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Shoulder Impingement
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Shoulder impingement is a common cause of shoulder
pain. Usually, a bone spur on the undersurface of the acromion (a portion of
the shoulder blade) develops slowly over time for unknown reasons in some
individuals. If big enough, this spur can pinch or "impinge" on the
underlying soft tissues, especially the subacromial bursa and the rotator cuff
tendons. Raising the arm above shoulder level can bring these structures
against the undersurface of the acromion to where a bone spur can rub on them
("impinge") and cause inflammation such as bursitis and tendinitis.
Eventually, this can lead to a rotator cuff tear (see section on rotator cuff
tears). |
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If no rotator cuff tear exists, the symptoms of
impingement syndrome can usually be controlled without surgical intervention.
Exercises, activity modification, and time can often lead to resolution of the
impingement syndrome. Sometimes, an injection of cortisone-type
medication may be required for resolution. |
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If the spur is very large, or if conservative treatment
does not work, surgical excision of the bone spur may be required. This can be
done arthroscopically on an outpatient basis. |
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X-ray of a patient with a very large acromial spur. |
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X-ray of same shoulder after arthroscopic spur
excision. Note the increased space above the round humeral head. |
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