Shoulder impingement is a term to describe pain in the shoulder or arm. It is usually associated with tendonitis in the rotator cuff and bicep tendon, bursitis above the rotator cuff, weak scapular muscles, and bone spurs that irritate the rotator cuff. Usually the pain is minimal at first and increases over time. Eventually the patient experiences pain with overhead lifting, pain at nighttime especially while lying on the affected shoulder, and loss of use of the shoulder due to pain.
In order to diagnose your shoulder impingement, Dr. Howard will need to examine you in person. X-rays will be taken on your day of visit. The soft tissues of the shoulder cannot be seen on x-ray, but things such as arthritis and bone spurs need to be ruled out. On your day of visit Dr. Howard will review your x-rays with you, perform a physical exam to determine if your problem is coming from your rotator cuff or elsewhere, and prescribe treatment
Non Surgical Treatments
If a shoulder impingement problem is diagnosed, Dr. Howard will often prescribe anti-inflammatory medications. He will also prescribed physical therapy for you. Physical therapy is done in person, but for the self-motivated or very busy individual a home exercise program can be performed as well. If you are an appropriate candidate, Dr. Howard will also offer you a cortisone injection into the shoulder to help relieve your pain. Dr. Howard will monitor your progress over 4-6 weeks to see if you improve and her pain goes away after starting these treatments. Often a follow-up appointment will be scheduled to see you back to make sure you are doing better. If your pain does not go away with these treatments, oftentimes an MRI will be ordered.
If you have tried cortisone injections, anti-inflammatories, and an exercise program and your pain has not gone away, an MRI is often indicated. MRIs use magnets, not radiation, to view the inside of the body and see soft tissue structures that cannot be seen on x-ray. When you are given a prescription from Dr. Howard for an MRI, our staff will help you set it up at one of the local imaging centers. Dr. Howard’s office does not have an MRI on site.
Magnetic Resonance Imaging (MRI)
The process of obtaining the MRI involves setting up an appointment at the imaging center for your MRI. At your appointment time the center will perform the MRI on you. After the MRI is complete, always ask for a copy of the MRI on a CD for your permanent records. Once the MRI is complete, if you have not scheduled a follow-up appointment you should schedule I with Dr. Howard to review the MRI and discuss treatment options.
Often if the patient has gotten to the point of getting an MRI, there is usually tendinitis that can be seen in the rotator cuff. Tendonitis without a tear is the definition of shoulder impingement. At your MRI follow-up Dr. Howard will discuss with you your treatment options.
If your symptoms are not going away with conservative treatment and the MRI does demonstrate tendinitis often times surgery can be a great option for the patient to relieve their pain.
Arthroscopic shoulder surgery is a minimally invasive technique to repair the rotator cuff tendon without cutting through major muscles or tendons. The rotator cuff tendon lies deep beneath the big deltoid muscle. Historically, the deltoid muscle was cut, split, or detached from the bones to expose the rotator cuff tendon. Dr. Howard’s advanced fellowship training has taught him the skills to avoid the majorly invasive technique. Dr. Howard uses a specialized camera and tools to make multiple small, less than half an inch, incisions to repair the rotator cuff.
Dr. Howard will use specialized implants called suture anchors to repair the rotator cuff down to the bone. Over time the suture anchors turn into bone, leaving no major permanent change to the bone. While operating on her shoulder if Dr. Howard sees any other abnormalities, he will go ahead and fix those to improve the shoulder function. Austin the bicep tendon is diseased, the labrum can have tears, cartilage can be worn, and bone spurs can be pinching the rotator cuff. Commonly all of these are fixed at the same time of a rotator cuff repair. Surgery last anywhere from 45 minutes up to 2 hours depending on the size of the tear. This surgery is performed on an outpatient basis. This means that he will come in and go home the same day as surgery. Often these surgeries are performed at a ambulatory surgery center that is separate from the hospital. Ambulatory surgery centers are often cleaner, more efficient, and less expensive to the patient than the hospital.
After your surgery, rehabilitation starts immediately. Some of the anesthetic medications can last in your system up to 24 hours. For the first 24 hours at home you should plan on having a friend or family member stay with you. Often times Dr. Howard would like you to start physical therapy within the first week after surgery. This will be at an outside physical therapy center close to her house. You will be responsible for making the appointment. The physical therapist can also answer questions and guide you through the first few weeks after surgery. The first few weeks are often the most difficult and improve week to week.
At your two-week office visit sutures (stitches) will be removed. X-rays will be obtained, and a general checkup will be performed. If you have not started physical therapy by this point you will be given a physical therapy prescription and will be asked to start therapy. If there are no complications, you will see Dr. Howard again in one more month. Rehabilitation can last for many months after a shoulder impingement surgery. Having a good relationship with your therapist and motivation to do your exercises is essential to have a good outcome.
Rehabilitation and full recovery varies from patient to patient. Expect 2-4 months of therapy and rehabilitation to obtain optimal shoulder function, depending on what was performed during surgery. Some patients can see improvement in function up to 12 months from surgery. Dr. Howard will want to see you at 3 months and 6 months from surgery to ensure that you have made a full recovery.