Shoulder Impingement Treatment in Gurgaon
- Unable to use your shoulder properly during play, especially when throwing or swimming or raising your racquet high?
- Are you experiencing pain even when it is at rest or when lying down?
- Have you noticed your shoulder pain when you move your arm to the front or outside the shoulder joint?
If the response to these questions is a “yes”, then you need to approach an orthopaedic surgeon right away!
Dr. Ratnav Ratan is the best sports injury doctor in Gurgaon to treat shoulder impingement pain and recover from it.
If the patient complains of pain in the shoulder when moving in the front or raising, it can be a case of shoulder impingement. It is also known as thrower’s shoulder or swimmer’s shoulder. It occurs when the tendons of the rotator cuff get trapped in the shoulder joint, causing inflammation and pain.
Symptoms of shoulder impingement
- Initially, the shoulder pain is noticeable and bearable.
- Increased in the intensity of pain over time.
- Pain increases when the arm is raised overhead.
For eg. during swimming, throwing or lifting a racquet.
- Also, it is painful to move the arm sideways.
During the physical checkup, the treating doctor may assess the shoulder’s condition through various tests such as the Empty can test, Neers test, and Hawkins-Kennedy test.
The orthopaedic surgeon may suggest an X-Ray or MRI for knowing the exact cause and location of the impingement.
Anatomy of shoulder impingement
This condition occurs when the tendons of the rotator cuff muscles get trapped in the subacromial space, a narrow bony channel in the shoulder joint. The inflammation and irritation are due to repetitive pinching of the trapped tendons.
Also, the tendons tend to thicken, leading to even less space for movement leading to further inflammation. If not treated on time, the intensity of pain and inflammation increases greatly.
Causes of impingement shoulder
Shoulder impingement relates to signal of issues or injury or damage in the shoulder joint of the patient which are
- Rotator Cuff Injury – Strain or tear in the tendons of the rotator cuff
- Bone spurs – Tiny bony outgrowth which pinches the tendons
- Injury to the Labrum – Injury to the labrum, which provides lining to the shoulder joint.
- Dislocation in the shoulder – In case of partial dislocation of the shoulder, leading to instability in the shoulder.
- Biceps tendinopathy – damage in the tendons of the biceps muscle due to an injury
- Scapular Dysfunction – Abnormality in movement patterns of the girdle or the blade of the shoulder.
In sportspeople and regular patients too, the shoulder impingement can occur due to excessive use of the supraspinatus tendon.
In case of persistent use of the injured tendon, the rotator cuff muscles do not work properly, and the upper arm bone is likely to shift. This shift can cause inflammation of the bursa and the shoulder impingement further worsens.
Types of shoulder impingement
The causes of shoulder impingement determine the type of impingement, external and internal impingement.
External impingement is again of two types –
Primary external impingement is due to congenital abnormalities or degeneration in the acromial arch of the shoulder joint. In this condition, the presence of bone spurs detected in the arch impinge the tendons.
Secondary external impingement is due to overuse of the rotator cuff tendons, which have weakened. The other reason could be a muscular imbalance between the rotator cuff muscles and the deltoid muscle. This condition also occurs due to issues in the shoulder blade stabilization, which leads to impingement of the tendons as the physical position of the acromion changes.
Internal impingement is noticed in sportspersons involved in baseball, basketball, and javelin throwers. The patients complain of pain in the rear side of the shoulder joint and occasionally in the front section too. In this condition, the underside of the rotator cuff tendons gets pinched against the glenoid labrum.
Treatment of Shoulder Impingement
At the outset, the orthopaedic surgeon will suggest treatment options to reduce inflammation, discomfort, and pain. After the reduction in pain and inflammation, the focus of treatment will shift to maintain the mobility of the shoulder or improvise it. Alongside, the treatment will work to correct the postural issues and strengthen the weakened muscles.
The order of preliminary nonsurgical treatment of shoulder impingement include –
- Rest – It is essential to give the shoulder ample rest from any movement.
- Ice – Application of ice on the painful area for 15 minutes at least 3 – 5 times daily should provide much relief.
- Medicines – If suitable and/or suggested by the doctor, the patient may take pain relievers for the first couple of days.
- Physical Therapy and Exercise – Only if there is a reduction in inflammation and pain, the suggested physical therapy could include stretching exercises and correcting the posture for improving the range of motion and pain relief, respectively. After considerable improvement, the patient can proceed to strengthen and improve the rotator cuff muscles.
Steroid injection – The surgeon will recommend steroid injection if the above non-surgical options fail to relieve the pain of the shoulder impingement.
This injection is administered directly into the bursa below the acromion under local anaesthesia for pain relief.
Surgical treatment for shoulder impingement
Arthroscopic Surgery for shoulder impingement
The surgeon will suggest scarless arthroscopic surgery which promises immediate relief and a pain-free shoulder. The surgeon inserts an arthroscope, a small camera in one of the small incisions made around the shoulder. Through the camera, the surgeon can inspect and assess the shoulder joint, area including biceps, rotator cuff tendons and do the repair through the other very small incisions made around the shoulder.
It is preferable to perform an arthroscopic surgery as the arthroscope offers a better view of the surgical site which are otherwise not visible in an MRI or an open surgery.
Arthroscopy is a scarless keyhole surgery recommended to young and active people who wish to be independently when performing daily activities and also return to sports. It is also recommended to patients in the age group of 25 – 40 years who have not recovered after seeking non-surgical treatment for moderate shoulder impingement.
The orthopaedic surgeon could treat and repair existing conditions such as biceps tendonitis, a partial rotator cuff tear, acromioclavicular arthritis, and so on during the arthroscopy
Role of Physical Therapy and rehabilitation in Shoulder Impingement
It is advisable to seek prehab and post-operative rehabilitation in shoulder impingement conditions. The physical therapist will suggest strengthening and range-of-motion exercises before the surgery for the best outcomes of the surgery. These exercises can be performed with resistance bands, dumbbells and other traditional equipment.
Postoperative rehabilitation is an extensive schedule that could last for 4 – 6 months in a phased manner to improve the range of motion and the strength of the shoulder in order to return to active sports or perform daily routines seamlessly.