Huw David

Shoulder pain - Subacromial Impingement

This is perhaps the most common shoulder condition seen in clinical practice. Also known as subacromial bursitis, rotator cuff impingement or painful arc, the condition is characterised by pain, typically felt in the upper, outer, aspect of the arm. The pain usually occurs with movement - especially those actions that involve the arm moving away from the side of the body and with rotation. Reaching to get something from the back seat of the car, taking something down from a shelf, putting one’s arm through the sleeve of a jacket are all examples of those day-to-day movements that can give rise to discomfort. Patients may have strained or over used their arm before the onset of problems. Individuals quickly learn that, provided they keep their elbow tucked in to their side where possible, they can, to some extent, minimise the times and frequency when pain is felt.

Rubbing or catching of the shoulder tendons gives rise to inflammation and pain. Subtle impairment in movements and strength can compound the problem. Treatment is aimed at reducing the inflammation and improving muscle strength. For the majority of individuals avoidance of exacerbating activities and a course of specific physiotherapy with or without an injection of an anti-inflammatory into the space around the tendons (subacromial space) will be all that is required. Sometimes however surgery will prove necessary and a subacromial decompression, which in this day and age would normally be performed arthroscopically (keyhole surgery) is the mainstay of treatment.

Huw will be able to explain to you in detail the nature of both the condition and treatment options available.