Subacromial impingement/bursitis refers to a condition in which the rotator cuff tendons are pinched between the humeral head and the acromion process of the shoulder blade. The bursa is a fluid filled sac located between the rotator cuff tendons and the acromion process. The intermittent pinching may lead to inflammation and/or partial tearing of the rotator cuff tendons. The bursa also become inflamed and irritated with pinching; this condition is called “bursitis.” Over time, some patients may develop bone spurs on the bottom of the acromion process, which may lead to more severe symptoms.
- Sharp pain on the front and outside of the shoulder with overhead activity
- Shoulder weakness due to pain
Diagnosis And Treatment
Dr. Keller considers each patient’s symptoms, as well as a detailed physical examination and x-rays to make the diagnosis of outlet impingement. Dr. Keller may also consider an MRI to evaluate the rotator cuff. Most patients with impingement can be treated successfully without surgery with a dedicated physical therapy program. Physical therapy focuses on restoring the natural mechanics of the shoulder, with particular emphasis paid on posture and strengthening certain muscles around the shoulder blade. Other non-surgical treatment options include a course of anti-inflammatory medications, activity modification, as well as injections. The most common type of injection that Dr. Keller recommends is a steroid injection. A steroid is a powerful anti-inflammatory medication that can significantly reduce pain. In those patients with severe impingement/bursitis who do not recover with the above-mentioned treatment options, Dr. Keller may recommend surgery.
During surgery, Dr. Keller uses a minimally invasive, arthroscopic approach to remove the inflamed bursal tissue and any bone spurs on the undersurface of the acromion process. Dr. Keller also carefully visualizes the rotator cuff. In those patients with significant injury to the rotator cuff, Dr. Keller may clean the edges of the rotator cuff tissue or repair the tissue if it is torn extensively.