Treating shoulder impingement syndrome

Caring for your shoulder at home

If shoulder impingement syndrome is only mild, the following measures may be all that areneeded:

• Rest the tendon Avoiding any overarm movements will help prevent any further inflammation (swelling) or damage. Your doctor or physiotherapist will tell you how long you should rest it for, and when you should start exercises (see below).
• Ice packs Holding an ice pack to the shoulder for around 20 minutes several times a day may help to ease the pain. Don't put ice directly on your skin wrap it in a towel. If you don't have an ice pack, tryice cubes or a bag of frozen vegetables wrapped in a towel.
• Painkillers Mild non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen , can provide short-term pain relief and are available as tablets or a gel that you apply to the shoulder. Other painkillers, such as paracetamol ,may also help to ease the pain. If your pain is more severe, a stronger painkiller such as codeine can be prescribed.

Exercises

While it's important to rest the shoulder joint, you shouldn't stop movement altogether. Inactivity will cause the muscles to weaken, which will worsen the problem andcause yourshoulder to stiffen up. For this reason, a sling is not usually recommended.

Your GP may refer you to a physiotherapist, who will be able to recommend some arm exercises to help stretch and strengthen your shoulder, and improve your range of movement.

After an initial period of supervision by a physiotherapist, you will usually be able to continue doing these exercises at home.

If there is swelling and evidence of inflammation in your shoulder, corticosteroids can be injected directly into the affected area.

They may also be combined with local anaesthetic to further help relieve your pain.

Although corticosteroid injections can relieve pain, without physiotherapy they do not have a long-term effect, and it's common for the pain to return. You can sometimes have another injection, but you will need to wait at least six weeks.Usually, no more than one to two injections into the same area are recommended.

Possible side effects of corticosteroid injections include thinning and lightening of the skin.

Surgery

If the treatments above aren't effective, you may need an operation to widenthe subacromial space in your shoulder, so the rotator cuff tendon is no longer rubbing against the bone above. This is known as subacromial decompression.

This can usually be doneusing a technique called arthroscopy , which is a type of keyhole surgerycarried out under general anaesthetic ,where special surgical instruments and a thin, flexible tube containing a camera are inserted through small cuts in your skin.

This means you should recover faster andwith less scarring than if a larger cut was made. Most people are able to go home the same day or the day after.

This techniquecan also be used to remove any calcium deposits that have formed in the tendon in your shoulder.