Syndrome > Treatments
If shoulder impingement
syndrome does not respond to conservative treatment
of rest, anti-inflammatory medication, and physical
therapy, your physician may recommend a subacromial
decompression to alleviate pain. In this procedure,
the underside of the acromion bone, the bone that comprises
the "roof" of your shoulder, is removed arthroscopically
to reduce pressure on the rotator cuff tendons and bursa
that lie beneath it. In some patients, the acromion
may be shaped in such a way that a larger piece may
have to be removed or reshaped to reduce impingement.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
Getting a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your subacromial decompression. There may be separate
check-in areas for ambulatory outpatient (patients who
go home the same day after surgery) and for overnight
inpatient surgery, so be sure to ask your physician
or an assistant about this. After you have checked in
to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your shoulder may be shaved, though
this is not always necessary. You will wear a hospital
gown, and, if applicable, remove your watch, glasses,
dentures, and jewelry. You will have the opportunity
to speak with your orthopedic surgeon or an assistant,
and meet the anesthesiologist or anesthetist (a nurse
who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
you may be unable to drive, arrange for someone to help
take you out of the hospital and drive you home when
you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Subacromial decompression is almost
exclusively performed arthroscopically, with surgical
instruments inserted into your shoulder through tiny
incisions, and takes one to two hours to complete. You
usually are able to go home the same day after your
usually are given general anesthesia for this procedure,
and you may also be given an interscalene block, also
referred to as regional anesthesia, that will numb your
shoulder and neck area. This is administered with an
injection in the side of your neck.
tiny (3 1/2 to 4 millimeter) incisions are made in your
shoulder, through which the arthroscope is inserted.
The arthroscope transmits images to a TV camera so that
your surgeon can view the structures inside your shoulder.
surgical instruments are inserted into your shoulder
through the incisions and the underside of the acromion
is removed, along with any bone spurs that may have
formed. The undersurface of the acromion is flattened
with a motorized burr.
incisions are closed with a suture and you are taken
to the recovery room.
When you awaken in the recovery room following
subacromial decompression, your shoulder usually is
wrapped in gauze, immobilized in a sling, and may be
covered with an ice pack. You may feel a moderate amount
of pain. You usually stay in the recovery room for at
least two hours while the anesthetic wears off. General
anesthesia wears off in about an hour and regional anesthesia
may take about two hours to wear off. You will be given
adequate pain medicine, either orally or through an
IV (intravenous) line, as well as instructions for what
to do over the next couple of days and when to return
for a follow-up appointment – usually in one or
two weeks. You should try to move your fingers while
you are in the recovery room to improve circulation.
Moving your wrist may be painful and you usually should
not try to move your elbow. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay. The majority of patients
leave the hospital after two or three hours. As soon
as you are fully awakened, you usually are allowed to
go home. You will be unable to drive a car, so be sure
to have arranged a ride home.
Following subacromial decompression to repair impingement
syndrome, you will need to take steps to reduce the
pain and inflammation in your shoulder. Rest, icing,
and anti-inflammatory painkillers such as ibuprofen
or aspirin can ease pain and swelling. Immobilizing
the shoulder in a sling for two or three days will help
keep it stabilized. Larger tears may require you to
wear the sling for a few weeks. You usually are instructed
to remove the sling for part of each day to perform
gentle motion exercises that will keep your shoulder
from tightening up. Here is what you can expect and
how you can cope with a sling immobilizing your shoulder:
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied for 15 to 20 minutes
at a time, three or four times a day.
the swelling has decreased after 72 hours, you may be
able to apply heat to help reduce pain. You should not
apply heat to swollen areas because heat increases blood
flow to the skin, which can prolong the healing process.
generally recommend that you wear the shoulder sling
day and night for about two or three days.
can usually remove the gauze bandage and bathe regularly
after two days. If surgeons had to make a 1 1/2-inch
"mini-incision" to suture your rotator cuff
tear, you may have to keep the bandage on and sponge
bathe for about seven days. You can take your sling
off for brief periods while you bath, but remember to
avoid moving your injured shoulder.
bleeding and fluid drainage is normal for the first
two days. Call your physician if bleeding continues
past a couple days.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. Slings should not
irritate your skin.
may feel some stiffness in your shoulder. If the stiffness
does not ease after two or three days, call your physician.
Physical therapy following subacromial decompression
to correct shoulder impingement usually progresses through
four phases. The time you spend in each phase depends
on the severity of your injury and your body’s
ability to heal.
first phase focuses on decreasing inflammation in your
shoulder. Your therapist usually helps you move your
arm and stretch your shoulder.
you feel comfortable moving your arm with your own strength,
you can work on restoring a full range of motion and
strengthening the hands, wrist, and elbow.
third phase focuses on shoulder strengthening exercises.
These may begin with isometric exercises, which strengthen
the muscles without motion, and progress to resistive
exercises that may involve pulleys or weights.
the muscles in the injured shoulder are about as strong
as the uninjured muscles, phase four of rehabilitation
becomes more activity oriented. You usually perform
sport-specific exercises and coordination drills under
the supervision of a therapist or coach.
Patients generally progress quickly through the four
phases of rehabilitation. Active people can usually
return to their sports within three months if impingement
syndrome was the only diagnosis treated.
The best way to prevent impingement syndrome from recurring
is to make the strengthening exercises you learned in
rehabilitation part of your everyday routine. You should
remember to stretch your shoulder and warm up before
exercising. Sports that involve repeated overhead motion,
like baseball and tennis, inevitably strain your shoulder.
To prevent injury, you need to keep all the rotator
cuff muscles toned and flexible with an exercise program.
You also may need to alter your work environment to
avoid repeated overhead activities. Physicians generally
recommend that you ice your shoulder after activities.
Competitive athletes may need to use anti-inflammatory
medication, like aspirin and ibuprofen, after sports
activities that cause swelling in their shoulders. If
you feel pain in your shoulder after you have had surgery
to correct shoulder impingement, you should cut back
your activity level and return to your physician for