Impingement Syndrome

The rotator cuff is made up of four muscles which blend together and attach to the ball of the shoulder, the humeral head. The rotator cuff helps to hold the ball down in the socket and to facilitate movement and arm positioning.

The cuff is between the top of the shoulder (the acromion, which is a part of your shoulder blade) and the ball (head of the humeral bone). Here the rotator cuff lives between the proverbial "rock and the hard place". Frequent irritation results in “bursitis” an inflammation of the bursa in this area. This tissue is forced to perform strenuous tasks in this unforgiving environment. As we age, the tendons of the cuff may wear and weaken, allowing the ball to apply more pressure to the cuff. This is what we refer to when we say "Impingement Syndrome". This problem is often associated with rotator cuff tears and arthritis between the end of the clavicle (collar bone) and the acromion (the acromioclavicular or “AC” joint).

Symptoms:
Initial symptoms may include shoulder pain or catching with certain activities like overhead sports or work. If the symptoms do not go away and pain increases in duration and frequency (like aching which keeps you awake at night), an exercise program may be helpful. The treatment program may include activity modification, specific stretching and strengthening exercises, rest, anti-inflammatory medications, an occasional cortisone injection, or other physical therapy modalities. Surgery for "impingement syndrome" is only considered after an adequate trial (generally at least 3 months) of dedicated non-operative treatment.

The Surgical Procedure: "Acromioplasty"
If non-operative treatment fails, we consider surgical treatment. The objective of this type of treatment is to take away the pressure on the rotator cuff and restore normal unrestricted motion. This is usually accomplished by removing bone from the roof (acromion) of the shoulder which often has a bone spur and removing the excess bursa. Sometimes it is only necessary to remove the bursa itself if the ligament and bone are not abnormal. We also release a ligament which attaches to the roof in the same location where the spur forms. This takes the pressure off the rotator cuff and allows you to perform the exercises that are necessary to rehabilitate the shoulder. Sometimes there is associated arthritis at the acromioclavicular joint which must also be treated by removing the end of the clavicle. Also sometimes it is discovered during surgery that there is a tear in the rotator cuff or the labrum that must be repaired and if that is the case, repair would be done during the same surgery.

Removal of the inflamed lining over the rotator cuff (the bursa), along with bone spur removal is done as an arthroscopic procedure. Arthroscopy allows us to look inside the joint and actually see the inner surface of the rotator cuff, the joint surfaces and ligaments. No muscle incision is required. Light general anesthesia and a nerve block makes the pain minimal in the early post op time period and facilitates out-patient surgery.

Surgical Risks:
The risks of the operation are those of any major surgical procedure. There is the risk of infection, either superficial (like skin) or deep (as in the joint). There is risk of injury to vital structures such as blood vessels or nerves, which may lead to bleeding, numbness, weakness, or paralysis. Mechanical or electrical instrument failure may potentially rarely occur, terminating the procedure or necessitating open removal of broken equipment. Occasionally, surgery is not helpful, resulting in recurrence or persistence of symptoms. As with any surgery there are potential risks to other organ-systems such as the heart, kidney, or lungs. Other risks of anesthesia (such as allergic reactions), are possible but are all extremely rare.

After the Operation:
We like to begin early motion to prevent scar tissue from forming. Surgery is generally done as an outpatient, unless associated medical problems make admission necessary.

After arthroscopic surgery we will see you a few days later. You will be instructed in home exercises and based on your progress over the first week to ten days, often you will begin out-patient physical therapy. You may assist the operated limb with the exercise motions, but it is all right to use the arm on its own. You may be out of your sling within a few days at least part-time as your comfort permits. Specific rehabilitation plans will be explained to you immediately after surgery based on the findings of surgery. You may begin the strengthening exercises as soon as you can do them comfortably.

We will see you 2-3 days after surgery to change your bandage and check your motion. Sutures are removed about 7-10 days after surgery. Full recovery from acromioplasty usually occurs by 3 months but is sometimes longer depending on the activities you must do and the severity of your condition. Often we suggest the assistance of a professional physical therapist in your post-operative recovery.