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Commonly asked questions about Shoulder Impingement

Q:

What is impingement?

A:

This refers to an overgrowth of bone on the undersurface of the collar bone which subsequently can rub (impinge) against the underlying rotator cuff muscle. With repeated activities, this can cause a tear of the rotator cuff muscle.

Q:

Who gets impingement?

A:

It is most common in middle aged people who use their arms frequently for repetitive overhead activities such as plasterers, painters and builders. It is also relatively common in athletic individuals participating in swimming, baseball and tennis.

Q:

How do you diagnose impingement?

A:

The diagnosis is made during clinical examination, confirmed with x ray. An ultrasound or MRI scan is also necessary to exclude a rotator cuff tear, which unfortunately is very common as presentation is often delayed..

Q:

What is the treatment for impingement?

A:

If there is no tear of the rotator cuff, simply trimming the over growth of bone using arthroscopic (key hole) surgery known as arthroscopic subacromial decompression. This reliably produces excellent result. If there is also a concomitant tear of the rotator cuff, an arthroscopic repair is advisable.

Q:

After surgery, can the bone spur grow back?

A:

No, the bone spur subsequently does not grow back.

Q:

What happens when the rotator cuff is also torn?

A:

The rotator cuff will also need to be repaired at the same time using key hole surgery. Using two to three little stab incisions (about 0.5 to 1cm each in size) around the shoulder, the camera as well as a variety of surgical instrument are inserted into the shoulder. The rotator cuff is fixed back onto bone (humeral head) using suture anchors which are 5mm screws with an eyelet at the end through which sutures pass through. The suture material is made of an ultra-high molecular weight polyethylene and multiple sutures are required to achieve a secure repair.

Q:

Can impingement progress?

A:

Yes. If untreated, chronic impingement gradually leads to subacromial bursitis, partial tear and thinning of the rotator cuff, eventually complete cuff rupture.

Q:

What can I do to lessen the pain with impingement?

A:

This mainly relates to taking anti-inflammatories and activity modification. For example, when lifting heavy objects, aim to lift close to the body; do not try and lift above shoulder level, throw underhand or sidearm, serve tennis underhand, maintain good posture and range of movements in the shoulder to prevent a secondary frozen shoulder

Q:

Can steroid injections help?

A:

In the short term, steroid injections can be extremely effective. However, in the long term, particularly when there is a tear of the rotator cuff, steroid injections can damage the ultrastructure of collagen molecules, reduce collagen density as well as inhibit the reparative properties of tendon by inhibiting tendon cell migration and synovial fibroblast proliferation. Its use is therefore best avoided as a long term treatment.


The information on this website does not replace medical advice. If you have a medical problem please see your doctor or consultant.