Shoulder Impingement Syndrome
Impingement and rotator cuff tears can be treated non-operatively or with surgery. Treatment for impingement usually begins with a non-operative treatment plan.
More than 2/3 of impingement patients can expect significant improvement in their symptoms with a physical therapy program
alone. These results are lower in older patients and in those with large bone spurs.
Non-operative treatment is similar for both impingement and rotator cuff tears. A vast majority of patients improve with this primary treatment alone.
The goals of a physical therapy program include:
- strengthening the rotator cuff tendons.
- stretching and regaining lost motion caused by pain and inflammation.
- allowing the humerus to be better positioned under the acromion, thus reducing compression of the bursa.
A non-operative treatment plan is often all that is necessary for most patients with impingement syndrome. However, the small percentage of patients whose symptoms have not improved after 6 months of dedicated physical therapy may be candidates for surgery. The shoulder should be reevaluated to make sure no other problems exist.
Subacromialdecompressionexpands the space between the acromion and rotator cuff tendons. This can be done either arthroscopically or with open incisions, depending on the preference of the surgeon. During an arthroscopy, a tiny fiberoptic instrument is inserted into the joint. In many cases, the doctor can assess and repair the damage through this scope without making large incisions. Scar tissue or bone spurs can successfully be removed with either technique. If a rotator cuff tear is found at the time of surgery, it can also be repaired if necessary.
Postoperative treatment and rehabilitation
Incisions must be kept dry for two or three days after surgery.
Rehabilitation programs for impingement
Impingement rehabilitation begins almost immediately:
- Exercises to regain shoulder motion usually begin with a therapist in the first week after surgery and continue for about 6 weeks.
- At 6 weeks, most patients have regained full motion and will continue to regain strength with a home exercise program.
- Full recovery time after surgery varies; most patients have greatly improved at 3 months and are close to normal by 6 months.