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Impingement syndrome
Treatment for impingement syndrome is available privately at The Edinburgh Clinic Shoulder Service. Enjoy fast access to appointments with specialists within the calming, unique and quality clinical environment at The Edinburgh Clinic.
What is impingement syndrome?
This is the most common symptomatic shoulder condition, sometimes called ‘bursitis’ or ‘tendonitis’. No one really knows what causes impingement syndrome but it is thought that the supraspinatus tendon – one of the four tendons in the shoulder that make up the ‘rotator cuff’ – becomes inflamed. A fluid-filled sac, the ‘bursa’, overlies this tendon and also becomes inflamed. The supraspinatus tendon and the bursa run through a narrow bony canal, which can become narrowed in certain positions, such as when the arms are out in front of you and at or above shoulder level, and may impinge the tendon and bursa causing them to become inflamed.
How is it treated?
As part of our specialist Shoulder Service, we recommend assessment with our Specialist Shoulder Physiotherapist Christine Phillips initially, which you can self-refer to, or full consultation with Orthopaedic Surgeon Mr Jeffrey Reid, which you can request a referral for from your GP or healthcare provider.
If initial physiotherapy or conservative treatment is unsuccessful, the next step on the treatment pathway is to repeat specialist physiotherapy approximately two weeks following injection of steroid under ultrasound guidance. This procedure should be carried out by a consultant radiologist using ultrasound to ensure the steroid is injected where it does the most benefit – in the bursa. The radiologist will perform a thorough assessment of the shoulder tendons. The injection then takes only a few seconds to carry out. The steroid usually takes effect by one week. After the injection many patients find the greatest benefit is being able to sleep without being woken by pain.
Surgery can be offered for impingement syndrome if clinically necessary but it is usually kept to the end of the treatment pathway, used as a last resort when less invasive treatments have been unsuccessful.
What are the side effects?
- Steroid can cause irritation following injection, creating the so-called ‘flare response’.
- With any injection into a joint there is a risk of infection. This risk is greatly minimised however, as the injection is done under ‘sterile’ conditions.
- Some of the steroid will travel around the body to other tissues and makes insulin work less well for this short period of time. Patients with diabetes must monitor their sugar levels for up to two weeks after the injection.
What happens after the injection?
You should be seen by the physiotherapist around two weeks after the injection, when the steroid is working fully. Physiotherapy is usually required to stretch and strengthen the shoulder and help reduce the risk of your symptoms recurring.
How do I access this service?
The diagnosis of impingement syndrome is usually made by an orthopaedic surgeon, physiotherapist or a GP with a special interest in musculoskeletal problems.
You can self-refer for specialist physiotherapist-led shoulder assessment at The Edinburgh Clinic Shoulder Service directly. If identified as suitable, your specialist physiotherapist can refer you for treatment to a consultant radiologist or orthopaedic surgeon.
You can be referred for Consultant Orthopaedic shoulder assessment at The Edinburgh Clinic Shoulder Service by your GP or healthcare provider. The orthopaedic surgeon will assess the shoulder to confirm the diagnosis and, if appropriate, the referral for treatment with physiotherapy or ultrasound-guided steroid injection will be made by the orthopaedic surgeon.