Subacromial impigment syndrome

What is it? 

The shoulder is moved by the muscles and tendons of the rotator cuff. Between these and the acromium, which is part of the shoulder blade, is the bursa, a kind of cushion. This compartment usually has a height of about 1 cm. For various reasons (bony spur, instability, tendon thickness) this space may be further reduced so that the soft tissues are compressed between the humeral head and the acromion. This compression leads to inflammation of the bursa with corresponding pain or even tendon injury, particularly in the presence of repetitive shoulder activities.



What are the symptoms?

The main symptoms of subacromial impigment are pain during overhead movements and night pain in the lateral region of the shoulder and arm, which may radiate to the elbow. 


How do I know if I have this problem? 

In addition to physical examination of the shoulder performed by the physician, radiographs and ultrasound are usually performed, which allows the detection of lesions of the rotator cuff and fluid in the joint. If the rotator cuff rupture is suspected, a MRI with or without contrast agents may be required. Local injection with anesthetic may be useful for diagnosis.


What treatment options are there?

After diagnosis, conservative treatment is started, which includes medication with non-steroidal anti-inflammatory drugs and pain killers, as well as physiotherapy, posture corrections and self-exercises performed by the patient at home. When the pain is very severe and these measures fail, local injection with a substance similar to cortisone is indicated. Most cases improve with conservative therapies, with no need for surgery. However, if the pain persists despite these measures, surgery may be indicated. This is performed by arthroscopy, a minimally invasive procedure, without large incisions. In this procedure the bursa (ie, “the cushion”) and a few millimeters of bone are removed, creating more space for the tendon to move. 



What is the postoperative treatment? 

After surgery the shoulder can be moved freely as pain allows. The day after the surgery, physiotherapy begins with the GO team. The duration of physical therapy varies from person to person but usually lasts between three and six months. Depending on the type of patient's profession, the return to work is expected between six and twelve weeks after surgery.