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Impingement - Shoulder Injury


This group of ailments form the most common conditions in the shoulder joint. They can occur spontaneously or following an injury or overuse. They present with pain usually running down from the shoulder into the upper arm, worse with overhead activity and on stressing the shoulder joint such as when holding something with an out-stretched arm.


The tendon of the rotator cuff or bursa just above becomes inflamed. Swelling occurs with the inflammation and as the tendon is in an enclosed space further impingement occurs. Treatment is aimed at breaking this repetitive cycle.



The diagnosis is clinical in the first instance. Your physiotherapist is often the first to make this diagnosis and can treat this by rebalancing the muscles around the shoulder. This takes pressure off the tendon and if this resolves the problem no further treatment is required. The use of anti-inflammatory medication compliments this treatment as long as there are no reasons not to take these.


If symptoms persist despite this treatment review by a specialist is recommended. Further imaging in the form of an ultrasound or MRI scan will confirm the diagnosis and the source of impingement.


The next sensible option is to try a steroid and local anaesthetic injection. This works in about 60% of patients. Again it removes the inflammation in the tendon . This reduces swelling breaking the cycle of impingement and settling the symptoms. This is best achieved in conjunction with physiotherapy and anti-inflammatory medication. We try to avoid repeated injections. If the injection works for a long time i.e. over 12 months it can be repeated.


If the injections fail or cannot be undertaken for other reasons then the final option is surgery. This takes the form of arthroscopic shoulder decompression surgery. The surgery is undertaken under a general anaesthetic, usually done as day case surgery. After surgery the arm may be in a sling but only for comfort. Depending on your work, the time off is usually between three to six weeks, although this can sometimes be longer. Driving is restricted for a variable period after surgery usually approximately three weeks.


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Usually the first few weeks can be more uncomfortable with the symptoms gradually improving over 3 to 6 months. Success rate is in the order of 80 to 90% improvement in symptoms in a similar number of patients. You will have physiotherapy to help get back the range of movement and prevent a frozen shoulder. Other small risks are clots and infection.


Acromioclavicular osteoarthritis presents in a very similar way. It is often related to heavy work or excessive gym activity. Whilst the source of the impingement is different, the treatment is effectively the same excepting during the surgical procedure where the end of the collarbone is removed. The recovery is similar. The only additional issue with his condition is following surgery this joint can continue to click albeit not painfully.



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