What is shoulder impingement?

The shoulder is a complex joint with many large and small muscles helping to stabilize the joint and allow motion of the arm. The shoulder is the most mobile, but also most inherently unstable joint in the body. As a result, injuries to the shoulder are very common. A common shoulder injury seen mainly in adults occurs in the space above the rotator cuff tendons called the “subacromial bursa.” The rotator cuff muscles and their tendon attachments to the humerus bone (the top part of the upper arm), help stabilize the “ball and socket” joint as the larger muscles about the shoulder help move the shoulder in all directions. As we move through life, the bursa above the rotator cuff tendons can become inflamed and is known as bursitis. The shape of a part of the scapula above the rotator cuff called the acromion can influence how easily this space becomes inflamed. If the undersurface of the acromion develops spurs, repetitive overhead actions can inflame the area and cause pain. The rotator cuff tendons can also sustain damage from the spurring, contributing to the process of inflammation and pain. Shoulder impingement occurs when there is impingement (pinching) of tendons or bursa in the shoulder, caused by the movement of the bones of the shoulder. Often an over-use injury, shoulder impingement causes pain from the inflamed tissues within the shoulder. Dr. Alexander Brown, orthopedic shoulder specialist, treats patients in Nashville, TN and the surrounding communities who have shoulder impingement. He has extensive experience in getting patients back to the sports and activities they love, without shoulder pain.

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Shoulder Impingement

What are the symptoms of shoulder impingement?

The shoulder can feel painful with any movement, but particularly with overhead motions of the arm. Certain positions may provoke the pain more than others. Night pain often accommodates shoulder impingement, and radiating pain or numb, tingling sensations can spread down the arm and to the neck. Sometimes patients can remember a moment when they hurt their shoulder and other times, patients can’t recall a specific event but find that their shoulder has been bothering them for quite some time. Shoulder impingement is often accompanied by damage to the rotator cuff as well.

How do you treat shoulder impingement?

Dr. Brown treats shoulder impingement in all patient populations and specializes in arthroscopic bursal and bone spur removal when necessary. With an initial evaluation including a thorough history and detailed physical exam, Dr. Brown will determine if imaging such as x-rays, or more advanced imagining such as MRIs are necessary for further diagnosis. Once a diagnosis of shoulder impingement is made, non-operative measures are usually the first step. Many conditions will become less painful with anti-inflammatory medications, rest, and a directed physical therapy program. The use of an injection of steroids may be utilized as well to help calm down inflammation. Often, Dr. Brown will utilize an ultrasound to perform a shoulder injection to ensure the precise placement of medication.

If the history, exam, and images reveal shoulder impingement and a rotator cuff injury, non-operative measures can still be utilized to treat this condition in certain circumstances. However, in many situations, surgery is the best option to fully restore function and eliminate pain. Dr. Brown will remove the painful bursal tissue, shave down any bone spurs, and repair the rotator cuff (if needed) using minimally invasive techniques that require a small camera, small instruments, sutures, and anchors.

How long does it take to recover from shoulder impingement surgery?

As with many musculoskeletal injury conditions, recovery time is based on how long it takes for the tissues to heal before stressing them again with the actions of life that could cause re-injury if performed too early in the healing process. If a rotator cuff repair was not needed, patients are in a sling for about 4 weeks and are allowed to do full overhead daily activities around 2-3 months. Returning to sporting activities is usually allowed around 4 months depending on the patient’s progress. Physical therapy is an integral part of a good outcome with surgery. Patient’s will attend physical therapy sessions frequently during the initial weeks after surgery, and then will taper their visits as they become more mobile and stronger. These physical therapy visits will focus on pain and swelling control, getting motion back at the proper time points, and then strengthening the shoulder so it can re-enter the stress of daily life and sports.

For more information on shoulder impingement, shoulder pain and on the treatment options available, please contact the office of Dr. Brown, serving patients in Nashville, TN and the surrounding communities, at Nashville Sports Medicine and Orthopaedic Center, 615-284-5800.

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