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Shoulder Impingement Surgery

The goal of surgery is to create more space for the tendons of the rotator cuff. Enlarging, or “decompressing” the space between the acromion and the head of the humerus can relieve the symptoms of impingement.

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. Removing a part of the acromion can stop the tendons of the rotator cuff from rubbing on the bone.

Because inflammation in the subacromial bursa contributes to the pain of impingement syndrome, this lubricating sack is often removed. This part of the procedure is called a bursectomy or a debridement. These two procedures together are called a sub-acromial decompression.

The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.

Nonsurgical Treatment

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. 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 Treatment:

Acromioplasty surgery:

Surgical treatment can be performed using either an arthroscopic or open technique.

Arthroscopic technique:

The primary advantage of arthroscopic subacromial decompression is a shorter recovery time. This is the case because the incisions that are required in order to be able to see the subacromial space are smaller when an arthroscope is used.

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:

There are some instances in which the anatomy of the patient’s shoulder makes it difficult to see well enough to perform safely an adequate sub-acromial decompression. In these instances, a larger incision has to be made.

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.

In general, the recovery from this surgery is usually quite quick. Motion is started very soon after surgery in order to speed up the rehabilitation process.