Subacromial Impingement

What are the symptoms of shoulder impingement?

The most common symptom of shoulder impingement is a constant, dull pain located near the front and lateral (outer) part of the shoulder. Other symptoms include:

• Sharp pain when reaching overhead or behind the back

• Shoulder weakness

• Pain that radiates from the affected shoulder into the upper arm

• Worsening pain at night, especially while sleeping on the affected side

How is shoulder impingement diagnosed?

Dr. Koscso will obtain a comprehensive medical history and physical examination to properly diagnose shoulder impingement. Diagnostic imaging such as x-rays may be a fundamental step in providing an accurate diagnosis. Advanced imaging, such as an MRI, can often be avoided when evaluating shoulder impingement, though it may be requested to ensure there is no other soft tissue damage occurring in the shoulder. This would be determined at the time of your visit with Dr. Koscso.

What is the treatment for shoulder impingement?

Prompt medical attention is recommended if shoulder impingement is suspected. Because the tissue will continue to thicken and inflame with repeated shoulder use, the shoulder pain can worsen with the possibility of further damage to the rotator cuff. If treated early, patients can minimize swelling and continued discomfort.

Nonoperative Treatment

Patients diagnosed with shoulder impingement are generally able to heal with conservative treatment measures only. Non-steroidal anti-inflammatory medications can reduce the pain and inflammation. Activity modification, or temporarily avoiding the activities that worsen the pain, is another important step. A corticosteroid injection directly into the subacromial space can diminish pain and inflammation not relieved with oral medications and may be an option depending on the severity of your symptoms. After the reduction of pain and inflammation, a physical rehabilitation program aimed at correcting shoulder muscle imbalances, optimizing shoulder mechanics, and strengthening the muscles and tendons of the rotator cuff is critical to successful nonoperative treatment.

Operative Treatment

If conservative therapy is unsuccessful, or if a patient is experiencing more severe pain and inflammation, Dr. Koscso may recommend a shoulder arthroscopy, a minimally invasive surgical procedure using a small camera (arthroscope) to view the muscles and tendons of the shoulder. Any irregularities, such as bone spurs or tears, are removed and repaired with specialized surgical instruments. In most cases, the edge of the acromion where most bone spur formation occurs is removed along with damaged bursal tissue. This procedure utilizes smaller incisions in the shoulder that allows patients a quicker recovery time.