Shoulder impingement is a generic term given to shoulder pain. It is usually used when individuals have pain on lifting their arm above their head.
Sub Acromial Bursitis
Bursitis is the true name for impingement and can have several causes. Usually it is due to a weak and inflamed group of muscles called the rotator cuff which surround the shoulder and help with movement. Very occasionally it can be due to bony spur digging down from the Bone above the bursa.
Scapula Dyskinesia – Muscle Imbalance
Impingement can also be misdiagnosed for underlying scapula muscle problems. When you lift your arm up in the air, it relies on at least 20 muscles to work simultaneously to function smoothly. If one of these muscles doesn’t talk to the others, the scapula can be pulled incorrectly and jump out of place. This can be very painful and lead to impingement type symptoms.
Patients report pain and a dull ache around the side of the shoulder which moves down the side of the arm towards the elbow. Motion can be restricted with difficulty lifting the arm above the head especially with repetitive overhead activities. Sleep is generally disturbed with patients often unable to lie on the affected side at night with the pain causing people to wake up several times.
When you come to clinic a thorough history and examination is usually sufficient to diagnose the problem. You will be sent for an Xray and occasionally an ultrasound or MRI scan will be required to confirm the
diagnosis.
Impingement
Impingement requires focussed physiotherapy rehabilitation for at least 6-12 months. This maybe assisted with a steroid injection into the bursa, which reduces the pain to help with physiotherapy. If after prolonged physiotherapy and an injection, the pain continues, then an operation to take away the inflamed tissue and remove a potential bone spur may be required.
Scapula Dyskinesia
Scapula dyskinesia may require 12-24 months of specialist shoulder physiotherapy. It should never require surgery.
Aftercare
Following the operation, you will normally have a bulky dressing covering your wound for 48 hours. This is then removed to reveal the sticky dressing at until 14 days following your operation. The stitches will dissolve and do not require removal. You will require a wound check either at the hospital or your GP practice at 14 days.
Surgery for bursitis is quite painful and many patients report and increase in pain for a few weeks after surgery. After 6 weeks the pain starts to settle. It can take from 6 weeks to 12 months to recover from the surgery. Every patient is different hence the large variation of rehabilitation time.
Stiffness
Due to pain after surgery, patient may be reluctant to perform their exercises. If you do not gently rehabilitate your shoulder it can become stiff and you can develop a frozen shoulder.
Anaesthetic Risk
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
Recurrence
Is a rare complication.
