Last week, we began in-depth examination of Shoulder impingement syndrome, an injury common in both young athletes and middle-aged people. In Part 1, we discussed common causes and symptoms for this painful condition. In Part 2, we will explore the diagnostic process and treatment options for this particular injury.
Diagnosis of impingement syndrome begins with a medical history and physical exam by a physiotherapist. He will take X-rays to rule out arthritis and which may show changes in the bone that indicate muscle injury. Bone spurs or changes in the normal contour of the bone may be observed.
An ultrasound scan may be taken to visualize dynamic impingement and detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. During the ultrasound scan, the sonographer or radiologist can observe the shoulder move through the impingement zone.
In most cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function. Typical treatments include one or more of the following efforts:
Once the pain begins to improve, the therapist can start the patient on a strengthening program for the rotator cuff muscles.
When nonsurgical treatment does not relieve pain, your doctor may recommend surgery.
The goal of surgery is to create more space for the rotator cuff. To do this, the doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.
The surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.
After surgery, the affected arm may be placed in a sling for a short period of time. This allows for early healing. As soon as comfort allows, the sling can be removed to begin exercise and use of the arm.
The doctor will provide a rehabilitation program based on patient needs and the findings at surgery. This will include exercises to regain range of motion of the shoulder and strength of the arm. It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year.
If you are experiencing pain in your shoulder, don’t wait for your family physician; visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive individualized care from an experienced, professional physical therapist!
American Academy of Orthopaedic Surgeons (AAOS): http://orthoinfo.aaos.org/topic.cfm?topic=a00032
WebMD, Inc.: http://www.webmd.com/rheumatoid-arthritis/impingement-syndrome#1
Healthline Media: http://www.healthline.com/health/rotator-cuff-tendinitis
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