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Shoulder Impingement Syndrome
This is the most common causes of shoulder pain. It is often related to irritation and inflammation of the rotator cuff tendons and the bursa that lie beneath the acromion, which is part of the shoulder blade forming the roof over the shoulder. This can develop through overuse, age-related tendon change, or repeated overhead activity.
The condition commonly affects adults in middle age, although it can occur in younger or older patients as well. Symptoms usually include pain over the outer part of the shoulder and upper arm, especially when lifting the arm above shoulder height or reaching out to the side. Many patients also complain of weakness, discomfort during overhead activities, and pain at night, particularly when lying on the affected shoulder.
Diagnosis
The diagnosis is mainly based on the history and clinical examination. During the examination, the shoulder is assessed for movement, strength, and signs that the pain is arising from the subacromial space and rotator cuff. In some cases, imaging may be helpful. X-rays can assess the bony anatomy and exclude other causes of pain, while ultrasound or MRI scans may be used in selected patients to assess the rotator cuff tendons, the bursa, and to look for any associated tendon tear or other pathology.
Treatment
Treatment usually begins without surgery. Many patients improve with activity modification, pain relief, anti-inflammatory medication when appropriate, and a structured course of physiotherapy aimed at improving movement, strengthening the rotator cuff, and restoring shoulder blade control. A steroid injection into the subacromial space may also help reduce pain and inflammation in some patients.
Surgery is considered only when symptoms remain persistent despite adequate non-operative treatment, and when there is good clinical and imaging evidence of mechanical subacromial impingement. In such carefully selected cases, an arthroscopic subacromial decompression may be recommended. This is a keyhole procedure performed through small incisions around the shoulder. The aim is to increase the space beneath the acromion and reduce pressure on the rotator cuff tendons where there is clear evidence that the tendon is being mechanically impinged against the bone.
The operation is usually carried out as a day-case procedure. Recovery is generally straightforward, although postoperative rehabilitation and physiotherapy remain an important part of the overall outcome.
Further detailed information about the diagnosis and the most appropriate treatment options would be provided during consultation with Mr Khalid Ayoub. Back...
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