Dr. Carlos Rebollón
Subacromial impingement
in Panama
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Subacromial impingement
Subacromial impingement
Subacromial impingement syndrome is caused by the rubbing of the tendons of the rotator cuff against the acromion bone of the scapula. This problem often triggers intense shoulder pain that worsens when raising or lowering the affected arm.
WHAT IS SUBACROMIAL IMPINGEMENT?
Subacromial impingement occurs when one of the internal structures of the shoulder increases in size and causes narrowing of the cavity. This narrowing leads to the rubbing and pinching of the tendons of the rotator cuff and part of the acromion during movement, resulting in this uncomfortable condition.
Excessive joint activity generally causes the structures (bones, tendons, cartilage, etc.) to increase in volume, making subacromial impingement one of the most common shoulder injuries.
In some cases, subacromial impingement is accompanied by bursitis, as the bursae are located in the middle of the cavity and can be affected by the friction generated by the other components.
CAUSES OF SUBACROMIAL IMPINGEMENT
As mentioned earlier, subacromial impingement occurs as a result of an alteration in the volume of the internal or adjacent structures of the shoulder.
The growth of these components creates a reduction in the subacromial space, causing the muscles and tendons of the rotator cuff to rub and become injured, resulting in pain during arm movement.
The main causes of subacromial impingement are:
Overloading the shoulder through repetitive actions.
Degenerative or inflammatory processes such as arthritis and tendonitis.
Any other type of patient-specific malformation.
SYMPTOMS OF SUBACROMIAL IMPINGEMENT
Individuals with subacromial impingement experience pain when performing abduction and rotation movements. This pain can worsen when sleeping on the affected arm. In most cases, the supraspinatus tendon is the most affected tendon of the rotator cuff. When subacromial impingement syndrome is not promptly treated, the patient may experience joint weakness, stiffness, and even partial or total inability to move the limb.
TREATMENTS FOR SUBACROMIAL IMPINGEMENT
The clinical diagnosis of subacromial impingement includes imaging tests (X-rays or MRIs) to accurately assess the quality of the muscles and tendons of the rotator cuff, as well as the composition of the other joint structures.
Once the origin of the injury has been confirmed, a conservative or surgical treatment is applied for the identified pain. These can include:
Rest and medication: When impingement occurs due to the inflammation of a bursa (bursitis) or tendon (tendonitis), the goal is to reduce inflammation in the area as soon as possible with the help of anti-inflammatory medications and physical therapy. If this initial treatment does not have the desired effect, a corticosteroid injection may be suggested as long as there is no rotator cuff tear.
Therapies: Stretching exercises and physiotherapy have shown excellent results in the treatment of subacromial impingement. They can improve flexibility, strength, and physical and muscular function of the shoulder.
Surgery: If the problem is derived from a bone condition (wear and tear, fracture, osteophytes, etc.) or a rotator cuff tear, it is advisable to consider surgery (open or arthroscopic) to repair the shoulder anomaly.
SUBACROMIAL IMPINGEMENT SURGERY
Among the most common surgeries for subacromial decompression are:
Shoulder arthroscopy: It is a minimally invasive arthroscopic procedure that allows for the expansion of the joint space by correcting or removing damaged tissues and bones, thus restoring regular (pain-free) movement through small incisions on the shoulder.
Open surgery: In this option, a larger incision is made on the shoulder so that the surgeon can have a wider view of the cavity, enabling the extraction of tissues, inflamed bursae, relaxation of any ligament, or removal of deformed parts of a bone.
FREQUENTLY ASKED QUESTIONS ABOUT SUBACROMIAL IMPINGEMENT
In this section, we address some of the most common questions regarding subacromial impingement…
As mentioned earlier, there are many conservative options to treat subacromial impingement, including rest, cold compresses, physiotherapeutic techniques to relieve pain and regain joint strength, shoulder injections, prescribed analgesic and anti-inflammatory medications, manual therapies, among others.
Yes, essentially the exercise routines for subacromial impingement are the same as those applied to various rotator cuff injuries, including exercises for internal and external rotation with elastic bands, isometric exercises, stretching exercises, scapular retractions with and without resistance bands, wall push-ups, etc.
The recovery time after arthroscopic surgery is usually quite fast; however, your surgeon will monitor your recovery and provide instructions for the following actions. Generally, people can return to their academic or work activities within a few weeks, being careful not to engage in any physical exertion that could compromise the results of the operation.
On the other hand, patients who undergo open surgery have a gradual and slow recovery, and they may be on leave for a period of 3 to 6 months, depending on the complexity of the operation.
When subacromial impingement is derived from a degenerative disease, there is no way to prevent it. However, patients with very high risk factors can reduce the chances by engaging in sports activities to strengthen the internal structures of the shoulder and by reducing activities or tasks that involve lifting weight above the head.
