Your shoulder is a ball and socket joint. I always liken it to a golf ball sitting on a golf tee. Holding the ball in the joint is a “sock” or “cuff” of muscles (called the rotator cuff). The job of the rotator cuff is to hold the ball in place so that the bigger muscles (deltoid, pectorals, lat dorsi etc.) can move the shoulder. Above the joint is an arch of bone where the collarbone connects to the shoulder (it's just under the skin and you can feel it on your own shoulder).
In a healthy shoulder, there is enough room for movement of the joint and cuff muscles under the arch of bone without rubbing. However, if the space is reduced or the muscles are not working well, the muscles can start to rub under the arch, causing pain and discomfort. In some people, this is due to tightness in the joint itself. In others it is due to the bony arch drooping after many years of loadbearing. There are some people where it is a combination of factors.
Where non-surgical treatments have not been as effective as hoped for, an operation called a subacromial decompression may help to resolve the problem and get you out of pain.
Shoulder impingement commonly affects people aged 40 - 60. Rather than causing specific areas of pain, it tends to give a more generalised shoulder pain, hard to pinpoint precisely. The pain will often become worse when the arm is lifted above shoulder height or made worse on trying to raise and arm above shoulder height.
These symptoms are fairly common for a number of shoulder conditions, so it's important that other causes of shoulder problems ( e.g. muscle tears, arthritis) are always excluded before any treatment is started.
When I see you for a consultation, I will examine your shoulder and carefully move your arm into various positions to help me assess the severity of the problem and to see where it is most painful. I may arrange for you to have additional diagnostic tests, such as an X-ray, ultrasound, MRI or CT scan of the shoulder if they would help with the diagnosis.
This consultation is also your chance to ask any questions and raise any concerns you may have. Nobody knows the joint pain you are experiencing better than you, and it is important you tell me the different ways it is affecting you so that I can ensure any treatment options I advise are right for you.
The good news is that physiotherapy is really effective in the majority of cases and will often be all that is needed. Many people have a degree of tightness within the shoulder that settles with stretching and muscle strengthening exercises. We can liaise with your physiotherapist or provide therapy at Circle. Only a few patients will need to have surgery.
Should physiotherapy not be as effective as hoped, I can give a corticosteroid injection directly into the shoulder joint. This often relieves the pain very quickly and the effects can last a reasonable time.
If you still have shoulder pain, I can carry out a subacromial decompression to widen the space around the rotator cuff so that it no longer rubs or catches on nearby tissues or bone. People who have developed a tight space between the bony arch and the muscles tend to be those that do not respond to therapy.
Arthroscopy is a type of keyhole surgery. Using only tiny cuts into the shoulder, I'll insert a thin tube known as an arthroscope into the joint. The arthroscope has a light and a camera and gives me a really good view of the joint. Once I have assessed things, I will insert small surgical tools through the arthroscope and carry out the decompression. This will stop your shoulder pain.
Subacromial decompression will usually improve your pain, but it's important to be aware that it will take time to fully settle down and for you to feel the full benefits.
The operation itself is carried out as a day case procedure and you will be wearing a sling for a few days afterwards, but other than that, it is important to give the joint time to rest and fully recovery. The Circle physiotherapy team can also help with your recovery and to ensure you don't lose mobility in your shoulder during your recovery.
Of course, if you have any queries or concerns during your recovery, it's easy to contact me here at Circle and I am always happy to help.
I decided fairly early on in my orthopaedic training that I wanted to specialise in treating shoulder and elbow problems. During my years working as a shoulder and elbow specialist, I have been privileged to see the difference good, effective treatment makes to people's lives. Although not a commonly known procedure to most people, a subacromial decompression can be a very helpful operation for the small number of people who don't improve with physiotherapy and/or corticosteroid injections.
Your initial consultation will help us find out exactly what the problem is. We'll then be able to talk through the treatment options so that you can make an informed decision.
It's easy to schedule an appointment with me here at Circle, my private secretary will be delighted to help you book a time and day that is convenient for you.