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:
Pain relievers. Over-the-counter anti-inflammatory medications such as ibuprofen and naproxen sodium remain the most common treatment for impingement syndrome.
Physical therapy. A physical therapist will initially focus on restoring normal motion to the shoulder. Stretching exercises to improve range of motion are very helpful. If the patient has difficulty reaching behind the back, tightness of the posterior capsule of the shoulder may have developed (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.
Rest. Your doctor may suggest rest and activity modification, particularly avoiding overhead activities. Working through pain can further damage the injured shoulder.
Once the pain begins to improve, the therapist can start the patient on a strengthening program for the rotator cuff muscles.
- Steroid injection. If rest, medications, and physical therapy do not relieve the pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.
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.
- Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around the shoulder. The doctor examines the patient’s shoulder through a fiber optic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.
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.
- Open surgical technique. In open surgery, the doctor will make a small incision in the front of the affected shoulder. This allows the doctor to see the acromion and rotator cuff directly.
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!