Subacromial Impingement

Acromio Clavicular Joint Injury

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The bones, muscles, and tendons in your shoulder all work together so that you can reach, swing, and lift your arm. The rotator cuff is the group of muscles and tendons that enables the joint’s movement. As you raise your arm, the narrow space between the top of your arm bone (the humeral head) and the top of your shoulder blade (the acromion) naturally compresses.

Repeated overhead movements can lead to an impingement syndrome, which is the pinching of a tendon or the bursa (a flat, fluid-filled membrane that prevents the shoulder parts from rubbing together) between the bones in the shoulder. The result is inflammation and an excess of fluid in the joint.

Activities that can cause this include racquet sports, swimming and throwing sports. It can also be caused by painting, carpentry, construction work or other jobs involving overhead work. Even after years of normal use, older people may develop an impingement syndrome.

Subacromial impingement is a common impingement syndrome, where one of the rotator cuff tendons (supraspinatus) is pinched between the ‘ball’ part of the upper arm bone (the humeral head) and the undersurface of the top of the shoulder blade (acromion).

Pain, a pinching sensation, and stiffness when raising your arm. You may experience pain in the upper arm which can radiate into the forearm, hands, and fingers. Pain is typically worse at night, making sleeping painful and difficult.

The surgeon will make a physical examination of your shoulder – pain to touch, pain with motion and pain against resistance are typical indicators of subacromial impingement. X-rays and MRI scans will enable the surgeon to examine the shape of the acromion and to help exclude other injuries within the shoulder.

A number of small incisions are made around the shoulder. Using an arthroscope and video camera, the diagnosis of subacromial impingement can be confirmed. Any other injuries such as a rotator cuff tear, can also be identified and treated during the surgery.

The surgeon then shaves a section of bone from the underside of the acromion (top of the shoulder blade). This releases the pressure on the trapped tendon or bursa, so that the joint can move smoothly.
Most patients see a dramatic and rapid improvement of their symptoms soon after surgery, but it is possible for the symptoms to take up to three months to resolve. There is minimal to no scarring, and you should be back at work within a couple of days. An effective course of physiotherapy will help to achieve as complete a recovery as possible.