- Avoid placing the arm repeatedly in the position of impingement (overhead) till the pain has subsided
- A stretching and strengthening programme to improve the balance of the shoulder stabilizers – can be directed by a physiotherapist.
- Anti-inflammatory medication and other pain-relieving modalities like acupuncture may be used.
The injection is placed in the space between the rotator cuff tendon and the acromion. The cortisone is mixed with local anaesthetic and the shoulder is re-examined immediately after the injection: if the pain is better the diagnosis is confirmed. The cortisone then has a local anti-inflammatory effect on the rotator cuff.
The effect of the cortisone is usually evident after 2-3 days, and the duration of the effect can vary from a few days to months.
Needle between acromion (top) and cuff (bottom)
If all the above fail an “acromioplasty”can be done: The acromial spur is shaved off, creating more space for the rotator cuff to glide through.
||Upper arrow: Acromion Lower Arthroscopic acromioplasty: Shaving the acromion via three tiny key-holes.
This operation should preferably be done arthroscopically (“key-hole surgery”)
The operation can be done under general or local anaesthesia. The surgeon places the arthroscope into the shoulder joint through a small 3mm skin incision. One or two similar small incisions are added to pass the instruments.
The whole joint is thoroughly checked to verify the diagnosis: at times a different problem may be found (like a tear of the rotator cuff), which was not evident during the pre-operative examination. Such a “newly discovered” problem must be dealt with there and then, using the arthroscopic technique.
Rotator cuff tear
If only an acromioplasty is needed, the prominent tip of the acromion is shaved off till an adequate space for the rotator cuff is created. This only takes about 20 minutes, and can be done with local or general anaesthesia. The patient can be discharged from the hospital on the same day.
Left: Spur, Middle: Shaving off the Spur, Right: Smoothening the acromion