One of the most common reasons people seek the help of an orthopedic specialist is shoulder pain. The shoulder is one of the most complex parts of the body. It allows for a large range of motion by the arm. Because of the number of muscles, tendons, and bones in the shoulder, it is not uncommon for the shoulder to become injured or damaged.
Shoulder Impingement Syndrome
This is a common condition causing pain to the shoulder. When this condition occurs, there are two primary options for treatment:
- Shoulder impingement surgery
- Physical therapy
Understanding shoulder impingement syndrome and these two treatment methods can help you have fully informed conversations with your orthopedic specialist.
Shoulder Impingement Surgery and Physical Therapy
The human shoulder is made up of three bones, muscles, ligaments, and tendons. The clavicle, scapula, and humerus all meet in the shoulder joint. The spaces between these bones are the joints.
Muscles and tendons used for stabilization are found in the shoulder. All of these combine to provide the strength, flexibility, and range of motion humans have with their arms. The tremendous range of motion the shoulder has – along with the frequency of its use – makes the shoulder one of the most commonly injured body parts.
The rotator cuff is a group of muscles and tendons meeting at the top of the humerus. Together, these muscles and tendons keep the shoulder in place. Because of the amount of stress the rotator cuff can experience due to frequent and repetitive us, this area is particularly susceptible to injury. This is especially true for certain athletes like pitchers and swimmers. Athletes are at increased risk of orthopedic problems due to the nature of their active lifestyle.
Shoulder Impingement Syndrome
Shoulder impingement syndrome occurs when rotator cuff tendons become pinched between the bones in the shoulder. As the pinching continues, the impacted tendons become inflamed and damaged. This results in pain. The pain experienced due to impingement syndrome becomes gradually worse as the condition progresses. The pain will often become worse if the arm is brought above the head. Individuals who throw, swing rackets ,and swim will often find these movements particularly difficult. As the tendons swell, they are further pinched by the bones and other muscles in the shoulder.
Symptoms of impingement syndrome include:
- Pain in the shoulder becomes gradually worse
- Pain is sharp and sporadic at its onset
- Pain when making even slight or simple movements
- Increased pain when making overhead motions
- Little to no pain when lower, waist level movements are made
- Pain worsening in the evening or during sleep
One of the trademarks of shoulder impingement syndrome is that there often is no injury directly associated with the condition. More often than not, impingement syndrome is the result of overuse. In other instances, a minor injury failed to heal correctly and resulted in a condition that continued to worsen over time.
Diagnosis
In order to diagnose impingement syndrome, the doctor will begin by understanding your medical history and your symptoms. There will be a physical exam where the doctor will check to see if certain areas of your arm and shoulder are tender. The physical exam also allows your doctor to feel the structures of the shoulder in order to identify any issues. Beyond this, the doctor will have you move your shoulder so as to gauge your range of motion and your level of pain as you move the shoulder. The physical exam helps the doctor to rule out other conditions with similar symptoms and to provide a proper diagnosis.
The diagnostic phase of treatment continues with imaging. Imaging such as x-rays , ultrasounds, and MRIs provide a view of the soft tissues and bones of the shoulder. Additionally, images can help the doctor to determine if there is swelling or inflammation in the shoulder. Once the images are received, the doctor can make a fully informed diagnosis and create a treatment plan.
Physical Therapy
The first line of treatment for shoulder impingement syndrome is generally non-surgical. Although a non-surgical approach can take several weeks to be effective, it can be done at a lower out of pocket cost and a decreased recovery time. Treatment options often include a mixture of rest, medications, and physical therapy.
The goal of physical therapy is to return the shoulder to the level of function existing before the injury. This includes both the strength of the shoulder and the range of motion a person had. One of the most common activities during physical therapy is stretching. Stretching improves the range of motion a person has in their shoulder. Additionally, stretching exercises can help to relieve pain, making it easier to perform everyday tasks and to continue with further therapy. Once the pain is manageable, the physical therapy moves on to building strength in the shoulder.
Doctors will typically only recommend shoulder impingement surgery after physical therapy is not successful.
Shoulder Impingement Surgery
A surgical treatment option can address cases where physical therapy and other less invasive treatments have been unsuccessful. During the surgery, the goal is to increase the amount of space the rotator cuff has in order to stop and prevent impingement. The procedure may include removing parts of the shoulder in order to provide that room.
There are two types of shoulder impingement surgery available:
Arthroscopic Surgery – During arthroscopic surgery, small incisions are made so that doctors can access the area in question. Surgical instruments and a camera are then passed through these small openings. The camera provides video that the doctors use to guide the instruments to the impacted area of the shoulder. Using the instruments, bone and soft tissue can be removed from the shoulder as needed. Additionally, sutures can be placed using the arthroscopic arms. An arthroscopic approach allows doctors to treat the issue without damaging as much of the surrounding tissue. Generally, only a few sutures are needed on each of the small incisions in order to effectively close them.
Open Surgery – In open surgery, a large incision is made so that the doctor can fully access the shoulder. The doctor is then able to surgically address the rotator cuff and the surrounding areas for treatment. Treatment can include surgically removing the impacted tissues and bones in order to fully restore strength and range in motion. Once the procedure is done, the larger incision is closed using sutures. Recovery is necessary both for the shoulder and the surrounding areas that were disturbed by the surgery.
Recovery time can vary between individuals. Generally speaking, arthroscopic surgeries have shorter recovery time than open surgery. Once surgery is complete, patients much proceed to rehab. Rehab allows patients to begin to use their arm again in a controlled manner. It can take between several months to a year for patients to completely be free of the pain associated with impingement syndrome and to regain full use of their arm and shoulder.
Leading Shoulder Impingement Surgery Specialist
For over two decades, Dr. Howard Marans has provided world class orthopedic care for treating shoulder impingement. Please click below and enter your information – or – call 714.979.8981 to schedule your consultation.
