(Also known as painful arc syndrome and subacromial bursitis)
Shoulder impingement is a syndrome of pain felt around the shoulder when the arm is raised to shoulder height or above. This means that simple activities, such as brushing your hair, reaching for items on shelves, driving or getting dressed can trigger your pain.
Because your shoulder is such a mobile joint, even small structural, control or movement problems around your shoulder can cause internal parts to rub painfully against each other.
The subacromial space is the area between the top of your shoulder (the acromion), and the rotator cuff tendons (particularly supraspinatus and infraspinatus tendons). A fluid filled sac called the ‘subacromial bursa’ occupies this space and this gets inflamed in impingement. The diagram below shows this bursa and it’s location in your shoulder
Figure 1 Front and side-on views of the subacromial bursa (blue). Your larger outer muscle, the deltoid, has been removed to show the deeper structures
Typically a gradual onset of symptoms, with pain when raising or lowering the arm, often worst in the mid region of your arc of motion. Initially the shoulder tends to be painful only during motion, but this may develop into a constant pain like ‘toothache’ in the shoulder. it can affect sleep and often patients cannot lie on the affected side. Most people locate the pain to their upper outer arm.
The way you describe your symptoms and your examination findings are suggestive. Shoulder x-rays exclude other causes of pain. Ultrasound or MRI imaging can help identify any structural injuries in the shoulder. Occasionally, targeted injections can help localise the source of your pain.
Shoulder impingement is very common. Most patients are between 40 and 65yrs old and it is slightly more common in women. Some sports are 'high risk' for impingement (e.g. swimming and tennis)
There is natural variation in the shape of our shoulder blades. Some people have a tighter subacromial space in their shoulder and are therefore more prone to impingement. As we age, we can develop extra ridges of bone in our shoulder. These ‘bone spurs’ can cause impingement. These spurs are resected during a subacromial decompression.
With modern lifestyles, ageing and injury, many of us adopt unhelpful or abnormal postures causing our shoulder blades to sit and move incorrectly. This increases our risk of impingement. Even muscles and postures in other parts of your body can affect your shoulder joint. It is common to discover subtle weaknesses in core stability or the legs of patients with shoulder pain. We can also develop strength and control deficits in our rotator cuff muscles that can provoke symptoms of impingement.
By the time you have sought a specialist referral, you have probably tried simple measures, such as activity modification, painkillers and anti-inflammatories.
Physiotherapy. Correction of postural problems, specific muscle weaknesses and shoulder rhythm will cure impingement in many patients, although you may need a cortisone injection to help you complete your physiotherapy course. It typically takes 6-10 weeks to achieve an enduring improvement but, as with all physiotherapy, only by doing your prescribed exercises will you achieve positive results. A physiotherapist with an interest in shoulder problems will assess you carefully to identify which aspects need attention and then prescribe a few simple exercises that you should be able to do daily to help.
Subacromial Cortisone Injection. Your surgeon may recommend an injection. This is usually performed in the clinic. The injection contains local anaesthetic (to numb the pain for 6 hours after the injection) and Cortisone (a powerful anti-inflammatory medicine for prolonged relief). It is normally only moderately uncomfortable and you can drive home. The risks of injection are extremely low and most patients enjoy significant relief, providing an excellent window of opportunity for the physiotherapist to help you cure your problem.
If your symptoms remain troubling after a good quality rehabilitation programme, you and your surgeon may decide it’s time to consider surgery. This involves an arthroscopic subacromial decompression. More information on this procedure is available in the Treatment section.
Overall, 70% of patients get better with physiotherapy and an injection. For those that go on to have surgery, 85% to 90% will be happy with their outcome, but it can take several months (6-9 months) for full recovery. It is rare (less than 5%) for patients to be made worse with surgery
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
Spire Thames Valley hospital
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