“This information is meant only as a guide to help you understand and your treatment options. It is not a substitute for a consultation with a specialist Orthopaedic Shoulder Surgeon. We strongly recommend a thorough discussion with your surgeon about the most appropriate treatment about your problem.” 

Subacromial Impingement

Subacromial Impingement

Subacromial Impingement is one of the most common causes of pain around the shoulder. In this condition, the soft tissues at the top of the shoulder get pinched between the ball of the shoulder (the humeral head), and the bony roof of the shoulder (the acromion). For more information about normal shoulder structure and function, see our section on shoulder anatomy. 

Proper treatment of subacromial impingement helps prevent many other problems of the shoulder (e.g. rotator cuff tears, degeneration, cuff tear arthritis, etc).

Subacromial Impingement Symptoms

Pain is the most common presenting symptom. This is usually felt at the top or side of the shoulder, and is worse in certain positions. In severe cases, sleep might also be disturbed due to the pain.

If there is inflammation or damage to the rotator cuff, there might be weakness of the shoulder.

Subacromial Impingement Causes

Causes of Subacromial Impingement syndrome. Several conditions are thought to contribute to the development of subacromial impingement. Repeated overuse, poor posture are probably responsible in the majority of the patients.

Anatomical factors like extrinsic compression by bones and ligaments, and intrinsic factors like degeneration of the rotator cuff muscles also can cause this condition.

Subacromial Impingement Diagnosis

A thorough history and clinical examination is essential for the diagnosis. Your shoulder surgeon will request an X-ray to look for any bony changes, such as a bony spur or reduced subacromial space.

An Ultrasound or MRI of the shoulder might be needed to assess the rotator cuff and other soft tissues of the shoulder.  

Subacromial Impingement Treatment

The information given below is meant for patient education only. Please consult one of our specialist Shoulder surgeons or physiotherapists for proper diagnosis and treatment of your shoulder pain. 

The goal of treatment is to control pain and restore motion and strength. 

Nonsurgical Treatment

Majority of patients improve with relatively simple treatments to control pain and restore motion. 

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen, aceclofenac and paracetamol reduce pain and inflammation. 

Physiotherapy. Specific exercises will help restore motion. These are usually done under the supervision of a physiotherapist initially, and later on via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Sometimes heat is used to help loosen the shoulder up before the stretching exercises. 

Ultrasound guided steroid injections and Hydrodistention. Occasionally, your doctor might suggest injections into the shoulder joint to control the pain when it is severe. Steroid and local anaesthetic is injected directly into your shoulder joint. Ultrasound guidance helps accurate positioning of the needle into the joint, where it will act on the inflamed capsule. Ultrasound guidance also helps in assessment of the soft tissues covering your shoulder, and rules out tears of the rotator cuff.

Surgical Treatment

If your symptoms are not relieved by therapy, medicines and injections, you and your shoulder surgeon may discuss surgery. It is important to talk with your surgeon about your potential for recovery continuing with simple treatments, and the benefits and risks involved with surgery.

Arthroscopic Subacromial Decompression: In this procedure the space around your rotator cuff will be increased. Your hand will be made numb by anaesthesia. Your surgeon will then insert a pencil sized camera into the shoulder to directly visualise all the structures of your shoulder. This will accurately assess other problems like the cartilage, rotator cuff and the labrum. If there are any problems related to these structures, they can be repaired concomitantly. Then the inflamed subacromial bursa and the spur of the bone is removed to increase the subacromial space. This relieves the impingement and pain due to subacromial impingement. Most patients have good outcomes with these procedures.

Recovery.  After surgery, physiotherapy is necessary to improve the movements and strength of your shoulder. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.

Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and improved range of motion. 

Looking to learn more about Sports Injury, Shoulder Fractures, Shoulder Arthritis, Shoulder Dislocations, Frozen ShoulderRotator Cuff Tears . Take a look at our Patient education guide

Book An Appointment

Visit The Shoulder Centre Here