An Overview on Subacromial Impingement
Subacromial impingement occurs when the tendons of the shoulder joint (or rotator cuff) are injured as they glide against the bones and ligaments of the shoulder. More specifically, the rotator cuff tendons can rub against the acromion process during overhead activities which can lead to pain and degeneration of the tendons. In some cases, bone spurs can develop under the flat bone found at the top of the shoulder blade (acromion) and can lead to more severe cases of impingement. Shoulder impingement symptoms include pain and weakness in the shoulder region and upper arm area as a result of persistent inflammation, pinching or rubbing of the tendons (known as the “impingement”). Austin, Texas shoulder specialist, Dr. Jeff Padalecki is available to treat patients experiencing symptoms associated with subacromial impingement.
Subacromial impingement is tremendously common and can occur spontaneously with no apparent cause, although it is most often triggered by subjecting the shoulder joint to repetitive overhead activities— especially in athletic individuals. Age may also be a factor, since bone spurs tend to develop as we age. This condition is associated with mechanical irritation and inflammation of the subacromial bursa (known as bursitis).
Subacromial Impingement Symptoms
The most common symptom associated with subacromial impingement is pain. Patients will feel pain over the front of the shoulder and on the outside of the upper arm, which classically presents itself when the arm is lifted in an arc out to the side and up to the ear.
Patients may feel pain when trying to complete seemingly “normal” movements, such as putting on a coat or a jacket. Pain is evident at rest and may interfere with sleep at night. Some patients have even described feeling a “locking” sensation in their arm.
Subacromial Impingement Diagnostic Testing
Dr. Padalecki will conduct a thorough examination by observing the shoulder and assessing the range of movement and locations of pain. A variety of tests may be utilized to look at the bones and joints including using X-rays (to check for bone fractures, bone spurs, calcific tendonitis, etc.), or an MRI to assess the soft tissue associated with the muscles and tendons.
Subacromial Impingement Treatment
Treatment for subacromial impingement usually begins with a non-surgical approach. Dr. Padalecki will typically offer this approach first to see if conservative measures will be enough to promote the healing in the shoulder.
The pain and inflammation associated with subacromial impingement may be treated with a combination of rest and diminished use of the shoulder for a determined amount of time while using anti-inflammatory medications (NSAIDs). Dr. Padalecki will usually prescribe a physical therapy regimen for the patient to help foster mobility and range of motion. Therapy will also help to strengthen the muscles and tendons in the shoulder joint. To help relieve pain and confirm the cause of discomfort, Dr. Padalcki may opt to inject a corticosteroid drug into the subacromial bursa which can act as a powerful local anti-inflammatory and can often be more effective than NSAIDS.
Surgery is usually only necessary if the shoulder has not responded to any of the non-surgical treatments. Dr. Padalecki prefers to use an arthroscopic surgical approach to treat cases of subacromial impingement that do not respond to conservative treatments. Done through a series of small incisions, Dr. Padalecki utilizes a small camera and tiny surgical instruments to enter the shoulder joint and view the injured area. The operation involves the removal of any bone spurs or irregularities on the underside of the acromion, allowing the tendons to avoid being pinched. The advantage of arthroscopic surgery is that there is usually less pain and a faster return to normal activities
A rehabilitation program will be prescribed at your first post-operative visit with Dr. Padalecki. Rehabilitation after surgery is as important as the surgical repair itself. Without proper rehab, the chance of full recovery is diminished. Patients are advised to avoid extra and unnecessary physical stress until cleared by their doctor.
For more information on subacromial impingement, or to discuss shoulder impingement symptoms with shoulder specialist Dr. Jeff Padalecki, please contact his Austin, Texas orthopedic practice.