Impingement Syndrome

Shoulder impingement syndrome results from a rotator cuff injury. The rotator cuff muscles normally glide unrestricted through a bony channel between the top of the shoulder blade (acromion) and the upper arm bone (humerus). This channel is called the subacromial space. Degenerative changes (arthritis) in the acromioclavicular joint (joint located between the clavicle and the acromion), inflammation (swelling) of soft tissues, or bursitis in this region can result in narrowing of the subacromial space. This frequently leads to irritation of the rotator cuff, which can no longer slide freely through the channel during movement. This constant friction can result in rotator cuff fraying and tears.
The typical patient will experience shoulder activity-and position-related pain, pain-related loss of muscle strength and, in many cases, pain at night. In many cases, it is not possible to lie on the affected side.

Diagnosis:

If impingement syndrome is suspected, an X-ray will be obtained and MRI studies performed.

Treatment:

There are two methods of surgery for impingement syndrome: open surgery and arthroscopic surgery.

Open Subacromial Decompression (Widening of the Subacromial Space):

Surgical access is obtained through an incision in the skin over the shoulder joint. The incision runs diagonally and is approximately 5 cm in length.
Thickened soft tissues below the acromion and the inflamed bursa are then removed. This is followed by resection (removal) of bone from the undersurface of the acromion in order to enlarge the subacromial space so that the rotator cuff can slide through the space unimpaired.

Arthroscopic Subacromial Decompression (Widening of the Subacromial Space):

The camera and instruments are inserted in the shoulder through two small incisions. First, the joint is inspected systematically with the camera in order to detect and assess all damage in the joint. The actual surgery is then performed. Enlargement of the subacromial space is accomplished by removing excess soft tissue and by removing bone from the undersurface of the acromion.

Postoperative Care:

After surgery, the phase of postoperative physiotherapy will begin. In addition, the operated shoulder will be immobilised in a device called an abduction cushion for a short period (the abduction cushion holds the bent arm away from the body at a comfortable angle).

Procedure:

At our practice, patients are examined and informed of the specific type of surgery in advance. With your input, we will determine which treatment plan is best for you (date and type of surgery, hospitalisation and physiotherapy).
In most cases, you will check into the hospital in Münsingen on the day of surgery. The surgery will be performed during the course of the morning. On the day after surgery, mobilisation exercises will be started with the assistance of a physical therapist, and you can generally leave the hospital in about 3 to 4 days. Physiotherapy should be continued on an outpatient basis in order to re-establish shoulder strength and range of motion. Naturally, you will be requested to return to our practice for follow-up at regular intervals.