Impingement Syndrome
Impingement syndrome is a type of shoulder pain that results from inflammation in the subacromial area. It can be simply from bursitis or synovitis, but most frequently is from bone spurs under the acromion or the acromioclavicular joint. Some people are born with a predisposition for impingement syndrome due to an anatomically down-going acromion, termed a type 3 acromion. Non-operatively it is treated with anti-inflammatory medication or steroid injection. Surgically it is treated with a subacromial decompression, literally shaving the spurs off.
Bone spurs take years to form. If the spur remains there long enough gradually getting bigger it will cause pain as it impinges upon the underlying muscle, the supraspinatus. Sometimes however even a small spur can become symptomatic after a seemingly minimal trauma like a fall on the shoulder or even sleeping in an unusual position. Anything that activates inflammation in the subacromial area causes the symptom complex known as impingement syndrome.
If left untreated subacromial bone spurs can lead to a rotator cuff tear. This is why it is important to diagnose and treat this condition as soon as possible. Unless the bone spurs are significant the initial treatment of impingement syndrome is to take anti-inflammatory medication or steroid injection. In fact it is not uncommon to inject the subacromial area two or three times prior to surgical intervention. Nevertheless some patients prefer earlier surgical intervention to ‘avoid the inevitable’, especially when they have visible bone spurs or they were born with a type 3 acromion.
Scapular Y view shows a sharp spur tip of the Acromion.
The surgery to treat impingement syndrome is appropriately called a subacromial decompression. We do this arthroscopically and can be done in an outpatient surgery center without general anesthesia; usually a block is all that is required. Sometimes this surgery is done as the index procedure but most often is done in conjuction with a rotator cuff repair, a labral repair, a synovectomy or some combination thereof. Through very small arthroscopic portals we use a small burr to shave the spurs flat. This procedure is extrememly well-tolerated and not terribly painful.
Dr. Jared Salinsky – Orthopedic Surgeon