Impingement syndrome of the Shoulder

The Specialist shoulder surgery

Impingement syndrome of the Shoulder

It is very painful condition. May start after a minor injury, or spontaneously without any single incident of  trauma. Some patients may get the pain after a work. Repetitive injury is considered as a common causative factor to initiate the impingement syndrome.  Severity of Signs and symptoms are based on the degree and stage of the disease process.


Fig; shows the acromion  Bursa, rotator cuff.

The basic pathology is inflammation of the tissue under the acromion. These structure lies between  two strong bone, acromion and humeral head. Tight space created either by the overgrown bone under the acromion or swelling of the bursa or tendon in this  space. Some people have hereditary tendency to develop impingement syndrome, which may be associated with the shape of the bone of the acromion.
It has  been identified that there are three types of acromion (the bone at the tip of shoulder). Type one has got minimal risk of developing Impingement, but type two and three has got significant risk of impingement syndrome.
If the impingement is not treated, and persistent impingement lead to repeated episode of injuring the tendons. It may end up with Rotator cuff tear, and person is unable to lift the arm up and hold. He may be able to lift arm with the help of other hand but unable to hold it without  support.
Sometimes this condition progress to get Rotator cuff tear, which further damage to the group of muscles.

Main symptoms are;

Pain in the shoulder may radiate down to upper arm or down to elbow
Difficulty in wearing clothes
Difficulty reaching to the pocket
Difficulty in pulling up the trousers
Unable to fasten or unfasten her bra
Difficulty in sleeping
In very  sever cases may not be able to lay down on bed and prefer to sleep sitting on the sofa or a chair.


Certain tests are done for the assess of the Impingement syndrome and also to check for any damage to the tendons of the muscles which makes the rotator cuff.

After clinical assessment  some time diagnosis is very obvious, and no  more investigation is required, and treatment is suggested. But sometime it may need to do some imaging in the form of  Ultra sound scan or MRI scan to assess the extent of damage or to find and predict  the possible out come of the treatment.
Acromioplasty is performed to treat the Impingement syndrome. It is very rewarding procedure. There is 95-97% success rate to cure the problem.
Over grown Acrmion bone, or bony projection from under surface of the ACJ are excised and sub-acromial space is cleared  and in other words decompressed. More space is created for the tendons of the rotator cuff  to slide freely, without any impingement.

If the Rotator cuff (tendons of the muscles) is torn, it can be repaired surgically, if treated in time, outcome is very satisfactory and person can return back to his normal daily activities. If the diagnosis is delayed , or repaired is performed when the muscle is already retracted or degenerated, outcome is not that desirable. We as surgeons always try to make the diagnosis and offer treatment sooner to avoid the unfavourable results.
Rehabilitation are very important after surgery for impingement and Rotator cuff tear. Physiotherapist has got very important role to play after the surgery. Intensive physiotherapy is required  and followed by home exercises.


For more information on the procedure or to make an appointment with Mr. Mohammad Maqsood contact 01522 574706 or 01522 574703 At BMI hospital Lincoln.