Shoulder impingement syndrome – characterized by bursitis, inflammation, sometimes tearing of the rotator cuff, and bone spur formation in the shoulder -- produces pain and limits range of motion.
Symptoms include discomfort and, sometimes, acute shoulder pain when raising the arms above the head, reaching into a back pocket or while sleeping on the affected shoulder. People who frequently work with their arms above their heads may be more likely to get shoulder impingement syndrome.
What are my treatment options?
Before beginning treatment for shoulder pain, your doctor may take an X-ray. You doctor will also take a thorough history and examine you to ensure that the pain is not due to a problem in another area of the body.
Non-operative measures, including activity modification, physical therapy, anti-inflammatory medication, rehabilitation and, if appropriate, cortisone injection, are effective for more than 90 percent of patients in resolving the shoulder instability symptoms within three to six months of onset.
The doctor may suggest surgery for the patient who has not benefited from the non-operative management. The surgery may be performed arthroscopically or open, depending on which method the surgeon feels is more appropriate. This procedure improves function in about 85 percent of patients. The majority of cases are performed arthroscopically at Cleveland Clinic.
Arthroscopic subacromial decompression requires at least two 5mm incisions. The arthroscope is introduced through the skin and deltoid muscle to enter the shoulder joint. Once in the joint, a methodical inspection of the tissues is performed looking for tears in ligaments, muscles and tendons. Loose bodies may be found and an overall assessment of the joint surface is made. With this technique, the biceps tendon, rotator cuff tendons and joint can be examined for injuries that may not be evident on an MRI scan or with open surgery.
After the joint is examined, the arthroscope is withdrawn through the rotator cuff tendons and is placed in the space above the rotator cuff. It is in this space that the surgeon smoothes off the spur that is contributing to inflammation and impingement on the rotator cuff.
Arthroscopic surgery allows for a shorter recovery time and predictably less pain in the first few days following the procedure than does open surgery.
What are the risks of surgery?
All surgery entails some degree of risk, but the risk associated with this type of surgery is quite low. Some of the risks you should be aware of include infection, wound healing problems, bleeding and injury to nerves, blood vessels and the joint surface of the shoulder. Occasionally, patients can develop marked stiffness after the operation, which we sometimes call "frozen shoulder."
How do I prepare for surgery?
Try to be as informed as you can about the operation and the goals of the surgery. We encourage you to ask your doctor questions.
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
- Main Campus: 216.444.HAND (4263)
- Lutheran Hospital: 216.363.2311
- Refrain from eating or drinking anything after midnight the night before surgery.
Are there exercises I can start now prior to surgery?
It is very important to keep the shoulder joint as flexible as possible. This is difficult when it is painful, but guided use of medications, ice, heat and physical therapy does help.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens after surgery?
We will ensure that you have sufficient shoulder pain relief and that you are comfortable. You will receive prescriptions for appropriate pain killers to use at home. Your arm may be placed in a sling or splint.
Your surgeon will instruct you and your family on the appropriate rest and/or therapy and exercises for the treatment of your shoulder instability. You will be informed of the findings at surgery.
How long is the recovery period after surgery?
Your need for pain killers usually drops quickly during the first few days to week, and it is typically recommended to resume light activities at waist height after a few days. Most patients recover completely and return to work or normal activities within one week to three months following the procedure. After about four to six weeks, you will start to strengthen the shoulder again. Most patients achieve their maximum improvement over three to six months. Some may require more time.
What is the rehab after surgery?
A shoulder therapist will demonstrate exercises you can do to prevent stiffness and swelling. It is important to move your fingers, hands and elbow even if you cannot yet move your shoulder. You should avoid lifting objects to avoid muscle strain during the healing process.
How can I manage at home during recovery from the procedure?
Most patients can be fairly independent at home with eating and dressing within two to four days of the procedure. You can take a shower, but you should keep the wound dry with a dressing for the first few days to one week. If the dressing gets wet, you can change it. It is not advisable to drive until you have confident control and strength in your arm. Progress will vary between individuals.
How frequently should I schedule follow up appointments with my doctor following surgery?
Your doctor will inform you about when you need to be seen.
This information is provided by Cleveland Clinic and is not intended to replace
the medical advice of your doctor or health care provider.
Please consult your health care provider for advice about a specific medical condition.
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