The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems

The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems
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Common Shoulder Injuries

Shoulder problems


What is Subacromial impingement?

Impingement is one of the most common causes of pain in the adult shoulder. It results from pressure on the rotator cuff (tendons that move the shoulder).

impingement impingement
Pressure on the rotator cuff
Subacromial impingement

As the arm is lifted up the tendons get squashed under the tip of the shoulder blade (acromion).

The rotator cuff is a group of 4 tendons linked together. These tendons cover the shoulder joint & act as a cuff (similar to the cuff of a shirt sleeve). The function of these tendons is to keep the head of the humerus (arm bone) in the glenoid (socket), and to move the shoulder.

The acromion is the front edge of the scapula (shoulder blade). It sits over and in front of the humeral head. It hangs over the shoulder joint and as the arm is lifted the undersurface of the acromion rubs against the rotator cuff thereby causing pain and inflammation. Sometimes this may progress to rotator cuff tears over a period of time.


Who gets them?

Athletes who perform overhead sporting activities like swimmers, tennis players, badminton players etc. It is also common in certain occupations as painters & decorators, plasterers and builders.

What are the symptoms?

The main symptom of impingement is pain, though it may vary in severity from mild to severe. The symptoms may vary in severity depending on the amount of inflammation present. Patients usually complain of pain in the side of the upper arm and inability to perform overhead activities. In addition patients may experience difficulty in getting their arm to their back, for instance women may find it difficult to do their bra strap & men may have difficulty in tucking their shirt into their trousers at the back. Pain is noticed more at night. Sometimes patients may develop stiffness of the shoulder (secondary frozen shoulder).

What investigations are required?

A plain x-ray of the shoulder (3 views) will show the abnormality. In addition further investigation in the form of ultrasound scan or MR scan may be required.


Physiotherapy may help in early stages of the disease, especially to correct the posture. Injection is mainly used as a diagnostic aid though it may improve the pain & inflammation.

A keyhole operation called arthroscopic subacromial decompression is done frequently with great success. In this operation the tip of the shoulder blade (acromion) is partly removed to create more space of the tendons to move. This also prevents the tendons to be squashed when lifting the arm up.

Post operation physiotherapy

physio protocol for ASD