Shoulder Impingement Surgery - Procedure and Recovery

Shoulder impingement surgery is to regain a full, pain-free movement of the shoulders. Shoulder impingement occurs when the tendons of the rotator cuff and subacromial bursa become compressed against the acromion (a bone that sticks out from the scapula). Slowly as time passes, the tissues become inflamed and irritated. It results in shoulder pain which worsens at night. It may also cause shoulder and arm weakness and restricts normal arm movement.

Shoulder impingement syndrome is a condition that makes overhead arm movements difficult and painful. It can be caused as a result of acromioclavicular joint arthritis, thickening or clarification of the coracoacromial ligament, structural abnormalities, weakness of the rotator cuff muscles, or repetitive hand movements.

The shoulder impingement limits your range of motion around the shoulder. It results in pain and makes it difficult to perform common daily activities such as bathing, dressing, driving a vehicle, or lifting a hand. Shoulder surgery is the best and most effective option when stiffness and pain fail to improve with medications, steroid injections, physical therapy, and lifestyle adjustments. 

1. Individuals who are involved in activities that require significant rotational motion, such as tennis, baseball, swimming, painting, and volleyball, are at increased risk for developing shoulder impingement syndrome.
2. The other causes of shoulder injury include falling on the shoulder or on the outstretched arm. 
3. The impingement may also occur due to swollen or torn tendons, inflamed or irritated bursa, and the presence of bone spurs on the acromion.

Shoulder impingement is a painful condition. The patient should consult the doctor immediately. If the doctor advises the surgery, it should not be delayed. Delaying the surgery may lead to several complications such as:

1. Rotator cuff degeneration
2. Tearing of rotator cuff
3. Long term pain in arm and shoulder
4. Reflex sympathetic dystrophy
5. Frozen shoulder 
6. Adhesive capsulitis
7. Cuff tear arthropathy
8. Delaying the surgery may also result in reduced quality of life and debility.

The shoulder joint consists of several bones, muscles, tendons, and a bursa (fluid-filled area). Together, they work in harmony, enabling us to freely move our shoulders in all directions without any hassle. However, sometimes bone spurs, injury, or arthritis results in one of the bones of the shoulder pinching (impinge)the rotator cuff tendon or bursa. It results in discomfort and stiffness. Therefore, the surgeon removes the pressure on the rotator cuff tendon and the shoulder bursa through a minimally invasive shoulder impingement surgery. As a result, it helps relieve the pain and pressure and restore function.

The doctor will :

1. Seek information about your past medical history, including your family history.
2. Inform you about the surgery and what results you can expect, along with the risks or complications associated with the surgery.
3. Perform some tests to ensure you are suitable for the surgery.
4. Advice to not to eat or drink anything after midnight the day before the surgery.
5. Ask you to stop the blood-thinning medications (if you are on any) a week before surgery. 
6. Advice you to stop drinking and smoking a week before the surgery to avoid complications.
7. Suggest you to arrange some help from friends or family to ride you home back as you will be under the effect of anaesthesia.

You should arrive at the hospital at the allotted time. Once you reach the hospital, you need to fill out the informed consent form for undergoing the surgery. You will be asked to change into a hospital gown. Then the doctor will mark the shoulder that needs to be operated on. Once done, the staff will take you to the operation theatre. 

The shoulder impingement surgery is performed in the following steps:

1. Then the doctor will administer anaesthesia to put you to sleep and make the surgery painless.
2. The surgeon will make a small ½ half-inch incision in your shoulder.
3. The surgeon will insert an arthroscope through it. The arthroscope sends the images of your shoulder joint on the computer screen. The surgeon may insert a harmless fluid that will expand the area. It makes it easier for the surgeon to see and work on the shoulder.
4. The surgeon will make 2 or 3 more small incisions to repair the shoulder impingement. The surgeon uses specialized surgical instruments to remove bone spurs, repair the damaged tendons, and clean the damaged or inflamed tissue.
5. Once done, the surgeon will remove the arthroscope and other surgical instruments from the incisions made.
6. Finally, the surgeon closes the cut with the help of stitches or staples and covers the dressing.

1. The shoulder impingement surgery takes about one to two hours to complete.
2. Once done, you will wake up in the recovery room, where a trained nurse will monitor your vitals.
3. You may be discharged from the hospital the same day.
4. The doctor will give you the medication to control your pain and infection at the operation site. Take the medicines exactly as directed.
5. The doctor may prescribe you a cold pack and a small device to wear at home.
6. You will be asked to keep your arm in a sling for a week or longer. It is to keep the shoulder in position and to promote faster healing.

First follow-up appointment

The doctor will call you for your first follow-up after seven days from the day of discharge. The surgeon will remove the stitches or staples once the incisions heal. You will have regular follow up with your doctor in the first few weeks or months. You should follow all the instructions from your doctor and physical therapist. It is to ensure the best outcomes possible and reduce complications and risks. The recovery from shoulder surgery can take up to 6 months. 

You should consult the doctor if you see any side effects or complications after the surgery. Shoulder impingement surgery is a safe and effective procedure performed by a skilled surgeon. However, some of the risks or complications associated with shoulder impingement surgery are:

1. Allergic reactions to anaesthesia
2. Excessive bleeding ‘
3. Continued pain
4. Infection at the site of surgery
5. Fever
6. Breathing problems
7. Blood clot
8. Shoulder stiffness
9. Weakness in the shoulder
10. Blood vessels and nerve damage during surgery
11. Slow healing incision which requires further treatment
12. Recurring symptoms of shoulder impingement