CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Shoulder Impingement
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Injuries and Conditions: Shoulder Impingement : Shoulder Impingement : Treatment Options
 

Overview
Initial treatment for shoulder impingement should begin with and include rest and a reduction in activity. The avoidance of all overhead activities is recommended.

Treatment options:

Operative: Shoulder Impingement Overview
The treatment of subacromial impingement syndrome is dependent on the stage of the condition and the underlying structures of the shoulder that cause the impingement. The surgical procedures used to treat this condition remove the arthritic changes of the acromioclavicular joint or the degenerative bony spurs on the underside of the acromion. The surgical procedure can by carried out under direct visualization or by the use of arthroscopic techniques. The use of the arthroscope is becoming increasingly common and may lessen the post-operative recovery time.

Evaluation of Patient for Surgery

  • Patients undergo a complete history and physical, along with, specific diagnostic imaging studies to determine the severity and stage of subacromial impingement syndrome.
  • Determination if the cause of the impingement is from the undersurface of the acromion, the acromioclavicular joint, or both.

    Post Operative Recovery
    Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.

  • Post-operative pain will be present and may require over-the-counter or prescription medication to control the pain.
  • Surgery is performed as an ambulatory proceedure, with patients going home the same day.
  • A sling is worn for several days for comfort.
  • Physical therapy is usually begun the first or second week for range of motion and strengthening.
  • Most discomfort is gone by six weeks to three months, at which time sports may be resumed. Some minor discomfort, however, may persist for six months to one year.

    Surgical Procedure
    The most common surgical procedure for the treatment of stage II and stage III impingement is a combination of the removal of the undersurface of the tip of the acromion and any impinging soft tissue (e.g. bursa, coracoacromial ligament). The removal of the undersurface of the acromion is known as an acromioplasty. Occasionally patients will have arthritic changes in the AC joint and require removal of the end of the clavicle. The removal of the end of the clavicle is known as a Mumford procedure. The above surgical procedures are usually performed arthroscopically.

    The procedure summary:

  • Arthroscopic visualization of the shoulder joint and the undersurface of the acromion, the coracoacromial ligament and the acromioclavicular joint.
  • Removal of the undersurface and the tip of the acromion with any associated degenerative bone spurs to allow adequate room for the rotator cuff to travel freely under the acromion.
  • Cutting of the coracoacromial ligament.
  • Removal of the lateral 1-2 cm of the clavicle and the AC joint capsule, if AC joint symptoms are present.
  • Smoothing of all bone surface to prevent further irritation or erosion of the rotator cuff.
  • Repair of the rotator cuff as indicated. (This is not part of the acromioplasty or Mumford procedure).

    Long Term Expectations for Recovery
    Surgical treatment of shoulder impingement with rotator cuff tear repair as needed should allow the patient to regain near full range of motion of the shoulder with minimal or no pain.

  • The success of surgery is highly dependent on a progressive but aggressive physical therapy program designed to regain shoulder motion and to strengthen the muscles of the rotator cuff and deltoid muscles.
  • Most patients are able to return to sports or an avocation requiring repetitive overhead activities.

    Possible Complications and Risks

  • Occasionally, bone spurs may recur.
  • Excessive scar tissue may occasionally occur.
  • Failure to regain full motion of the shoulder after the surgical procedure.
  • Re-injury or further injury to the rotator cuff.
  • Risks during and after surgery include problems that may develop in relation to bleeding, infection, damage to nearby nerves and blood vessels and a reaction to anesthesia.

    Conservative Treatment of Shoulder Impingement Overview

  • Rest and Activity Modification: Initial treatment for shoulder impingement should begin with and include rest and a reduction in activity. The avoidance of all overhead activities is recommended.
  • Medication: Over the counter or prescription medications, including NSAIDs will help to reduce the inflammation and swelling of the shoulder muscles.
  • Icing: Ice applied to the injured shoulder is an excellent way to reduce inflammation and pain.
  • Injections: Moderate to severe cases may be treated with an injection of a corticosteroid into the subacromial area.
  • Physical Therapy: Specific rotator cuff stretches and strengthening exercises may be prescribed by your physician.

    Rehabilitation Program
    A rehabilitation program involving physical therapy is suggested after the initial shoulder symptoms have subsided.

    Medication and Medical Products
    NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Long-Term Expectations for Recovery

  • Patients who follow the recommended course of therapy, should expect a complete recovery within six (6) weeks. With a severe shoulder injury where tearing of the muscle and tendon has occurred, scar tissue may remain and full range of motion may never be obtained.
  • Patients with rotator cuff tears in addition to impingement often require surgery. In these cases, it may take 3-6 months for recovery; however, a majority will be able to return to their preinjury level of activity.
  • A complete recovery is dependent on the severity of the injury, the health and habits of the patient, the pre-injury condition of the shoulder, and the patient's compliance with a prescribed physical therapy program or conditions present.
  • Maintaining an active exercise program, which includes stretching and strengthening of the shoulder muscles to avoid stiffness and weakness is recommended. Adhesive capsulitis (Frozen Shoulder syndrome) may result if exercise is avoided.

    Possible Complications and Risks

  • Poor muscle conditioning or nutrition may increase the risk for further injury or prolong your recovery time.
  • Improper lifting of heavy objects following may inhibit healing or result in further injury to the tendons.
  • The participation in sports involving repetitive motion of this arm and shoulder may predispose the rotator cuff to further injury.

    Surgical Hardware Considerations

    This procedure does not require the implantation of surgical hardware.


    Factors in Transplant Source
    This procedure does not require the use of a transplant or graft.