Subacromial Impingement: Treatment options

Most treatment for subacromial impingement is non-surgical, although a small proportion of people require an operation. This is usually only when your shoulder has not responded to non-surgical treatment.

Non-surgical treatment

Painkillers
Pain medication and anti-inflammatory medicines will help to ease your symptoms of pain and stiffness. If your symptoms are mild, this may be enough to keep your condition manageable.

Injections
These are given to the bursa in the subacromial space. This is a fluid filled sac located between the acromion and the rotator cuff tendons. It allows for the smooth gliding of the rotator cuff under the acromion with overhead movements of the shoulder.

The injection is usually a mixture of local anaesthetic and steroid and will help to reduce inflammation in the area. Although you may feel increased pain for the first 24 hours, injections can be highly effective. Mr. Cole will not generally want to give you more than three injections into the same shoulder during one year, however. If your symptoms repeatedly return, he may suggest another treatment option to you.

 

Physiotherapy
An individual programme of exercises will be devised for you. These may include exercises to strengthen the muscles around your shoulder blade, improve your posture, strengthen your rotator cuff and other stretching exercises. Although the exercises may at times be hard work, tight or uncomfortable, they should not be painful.

If you are unable to carry out any form of exercise because of pain, your physiotherapist may suggest other non-invasive and painless treatments such as ultrasound.

Self-help
There is a lot that you can do to help alleviate the pain and promote healing in your shoulder. Resting your shoulder is an excellent place to start. If you can reduce the stress on your tendons, they can begin to heal themselves and the inflammation can begin to subside. Try to avoid the activity that causes you pain or find other ways of doing it. For example, if you frequently need to lift things above head height, use a stepladder so that you do not need to raise your arms. You could also try sitting with your arm by your side, with the elbow propped on an arm rest. This will help to keep your shoulder up and will minimise any impingement.

Surgical treatment

Should you need surgery, Mr. Cole will advise you on what type of treatment would best suit you and your situation. He will choose the most appropriate and least invasive for you.

Subacromial decompression
If your symptoms are not alleviated by non-surgical procedures, Mr. Cole
may suggest you have an operation known as subacromial decompression.
This is done by keyhole surgery (arthroscopy) and is normally completed
as day surgery (where you can go home on the same day). The operation
involves removing any bone spurs or prominence on the underside of the
acromion bone, so that there is a larger subacromial space and less
opportunity for tendons to become pinched.

If your rotator cuff muscle is torn, Mr. Cole may be able to repair it as part
of the same procedure.

Exercises
Following your surgery, your team of physiotherapists will work with you
to devise an exercise programme. This will be designed with advice from
Mr. Cole to help you recover as quickly and efficiently as possible.