SHOULDER ARTHROSCOPY

Q: What is impingement syndrome of the shoulder and how is it treated?

A: Impingement syndrome, or subacromial impingement, refers to a condition where elevation and rotation of the arm brings the rotator cuff into close contact with the corner of the shoulder blade called the acromion. The acromion creates a roof of sorts above the rotator cuff and the space beneath the acromion, referred to as the subacromial space, is quite limited. Anything that closes down this space, be it extra bone formation on the underside of the acromion or poor shoulder mechanics that allow the entire shoulder blade to pitch forward, a condition termed scapular dyskinesis, can lead to impingement of the acromion on the rotator cuff tendon.

Symptoms of subacromial impingement mirror those of other rotator cuff disorders, generally leading to pain with forward elevation or rotation of the arm. The pain is typically experienced in the upper arm region often leading patients to believe that they have an arm problem as opposed to a true shoulder problem. Nonoperative treatment of impingement syndrome involves a multimodal approach aimed at improving shoulder strength and reducing inflammation. Antiinflammatory medications such as ibuprofen and naproxen along with regular icing are simple measures that can provide pain relief. Administration of corticosteroid injections, sometimes called cortisone or steroid injections, can have a profound effect on inflammation and pain and are a mainstay in the nonoperative management of rotator cuff tears.

While most cases of impingement syndrome are largely related to poor coordination in the movement of the upper arm and shoulder blade and respond favorably to a dedicated physical therapy program, there are cases where the subacromial space is excessively tight due to the development of bone spurs or other factors in a patient’s anatomy. In these cases the excessive bone is gently removed arthroscopically with the assistance of video technology through small incisions using a motorized device that smooths the undersurface of the acromion in what is called and acromioplasty. Thickened bursa material that has formed over time from ongoing bursitis is also removed and the entire process opens up the space between the top of the humerus and the underside of the acromion thus “decompressing” the rotator cuff.

The recovery from decompression surgery is generally accelerated as there is no structural repair of damaged material that requires protection in order to heal. A brief period of time in a sling for comfort is recommended followed by a rapid transition to a physical therapy program geared toward optimizing the mechanics of the upper arm and shoulder blade movements.

To see a video of arthroscopic acromioplasty and decompression surgery visit www.ohioshouldercenter.com. Eric M. Parsons, M.D.

Ohio Shoulder Center for Arthroscopy Lake Orthopaedic

Associates, Inc. 36060 Euclid Ave., Suite 104 Willoughby 440-942-1050 9500 Mentor Ave., Suite 210

Mentor 440-352-1711 www.ohioshouldercenter.com