Giving It Space: How Shoulder Impingement Surgery Frees Up Your Arm

Shoulder pain is a common problem for many, though it’s usually short-lived and resolves itself with rest and basic care. However, if you regularly enjoy sports where your arms are raised over your head, activities such swimming or tennis, you may develop a chronic shoulder problem that causes increasing pain over time, as well as reducing the range of motion of your shoulder.

The subacromial space

There’s an area in your shoulder through which your rotator cuff tendons pass, called the subacromial space. During normal activity, these tendons can move freely. But as you repeat over-the-head motions, you may develop restrictions to those tendon movements, and they become pinched in the subacromial space. This is known medically as shoulder impingement.

Causes of shoulder impingement

Anything that causes the subacromial space to get smaller is a potential cause of shoulder impingement. For some people, genetics give a smaller space. The acromion, that defines the top of the subacromial space, may be more aggressively curved, interfering with tendon motion. Arthritic bone spurs can produce a similar condition.

The subacromial bursa is a cushioning fluid sac that can inflame with overuse, a condition known as bursitis, and that inflammation may also restrict the shoulder tendons. A ligament in the area may also tighten enough to interfere with normal shoulder motion.

Any of these conditions, alone or in combination, may put pressure on the rotator cuff tendons, causing increased friction. In turn, this causes the tendons to inflame, making space even more limited.

When these conditions continue in a cycle, you have shoulder impingement syndrome. If conservative treatments fail to produce results, shoulder impingement surgery may be the best way to restore motion and relieve pain.

Subacromial decompression

The medical name for shoulder impingement surgery is subacromial decompression, also called acromioplasty. It is the preferred course of action when months of rest and non-surgical treatments can’t address the pain and mobility issues.

Most approaches to subacromial decompression use arthroscopic techniques, sometimes called keyhole surgery for the small incisions through which I view and manipulate surgical tools. Typically, three such incisions are made.

An arthroscope is a small camera through which the internal surgical field can be seen. It has its own incision, accompanied by another incision for surgical instrument access.

The procedure starts with a tube in a third incision, for pumping fluid into your shoulder to expand the subacromial space for easier viewing and access.

Variations in shoulder impingement surgery

How your surgery proceeds has much to do with what I find through the arthroscope. X-Rays and other diagnostic imaging can’t match being inside the joint, so once the arthroscope is in place, I make decisions on how to perform your surgery.

Three aspects of the decompression procedure include:

• Acromioplasty: removal of bone spurs or bone tissue that narrows the subacromial space
• Ligament resection: the coracoacromial ligament may be removed if it is tight
• Bursa removal: an inflamed subacromial bursa sac may be removed

It’s also possible that your arthroscopic procedure switches to open surgery. Some conditions or combinations of conditions require greater access than arthroscopic techniques allow. I’ll discuss this possibility with you prior to your surgery.

Recovery from subacromial decompression

Full recovery usually takes months, but you should have greatly increased, pain-free mobility showing in a few weeks. After about six weeks, you can move your arm above your head. You may see additional improvements in motion and strength for up to a year.

Moving your shoulder after impingement surgery is fine. You can’t damage the surgery, but you should restrict heavy use, such as lifting or any activity that causes pain, for up to three weeks after the procedure. This lets your shoulder tissue return to normal. Post-surgical inflammation may limit your range of motion for a few days.

I’ll instruct you on a post-surgery rehabilitation plan, including exercises and possibly physiotherapy. While there’s a period of adjustment before returning to pre-impingement activities, you’ll likely feel free of pain, with greatly improved motion. Call my office today, or book an appointment online, and let’s get started on improving your quality of life.