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. 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. The length of recovery from a subacromial decompression procedure will usually be 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.
Patient Portal. Request an Appointment. Common shoulder conditions may include: Dislocation Instability Separation Labral Tear Rotator Cuff Tear Bursitis Arthritis Depending on the condition, individuals may experience stiffness, pain, loss of strength, limited range of motion and other debilitating symptoms. Shoulder problems may be diagnosed after a review of symptoms and a physical examination of the shoulder.
Additional tests may include X-rays, CT scans or MRI scans to rule out any other conditions that may be causing symptoms. Treatment for shoulder pain depends on the location and cause of the pain. Many shoulder conditions can be effectively treated through nonsurgical methods such as rest, applying ice or heat, stretching, physical therapy and anti-inflammatory medication. Some patients with severe shoulder conditions may require surgery, but most of these procedures can be performed through arthroscopy.
Surgery is often successful in repairing shoulder problems and restoring function and strength to the joint. Bursitis is a painful inflammation of a bursa, one of the small sacs at the joints that cushion the tendons, muscles and bones.
Bursae normally enable fluid movement, but when overtaxed they can inflame and fill with fluid. Once a bursa becomes irritated, gritty and rough, it can create painful friction in the joint.
Following subacromial decompression to repair impingement syndrome, you will need to take steps to reduce the pain and inflammation in your shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain and swelling. Immobilizing the shoulder in a sling for two or three days will help keep it stabilized. Larger tears may require you to wear the sling for a few weeks.
You usually are instructed to remove the sling for part of each day to perform gentle motion exercises that will keep your shoulder from tightening up. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:. The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied for 15 to 20 minutes at a time, three or four times a day. If the swelling has decreased after 72 hours, you may be able to apply heat to help reduce pain.
You should not apply heat to swollen areas because heat increases blood flow to the skin, which can prolong the healing process. Physicians generally recommend that you wear the shoulder sling day and night for about two or three days. You can usually remove the gauze bandage and bathe regularly after two days. You can take your sling off for brief periods while you bath, but remember to avoid moving your injured shoulder.
Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues past a couple days. When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises. You should move your fingers and hands in the sling as much as possible to help circulate blood. If you develop a rash or irritated skin around your sling, call your physician.
If you notice any abnormal wear or discomfort in the sling, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days.
Slings should not irritate your skin. You may feel some stiffness in your shoulder. If the stiffness does not ease after two or three days, call your physician. Physical therapy following subacromial decompression to correct shoulder impingement usually progresses through four phases. The first phase focuses on decreasing inflammation in your shoulder. Your therapist usually helps you move your arm and stretch your shoulder.
When you feel comfortable moving your arm with your own strength, you can work on restoring a full range of motion and strengthening the hands, wrist, and elbow. The third phase focuses on shoulder strengthening exercises.
These may begin with isometric exercises, which strengthen the muscles without motion, and progress to resistive exercises that may involve pulleys or weights. When the muscles in the injured shoulder are about as strong as the uninjured muscles, phase four of rehabilitation becomes more activity oriented. You usually perform sport-specific exercises and coordination drills under the supervision of a therapist or coach.
Patients generally progress quickly through the four phases of rehabilitation. Our experienced shoulder specialist Dr. Leon Popovitz will discuss your options and determine if arthroscopic surgery is right for you. October 11, Prefer to speak to someone right away? If you prefer to call us directly to book the appointment then we would be happy to take your call. Phone: Midtown 67 W. Suite , New York, NY
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