Shoulder pain is one of the most common complaints.  There are different reasons for impingement.  Your shoulder consists of three bones: humerus, scapula and clavicle.  Multiple muscles and tendons lead to stability.  The rotator cuff keeps the humerus head in the socket.  A sub-acromial bursa helps with lubrication during movement.  Pathology at any of these structures can cause shoulder pain.

Pain may occur when lifting the arm, blow drying your hair, an inability to place your arm behind your back or even at night.  It usually starts from the front of the shoulder and spreads down the side of the arm.

Impingement is initially treated conservatively.  If the conservative treatment fails, we will consider surgery. 

 

Conservative treatment:

  • Sub-acromial injections
  • Anti-inflammatory medication
  • Physiotherapy ‒ rotator cuff strengthening, scapular stabilisation and capsular stretching

 

We infiltrate a maximum of 3 times.  It is a sub-acromial infiltration and consists of local analgesia (lignocaine and bupivacaine) and Celestone soluspan.

 

Surgery:

The surgeon will discuss the procedure with you before surgery.  Surgery entails a sub-acromial decompression done arthroscopically.  Three small holes are made and a camera and instruments are used for the surgery.  The shoulder joint will also be evaluated and photographs will be taken for post-operative discussion with you.

Other pathology will also be addressed during the surgery (e.g. acromioclavicluar joint, biceps tendon or rotator cuff pathology).

After a sub-acromial decompression you will wear a sling for 2 weeks.  You will be seen by the physiotherapist before and after the operation to start your rehabilitation. 

 

Rehabilitation is important and entails:

  • Rotator cuff strengthening
  • Capsular stretching
  • Improvement of scapulothoracic movement and scapular rotation
  • Improved proprioception.

 

The aim of the surgery is to give you a pain free shoulder.  It usually takes 2 to 4 months for pain relief, but it can take up to a year.