Subacromial Impingement Syndrome

Q1: What is Subacromial Impingement Syndrome?

Subacromial Impingement Syndrome (SIS) is a common cause of shoulder pain. It occurs when the rotator cuff tendons (a group of muscles and tendons that stabilize your shoulder) and/or the bursa (a fluid-filled sac that reduces friction) in your shoulder get pinched or "impinged" between the top of your arm bone (humerus) and the bone on top of your shoulder blade (acromion) when you raise your arm. This pinching can cause irritation, inflammation, and pain.

Q2: What causes Subacromial Impingement Syndrome?

SIS often results from repetitive overhead activities, such as those in sports (swimming, tennis, baseball) or certain jobs (painting, construction). Other causes can include:

• Bone spurs: Extra bone growth on the acromion can narrow the space.
• Acromion shape: Some people have an acromion that is naturally more hooked or curved, reducing the space.
• Rotator cuff weakness or imbalance: If your rotator cuff muscles are weak or not working together properly, the humerus can move upward too much, leading to impingement.
• Shoulder instability: If your shoulder joint is not stable, it can lead to abnormal movement and pinching.
• Injury: A direct injury to the shoulder can sometimes trigger inflammation and impingement.

Q3: What are the common symptoms of Subacromial Impingement Syndrome?

Common symptoms include:

• Pain in the shoulder, often radiating down the side of the arm.
• Pain that worsens with overhead activities or when lifting your arm.
• Night pain, especially when lying on the affected side.
• Weakness in the affected arm.
• Limited range of motion in the shoulder.
• A catching or clicking sensation when moving your arm.

Q4: How is Subacromial Impingement Syndrome diagnosed?

Your doctor will typically diagnose SIS based on:

• Medical history: Asking about your symptoms, activities, and any previous injuries.
• Physical examination: Checking your shoulder's range of motion, strength, and performing specific tests that can reproduce your pain.
• Imaging tests: X-rays can show the shape of your acromion and rule out other bone problems. An MRI or ultrasound may be used to get a better look at the soft tissues, such as the rotator cuff tendons and bursa, and to check for inflammation or tears.

Q5: What are the non-surgical treatment options for SIS?

Most cases of SIS can be treated without surgery. Non-surgical options include:

• Rest and activity modification: Avoiding activities that worsen your pain.
• Ice and heat: Applying ice packs to reduce inflammation, or heat to relax muscles.
• Pain relievers: Over-the-counter anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen can help reduce pain and swelling. Your doctor may also prescribe stronger medications.
• Physical therapy: This is often the most important part of non-surgical treatment. A physical therapist will teach you exercises to improve shoulder strength, flexibility, posture, and movement patterns.
• Corticosteroid injections: Your doctor may inject a powerful anti-inflammatory medication (cortisone) into the subacromial space to reduce pain and inflammation, allowing you to participate more effectively in physical therapy.

Q6: When is surgical treatment considered for SIS?

Surgery is typically considered if non-surgical treatments have not relieved your symptoms after several months (usually 3-6 months), or if there is a significant rotator cuff tear that isn't healing with conservative management.

Q7: What does the surgical procedure for SIS involve?

The most common surgical procedure for SIS is called a subacromial decompression or acromioplasty. This is usually performed arthroscopically, meaning through small incisions using a tiny camera and instruments. During the procedure, the surgeon will:

• Remove any inflamed bursa (bursectomy).
• Shave off a small portion of the acromion bone to create more space for the rotator cuff tendons to glide freely.
• Address any other issues found, such as minor rotator cuff fraying.

Q8: What are the potential risks of shoulder surgery for SIS?

While generally safe, all surgeries have potential risks. These can include:

• Infection
• Bleeding
• Stiffness (frozen shoulder)
• Nerve or blood vessel damage
• Persistent pain or stiffness
• Anesthesia risks
• Failure to improve symptoms

Your surgeon will discuss these risks with you in detail.

Q9: What do I need to do to prepare for surgery (if applicable)?

If you are having surgery, your healthcare team will provide specific instructions. Generally, preparation may include:

• Medical evaluation: To ensure you are healthy enough for surgery.
• Medication review: Discussing all medications you take, including supplements, with your doctor. You may need to stop some medications before surgery.
• Fasting: Instructions on when to stop eating and drinking before surgery.
• Arranging for help: Planning for someone to drive you home and assist you with daily activities in the initial recovery period.
• Home modifications: Setting up your home to be comfortable and safe for recovery (e.g., easy-to-reach items).

Q10: What can I expect immediately after shoulder surgery?

Immediately after surgery, you can expect:

• Pain management: You will receive medication to manage pain.
• Sling: Your arm will likely be in a sling for a short period (usually 1-2 weeks) to protect the shoulder and promote initial healing.
• Ice: Applying ice to the shoulder will help reduce swelling and pain.
• Activity restrictions: You will have specific instructions on how to move and not move your arm.

Q11: How long is the typical recovery period?

Recovery time varies for each person, but generally:

• Initial healing: 1-2 weeks.
• Regaining motion: 2-6 weeks.
• Strengthening: 6 weeks to 3 months.
• Return to full activities: 3-6 months, and sometimes up to a year for complete resolution, especially for overhead activities or sports.

Consistency with your physical therapy is crucial for a good recovery.

Q12: What does rehabilitation/physical therapy involve?

Physical therapy is essential for recovery. It typically involves stages:

• Phase 1 (Pain and Swelling Reduction, Gentle Motion): Focus on reducing pain and inflammation, and starting gentle passive range of motion exercises (where the therapist moves your arm).
• Phase 2 (Restoring Active Motion and Flexibility): Gradually progress to active exercises to improve your shoulder's natural movement and flexibility.
• Phase 3 (Strengthening): Begin strengthening exercises for your rotator cuff and surrounding shoulder muscles.
• Phase 4 (Return to Activity): Sport-specific or work-specific exercises to prepare you for full return to your desired activities.

Q13: How will pain be managed during recovery?

Pain will be managed using a combination of methods, which may include:

• Prescription pain medications (especially after surgery).
• Over-the-counter pain relievers like NSAIDs.
• Ice and heat application.
• Physical therapy techniques, such as manual therapy and modalities.
• Gradual increase in activity levels as pain allows.

Q14: What signs or symptoms should I watch out for and report to my doctor immediately?

Contact your doctor immediately if you experience:

• Increased pain that is not relieved by medication.
• Fever or chills.
• Redness, warmth, or pus around incisions (if applicable).
• Numbness or tingling in your hand or arm.
• Significant swelling that doesn't improve with ice and elevation.
• New or worsening weakness.
• Any signs of infection or other unexpected problems.

Q15: What is the expected long-term outlook for Subacromial Impingement Syndrome?

The long-term outlook for SIS is generally very good, especially with consistent non-surgical treatment and physical therapy. Most people experience significant improvement in pain and function. If surgery is required, it is often successful in relieving symptoms. Following your doctor's and physical therapist's recommendations is key to a successful outcome and preventing recurrence.

‍

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.