Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons of the rotator cuff become compressed between the head of the humerus bone and a part of the shoulder blade. This syndrome can lead to a chronic inflammatory condition that may eventually develop into the weakening of the rotator cuff tendons. Ultimately, this situation could result in a torn rotator cuff.

Cause

Rotator cuff pain is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.

Pain may also develop as the result of a minor injury. Sometimes, it occurs with no apparent cause.

Shoulder Conditions

  • Bankart Lesion
  • Biceps Tendon Rupture
  • Broken Collarbone
  • Burners & Stinger
  • Bursitis
  • Chronic Shoulder Instability
  • Fracture of the Shoulder Blade
  • Frozen Shoulder
  • Labral Tear
  • Rotator Cuff Tear
  • Shoulder Arthritis
  • Shoulder Dislocation
  • Shoulder Impingement Syndrome
  • Shoulder Pain
  • Shoulder Separation
  • Superior Labrum Anterior to Posterior (SLAP)
  • Throwing Injuries[/li_item|

Shoulder Treatments

  • Acromioplasty
  • Arthroscopic Bankart Repair
  • Biceps Tendon Rupture Surgery
  • Biceps Tenodesis
  • Broken Collarbone Surgery
  • Bursitis/Shoulder Impingement Surgery
  • Closed Reduction Shoulder Surgery
  • Labrum Surgery
  • Instability Shoulder Surgery
  • Reverse Shoulder Replacement Surgery
  • Revision Shoulder Replacement Surgery
  • Rotator Cuff Repair
  • Shoulder Arthritis Surgery
  • Shoulder Arthroscopy Surgery
  • Shoulder Impingement Syndrome Treatment
  • Shoulder Separation Surgery
  • Total Shoulder Replacement Surgery
  • Throwing Injury Surgeries

Conservative Treatments

The Orthopedic physicians at Peninsula Bone & Joint Clinic provide conservative treatment options for Shoulder conditions and injuries.

Symptoms

Rotator cuff pain commonly causes tenderness in the front and side of the shoulder.

You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.

Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage.

These symptoms may include:

  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements
  • Athletes in overhead sports may have pain when throwing or serving a tennis ball.

As the problem progresses, the symptoms increase:

  • Pain at night
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering
  • If the pain comes on suddenly, the shoulder may be severely tender.

All movement may be limited and painful.

Diagnosis

Physical Examination & Patient History

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

Treatment Options

Non-Surgical

In most cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.

Rest. Your doctor may suggest rest and activity modification, such as avoiding overhead activities.

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling.

Physical therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.

Once your pain is improving, your therapist can start you on a strengthening program for the rotator cuff muscles.

Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.

Surgical

When nonsurgical treatment does not relieve pain, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Acromioplasty

He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic Technique

In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue.

In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open Surgical Technique

In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.

Shoulder Treatment Highlights

Reverse Total Shoulder Replacement by Dr. Todd Kim

Dr. Todd Kim provides innovative shoulder replacement options to patients with shoulder joint compromise.

A standard total shoulder replacement is designed to work only if the rotator cuff muscles and tendons are in tact and working properly. If the rotator cuff muscles are not working properly, a Reverse Total Shoulder replacement is needed.

In a Reverse Total Shoulder replacement, the glenoid component is shaped like a ball and anchored to the scapula by screws. The humeral component then becomes the new socket of the joint and attaches to the upper end of the humerus.

The joint configuration of a Reverse Total shoulder replacement allows the patient to now us the deltoid muscle instead of the torn rotator cuff to lift the arm.

Total Shoulder Replacement by Dr. Todd Kim

Dr. Todd Kim provides innovative shoulder replacement options to patients with shoulder joint compromise.

Total shoulder replacement arthroplasty is a well-established surgery for restoring comfort and function to the arthritic shoulder.

In this procedure the arthritic ball is replaced by a smooth metal ball fixed to the arm bone (humerus) by a stem that fits within it.

The arthritic socket (glenoid) is resurfaced with high-density polyethylene prosthesis. Among the different surgical options this procedure appears to provide the most rapid and complete improvement in comfort and function for shoulders with arthritis.

Success requires technical excellence of the surgery and a commitment to the exercise program until the desired range of motion can be achieved comfortably.

Peninsula Bone & Joint Clinic

The Orthopaedic physicians at Peninsula Bone & Joint Clinic provide comprehensive services to all members of the family.
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