Shoulder impingement
Causes
Because of the shape of the shoulder roof (acromion) which is not straight but sloping, a conflict easily arises with the protrusion (tuberculus majus) where the main tendons (rotator cuff) of the shoulder attach. A bursa helps the tendons slide under the roof of the shoulder. If this bursa becomes inflamed (bursitis), it can interfere with the gliding mechanism.
When inflammation of the bursa occurs in addition to inflammation of one of the tendons, we speak of tenditis. Persistent inflammation can damage the tendon through further irritation. This can eventually lead to a rotator cuff tear.
Symptoms
You experience pain in the upper arm during or after an activity or spontaneously at night. In further stages, the pain may remain present and severely interfere with sleep. You also have a harder time performing strenuous strength efforts above shoulder height.
Diagnosis
Based on your symptoms, a diagnosis will be made. An ultrasound or X-ray may provide more clarity.
In some cases, you will also need to undergo an arthro-CT scan or arthro-NMR scan (MRI) to confirm the diagnosis.
Treatment
An attempt is always made first to rest the tendon. You will be given anti-inflammatory medication in pill form (NSAID) or injections of cortisone. Usually you get two to three injections directly into the bursa. If necessary, this is combined with physical therapy where the focus is on regaining your mobility.
Intervention
If the treatment does not work enough, surgery may be necessary. The goal of the procedure is to straighten the sloping part of the roof. This creates more room for the tendon and there is less chance of entrapment. This allows the inflamed tendon to heal. At the same time, the inflamed bursa is also removed so that a new, healthy bursa can form. This procedure is done through keyhole surgery.
Rehabilitation
After surgery you can follow an orthopedic rehabilitation program. The first weeks you must rest your shoulder as much as possible and wear a sling. After this, you will be given exercises that focus on regaining mobility, strength and limiting pain.
Departments
For more information, please visit the orthopaedics department.