Shoulder Impingement syndrome & acromioclavicular joint arthritis

The right therapy to relieve your shoulder

Shoulder impingement is a common cause of pain in the shoulder, making some of the most simple tasks a painful burden. From footballers and rugby players to the average person, shoulder impingement can affect anyone, though the causes can vary.

Our shoulder surgeons at Schoen Clinic London have many years of experience in treating all aspects of shoulder impingement, from rotator cuff tendonitis to acromioclavicular joint arthritis. Whatever is causing your shoulder condition, you are in the best hands with us.

How does shoulder impingement syndrome occur?

The shoulder is a very complex structure made up of several joints, tendons and muscles all working together to give you a range of motion and functionality. Due to the complexity of the shoulder there are many structures within it which are vulnerable to injury. The subacromial area lies between the top of the arm bone (humerus) and a bony prominence on the shoulder blade (acromion). The coracoacromial ligament completes the arch. A muscle and fluid filled cushion (bursa) lie between the arm bone and acromion. With certain movements and positions these structures can become pinched and inflamed, causing irritation or pain. This is what we call impingement.

Shoulder impingement syndrome symptoms

There are a number of symptoms which could be warning signs of shoulder impingement syndrome. These may only be mild during the earlier stages of the condition, but can gradually get worse as the problem progresses further.
  • Pain during rest periods and activity
  • Stiffness when lifting your arm
  • Sports involving overhead actions may become difficult
  • Loss of strength and range of motion
  • Night pain
  • Local swelling and tenderness

What causes shoulder impingement syndrome?

The pain that you have been experiencing is caused by the pinching of the structures in your shoulder and is typically felt on movements such as reaching and putting your arm into a jacket sleeve. Most of the time a dysfunction of the rotator cuff muscles, either due to wear and tear of the tendons, or to a muscular imbalance, might be responsible for the conflict between the bony structures and the tendons. Recovery of the muscular balance is crucial to improve this condition and for this reason physiotherapy plays a major role in conservative treatment or in the post-operative phase.

The acromioclavicular Joint (ACJ) is a small joint formed between the top of the shoulder blade (acromion) and the collarbone (clavicle). This joint can also be a frequent source of pain in the shoulder region, especially while performing movements at or above the level of the shoulder. Moving your arm across the chest at shoulder level to touch the opposite shoulder can produce significant discomfort if this joint is affected.

How we diagnose shoulder impingement syndrome?

Diagnosis can be reached through an accurate clinical examination supported by X-rays taken in two or three different views. Often an ultrasound scan can be useful to exclude any tendon damage.

Treatment options for shoulder impingement syndrome

There are different treatment options available for shoulder impingement syndrome depending on the severity of your case. Whatever condition you present with, our team of shoulder experts will ensure you get rapid diagnosis and specialist treatment to effectively relieve your symptoms.

Conservative treatments for shoulder impingement syndrome

Conservative treatment includes a course of physiotherapy and a programme of home exercises, often combined with one or two subacromial steroid injections performed under ultrasound. While this might be effective in about 65-70% of cases, if symptoms persist more than three to six months, surgical intervention is recommended.

Arthroscopic subacromial decompression (ASD)

The operation is performed by arthroscopy, or “keyhole” surgery, usually through two or three 4mm incisions. An arthroscopy is a minimally invasive procedure that allows the surgeon to access the joint using an arthroscope (tiny camera) and resolve the issue using specially designed surgical instruments. The operation aims to increase the size of the subacromial area and reduce the pressure on the muscle. It involves cutting the coracoacromial ligament and shaving away part of the acromion bone (ASD). This increases the space of the subacromial area and reduces the pressure on the tendon and bursa allowing them to heal.

Pain may arise as well from the small joint between the shoulder blade and the collar bone acromioclavicular (AC) joint due to a cartilage tear, or arthritis with wear and tear. In these cases, a resection arthroplasty of the AC joint is performed, with removal of a few millimetres of bone from each side of the joint.

If a rotator cuff tear is detected during arthroscopy, your surgeon may need to repair this torn tendon. This will involve a different post-operative regime to ASD and if this is the case, you will not be allowed to use your arm or drive for 4-6 weeks.

As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation and your specialist consultant will go through these with you.

Potential complications include:

  • Complications relating to the anaesthetic
  • Infection
  • Failure to achieve a successful result
  • A need to redo the surgery
  • Injury to the nerves or blood vessels around the shoulder Fracture
  • Prolonged stiffness and/or pain

Aftercare

You will usually be in hospital either for a day or overnight. A supplementary local anaesthetic or nerve block is used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help with this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes.

Your consultant or physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery. You will be given a sling. This is for comfort only and should be discarded as soon as possible (usually within the first one to two days). After leaving hospital you should exercise the arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for 2-3 exercise sessions per day.

This is a keyhole operation usually done through two or three 4mm puncture wounds. Often there will be no stitches, only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5-7 days.

You may begin driving one week after your operation or when you feel comfortable. You should be back at work between one and four weeks depending on your job. If you are in a sedentary job you may return as soon as you feel able usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.

You should avoid sustained, repetitive overhead activities for three months. With regards to swimming you may begin breaststroke as soon as you are comfortable but you should wait three months before resuming front crawl. Golf can begin at six weeks. For guidance on DIY and racquet sports you should speak with your consultant or physiotherapist.

A follow-up appointment will be made at the hospital around three weeks after your surgery. At this stage you will be reviewed by your consultant who will check your progress, make sure you are moving your arm properly and give you further exercises as appropriate.

Your symptoms should be approximately 80% better after three months but may take a year to totally settle.

Shoulder impingement syndrome: Our specialists

At Schoen Clinic London, you can receive comprehensive advice from our shoulder and elbow specialists and discuss which treatment is best for your symptoms.

Shoulder impingement syndrome: Our specialised hospital

Schoen Clinic Orthopaedic and Spinal Hospital London boasts some of the finest experts in shoulder impingement conditions. With a state-of-the-art diagnostics suite and leaders in the field of shoulder conditions, we are able to provide rapid diagnosis and effective treatment to relieve your symptoms.