Shoulder impingement syndrome | Surgeons tell patients say no to surgery in new research
You had shoulder pain and your health care provider gave you a diagnosis of shoulder impingement syndrome. Why did you get this diagnosis? What does it mean?
For one thing, when you have shoulder pain that has a somewhat nondescript cause (your whole shoulder is problematic), shoulder impingement is often used as a diagnostic term to validate treatment. Impingement means something is trapped and being squeezed. In this case, it is your rotator cuff tendons. They are being trapped under and being squeezed by the acromion, a bony “wing” of the shoulder blade. In the illustration below this is shown in the example of the EXTERNAL IMPINGEMENT.
So if you tell your health provider you have pain trying to reach for something at shoulder level or above your head, shoulder impingement will likely be discussed along with possible treatments.
Shoulder instability is very treatable with Prolotherapy, see our main page Prolotherapy for Shoulder Pain for more treatment information.
Is shoulder impingement a diagnosis or a symptom of a bigger shoulder problem?
In our clinics, we do not like to describe shoulder impingement as a diagnosis. We like to describe it as a symptom of shoulder instability. What this means is that if you try to repair shoulder impingement alone without addressing the problems of the shoulder which can cause the tendons to be trapped or the problems of the extra pressure of bursitis or swelling causing irritation, pain and constant wearing and weakening of the rotator cuff tendons, you will likely not be successful.
In research, doctors in Germany wanted to make clear that shoulder impingement is indeed, a whole shoulder issue and treatment should include
The German team from the Technical University of Munich writing in the German language journal Der Orthopäde (Orthopedics) reported these findings:
- Isolated impingement syndrome of the shoulder is the most common diagnosis in shoulder disorders and is of high relevance in orthopedic sports medicine.
- In fact, impingement of the shoulder is not the diagnosis but rather a symptom of a functional or even a structural shoulder damage. (We call this shoulder instability, the excessive motion of the shoulder due to weakened and damaged ligaments, allows the soft tissue of the rotator cuff to be pinched, caught, or impinged upon by the bones of the shoulder).
- Detailed knowledge about the different types of impingement and the underlying causes is essential to provide adequate treatment.
- Primarily, impingement of the shoulder should be treated nonoperatively.(1)
Which brings us to the latest research on surgery for shoulder impingement.
New research: No surgery for shoulder impingement syndrome. It’s “useless.”
This is from a press release issued by the University of Helsinki upon the publication of a new study from the University’s researchers in the July 19, 2018 edition of the British Medical Journal.(2)
“In a landmark study published this week in the British Medical Journal, (our) researchers show that one of the most common surgical procedures in the Western world is probably unnecessary.”
“Keyhole (arthroscopic) surgeries of the shoulder are useless for patients with “shoulder impingement”, the most common diagnosis in patients with shoulder pain.”
“These results show that this type of surgery is not an effective form of treatment for this most common shoulder complaint. With results as crystal clear as this, we expect that this will lead to major changes in contemporary treatment practices,” said the study’s principal investigators chief surgeon Mika Paavola and professor Teppo Järvinen from the Helsinki University Hospital and University of Helsinki.”(3)
Surgery useless? Then what type of treatments can I get? A different surgery? Non-surgical Prolotherapy?
Arthroscopic shoulder impingement surgery shaves down the bone of the acromion to give the rotator tendons more room to move about pain-free. We now see that this is a useless surgery in the long-run. Rotator cuff tendon surgery then may be recommended for lack of anything better than conservative treatments including pain medication, anti-inflammatory medication, physical therapy and exercise did not offer a positive response.
We feel that someone suffering from impingement syndrome should seek a consultation with a Prolotherapist for a non-surgical regenerative medicine consultation before jumping into rotator cuff surgery.
In our office, we stimulate the soft tissue of the shoulder to repair with Prolotherapy injections to the ligaments and tendinous insertions of the rotator cuff and deltoid. Prolotherapy, in combination with gradual re-strengthening of the rotator cuff muscles, gives an excellent chance for a full recovery.
Prolotherapy gets rid of the impingement by stabilizing the acromioclavicular (smaller shoulder joint) or the glenohumeral joint (larger shoulder joint). The excessive motion that was pinching the tendon no longer occurs, because the joint is stabilized. The excessive motion is gone, the pinching and symptoms are gone, and over time the bone spur will be reabsorbed by the body.
Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD
1 Beirer M, Imhoff AB, Braun S. Impingement syndromes of the shoulder. Orthopade. 2017 Apr;46(4):373-386. [Google Scholar]
2 Paavola M, Malmivaara A, Taimela S, Kanto K, Inkinen J, Kalske J, Sinisaari I, Savolainen V, Ranstam J, Järvinen TL. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. bmj. 2018 Jul 19;362:k2860. [Google Scholar]
3. University of Helsinki press release – Finnish study shows that most common shoulder operation is no more beneficial than placebo surgery