Friday 14 March 2014

Shoulder Impingement Syndrome: An often missed and un-treated cause of shoulder pain.

What is Shoulder impingement syndrome?

The shoulder joint is covered by a group of 4 muscles called the rotator cuff. These muscles merge and form a sheet around the shoulder. It is the action of these muscles that keep the ball of the shoulder centered in the socket. There is also a layer called the bursa which normally acts as a cushion between the rotator cuff and the bone above it, the acromion. In some people due to reasons unknown, bursa may get thickened and inflammed (bursitis), or the rotator cuff itself may become inflamed (tendonitis) and cause pain and symptoms. There is also the possibility of the cuff getting pinched between the arm bone and the bone above it. This group of problems is called shoulder impingement.

So what are the symptoms?

Impingement usually presents as an aching pain present in the background, with sharper pain on lifting the arm up above shoulder height or in certain positions. The cause is unknown, but sometimes an episode of minor injury or strenuous work with the arm can precipitate it. It can also result in pain at night, with muscle spasm at the base of the neck and difficulty in lying on the affected side.

What are the treatment options?

The initial treatment of impingement is rest from strenuous work, analgesics and shoulder exercises to improve the strength and rhythm of the shoulder movements. If these do not work, the next step up is an injection of a combination of a small dose of locally acting steroid and a local pain killer.This usual gives relief which may be permanent or last a few weeks to months. In some people the injection does not produce a significant effect. In such cases, surgery will be the way forward.

What happens if I leave it alone?

There is a possibility that the cuff might develop a partial or a complete tear over time. This could result in weakness, pain and further worsening of symptoms.

What does surgery involve?

Surgery for impingement involves clearing out the inflamed tissue and trimming the protruding bone so that it no longer rubs against the cuff muscles. This is done through key-holes( arthroscopic surgery), and is done as a day-case procedure under a short general anaesthetic. The advantage of key-hole surgery is a smaller wound, quicker recovery and less trauma to the soft tissues as it involves only tiny incisions. You will need physiotherapy to complement the gain from surgery and the speed up recovery. You can expect to be back to using your arm as normal by about 2-3 weeks after surgery. In some patients some discomfort may last for up to 3 months post surgery. This surgery by and large is very successful in relieving pain and symptoms of impingement.
This treatment is offered by Shoulder Surgeon Cochin.

For more information, please visit

Dr Vinod Kumar
Consultant Orthopaedic Surgeon
ASTER Medcity

Saturday 1 February 2014

Shoulder dislocations

Shoulder joint , which is a ball and socket joint, is the most mobile joint in our body, which means it moves well in all directions. However, this occurs at a cost-it is susceptible to become unstable.
The shoulder joint is made stable by a few anatomic structures including a bumper which goes all the way around the socket- the labrum, the ligaments-which are cord like structures and muscles around the shoulder. Anything that interferes with the normal functioning of these structures or anything that damages these structures can result in shoulder instability.

Shoulder dislocation is said to happen when the ball comes out of the socket completely, a subluxation is said to happen when it only comes out partially.

Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include:

Falling on an outstretched arm
A direct blow to the shoulder
A sudden pull, such as when trying to lift a heavy object
A violent overhead reach, such as when trying to stop a fall or slide

Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion.

Dislocation is characterised by severe pain, muscle spasm, obvious deformity of the shoulder and sometimes numbness and a sensation of the whole arm feeling 'dead'. 
Once, the shoulder dislocation happens, the ball needs to be pulled back into the socket at the earliest. Occasionally it slips back on its own, more frequently the shoulder joint needs to be relocated manually by the doctor.

In most cases some pain may persist for a couple of weeks, and in some it can be accompanied by an injury to a nerve, which is usually temporary. 

This episode of dislocation can result in long term problems of instability and recurrent dislocation especially so, if a person sustains his/her first dislocation at a very young age, i.e in their teens or twenties.
Although the symptoms can be kept under control to some extent, recurrent dislocations or instability symptoms may require surgical intervention, to repair the damaged structures.

Futher information can be obtained from

or write to me at,

Dr Vinod Kumar
Consultant Orthopaedic Surgeon
Aster Medcity, Cochin.