Rotator Cuff Impingement And Subacromial Decompression

The rotator cuff is a set of 4 muscles at each shoulder. These muscles work together to keep the "ball in socket" as you move your arm out or overhead. If the tendon of one of these muscles is injured, it will be painful for you lift anything, reach overhead, or reach behind your back. The rotator cuff tendons can be injured traumatically in a fall or other accident or be worn down over time by repetitive activity, presence of bone spurs, or use of poor posture. Although the injured tendon is in the shoulder, pain from the rotator cuff is most commonly felt in a band around the upper half of the upper arm. A rotator cuff injury can often be diagnosed based on clinical presentation, but if conservative treatments do not resolve the issue, an MRI may be ordered to determine which of the tendons are involved and whether they are torn or just inflamed.

Rotator cuff inflammation symptoms are addressed by conservative treatments initially. These can include use of anti-inflammatory medication, physical or occupational therapy intervention, avoidance of aggravating activities, and possibly use of a steroid injection. If the tendon is inflamed because it is being pressed against a bone spur during certain movements, it is possible that performing the right exercises to improve posture may open up the space in the shoulder, giving the tendon more room to move without getting "pinched". In other cases, the spur may be too large, or the posture may be too poor for the issue to be addressed conservatively. In these cases, surgery may be an option.

A subacromial decompression (SAD) is performed arthroscopically on an outpatient basis. The goal of this surgery is to create more space for the rotator cuff tendon. During an SAD, the surgeon will remove the bone spur and "clean up" any arthritis in the area. After this type of surgery, a sling may be used for a short time for comfort, but early motion is typically recommended. Physical or occupational therapy performed after surgery will guide the patient through rehab protocol beginning with active and passive range of motion exercise and progressing to strengthening after the first month. Patients treated with SAD typically are released to resume regular activity and return to work about 10 weeks after surgery.

For information on surgical options, see the link on Dr. Ahn's and Dr. Freehill's page.