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