, the sling will be discontinued after a few days to reduce the risk of postoperative stiffness. Once the sling is no longer necessary, a rehabilitation program will begin that focuses on increasing strength and range of motion of the affected shoulder. Improvements to the shoulder in comfort and function are typically apparent within a few months after the subacromial decompression procedure, but full recovery may take as long as a year.