Impingement Syndrome

What is Impingement Syndrome of the shoulder?

Impingement syndrome is a widely recognized cause of shoulder pain involving a growth of a bone spur on the underside of one of the primary shoulder bones (acromion) which may cause mechanical irritation and/or damage to the underlying rotator cuff tendons.  

I’ve been told I have Bursitis and also Impingement Syndrome.  Which is it?

Likely both, there is quite a bit of overlap with Shoulder Bursitis and Impingement Syndrome.  Impingement syndrome can cause inflammation and damage to the rotator cuff or the bursa associated with the rotator cuff. The purpose of the bursa is to cushion, lubricate and provide nutrition to the rotator cuff tendon.  The bursa is very rich in nerve endings so inflammation of the bursa can be quite painful.  The same activities that can irritate the rotator cuff can irritate the bursa which tends to be a little more prone to irritation than the rotator cuff tendon itself.  Often, however, shoulder bursitis can be a precursor to development of rotator cuff tendonitis or even degenerative tearing if not appropriately addressed.  Fortunately, bursitis can be treated with nonsurgical means.

Rotator cuff tendonitis is similar to bursitis, just directly involving inflammation of the rotator cuff tendon itself, often following a prolonged course of bursitis.  This can be a more tenacious problem than bursitis but still typically does not require surgery for successful treatment.  Rest, physical therapy and anti-inflammatory medications (either oral or injected) are typically successfully employed to treat these issues.  While surgery is occasionally necessary, this is not the norm in our office as our nonsurgical options have a high rate of long-term success.

What are the symptoms of Impingement Syndrome?

Gradual onset of pain in the shoulder which can extend even down past the elbow.  There is often pain with activity and at night.  Occasionally some clicking and general weakness of the shoulder are present. 

How is Impingement Syndrome treated?

Usually nonsurgically.  When true subacromial impingement is present, it can usually be treated with therapy, oral anti-inflammatory medication and steroid injections.  In rare cases in which these measures fail, surgical removal of the spur typically results in relatively rapid resolution of the problem but does require a period of recovery and rehab.  This is a straightforward and minimally invasive outpatient corrective surgery performed arthroscopically in approximately 30 minutes.

Rotator cuff tendonitis and bursitis often are present with Impingement Syndrome and are also typically most successfully treated with a nonsurgical approach.  

If I have a spur on my acromion, can I get better without having it removed?

Absolutely–Impingement Syndrome is a widely recognized cause of shoulder pain but potentially can be overdiagnosed and overtreated. Often, what is called impingement, is an inherent inflammatory or degenerative condition of the rotator cuff tendon itself.  This is an important distinction to make as spur removal in this setting will not solve the problem, leading to an unsuccessful surgery and recovery.  Furthermore, most of these patients actually see full resolution of their rotator cuff inflammation without any invasive measures.  

Drs. Bak, Frush and Silas treat this condition routinely and have a high rate of successful treatment with nonsurgical methods as well as surgical correction when required.