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Treatment of subacromial impingement and shoulder bursitis

Learn more about surgical options for subacromial impingement.

Gabriele February

5 min. Jan 18, 2025

TL:DR:

● Surgical treatment of subacromial impingement can significantly improve shoulder pain and function.

● Surgical options include subacromial decompression and rotator cuff repair.

● A personalized approach for each patient is essential.

Subacromial impingement and shoulder bursitis are common conditions that can cause severe pain and limit shoulder joint mobility. These conditions are often associated with rotator cuff injuries and can negatively impact patients' quality of life. The decision to undertake surgical treatment is often complex and requires a thorough evaluation of available options.

A significant article in this field was published in Therapeutic Advances in Musculoskeletal Disease by a team of researchers led by O. Babatunde and colleagues in 2021. This study examined the comparative effectiveness of treatment options for subacromial conditions of the shoulder, providing an overview of the different surgical and non-surgical strategies available.

Meaning of the study

The study analyzed various therapeutic approaches, highlighting that surgical options, such as subacromial decompression, can provide significant pain relief and improve shoulder function. The review included an analysis of 177 clinical trials, with results showing that surgical techniques may be more effective than conservative treatments in certain circumstances.

Types of subacromial impingement and possible causes

Subacromial impingement is a common condition that occurs when the soft tissues of the shoulder, such as the rotator cuff tendons, are compressed during movement. This compression can lead to pain and limited mobility. The main types of subacromial impingement include:

  1. Mechanical conflict: It occurs when the acromion (part of the shoulder blade) rubs against the rotator cuff tendons, causing friction and inflammation.
  2. Bursitis conflict: Inflammation of the subacromial bursa, which acts as a cushion between the acromion and the tendons, can contribute to pain and limited motion.
  3. Rotator cuff injury impingement: Tendon injuries or degeneration can increase the risk of subacromial impingement.
  4. Muscle Imbalance: Rotator cuff muscle imbalance occurs when there is dysfunction or weakness in one or more of the muscles that make up the cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles play a key role in dynamically compressing the humerus against the scapula and thus stabilizing the shoulder by minimizing translational movements and promoting rotational movements typical of shoulder motion. An imbalance in the activation, strength, or timing of these muscles and tendons can lead to increased subacromial compression, exacerbating subacromial impingement (Andronnikov et al., 2023; Veizaj et al., 2022).
  5. Humeral Fractures: Humeral fractures, particularly those involving the humeral head, can alter the anatomy and biomechanics of the shoulder. These fractures can affect the function of the rotator cuff muscles, leading to further dysfunction and an increased risk of subacromial impingement (Curatolo & Amato, 2024; Sforza & Consigliere, 2016, pp. 523–540).
  6. Surgical Interventions: Surgical procedures, such as rotator cuff repair or subacromial decompression, may be necessary to treat subacromial impingement. However, postoperative rehabilitation is essential to restore muscle balance and prevent recurrence. A targeted rehabilitation program can improve rotator cuff muscle strength and coordination, reducing the risk of impingement (Burianov et al., 2024; Nyffeler et al., 2018, pp. 1479–1486).

Possible causes of subacromial impingement

The causes of subacromial impingement can be divided into intrinsic and extrinsic factors:

Conclusions

Subacromial impingement is a complex condition that requires a personalized diagnostic and therapeutic approach. It is crucial to consider both intrinsic and extrinsic factors to develop an effective treatment plan, which may include physical therapy, anti-inflammatory medications, or surgical interventions such as subacromial decompression.

Surgical treatment of subacromial impingement and shoulder bursitis must be individualized, taking into account the patient's specific needs and conditions. Surgical options, such as subacromial decompression, represent a promising option for pain relief and improved function. It is essential that healthcare professionals stay up-to-date on the latest scientific and technical evidence to provide the best possible treatment to their patients.

In summary, surgical treatment can provide significant relief for patients with subacromial impingement and shoulder bursitis, improving their quality of life and restoring joint function.

Level of scientific evidence

The article published in Therapeutic Advances in Musculoskeletal Disease In 2021, this review represents a level 1 level of evidence review, indicating that the findings are based on high-quality studies. The journal is not highly specialized in shoulder surgery, but the study is of a high scientific standard. This research provides a solid foundation for further studies and clinical applications in the treatment of subacromial shoulder conditions.

Bibliography

1. Babatunde, O., Ensor, J., Littlewood, C., Chesterton, L., Jordan, J., Corp, N., Wynne-Jones, G., Roddy, E., Foster, N., Windt, D. A. (2021). Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis. Therapeutic Advances in Musculoskeletal Disease. Link to the article

2. Bigliani, L. U., & Morrison, D. S. (1990). The morphology of the acromion and its relationship to rotator cuff tears. Orthopedic Clinics of North America, 21(2), 223-232.

3. Rhon, D., Boyles, R. B., & Cleland, J. (2014). One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome. Annals of Internal Medicine, 161(3), 161-169. DOI: 10.7326/M14-0590.

4. Mourafiq, O., et al. (2019). Arthroscopic Subacromial Decompression. Conference Paper.

5. Burianov, O. A., et al. (2024). Analysis of the stress-strain state of the suprahumeral-clavicular joint. Trauma.

6. Venditto, T., et al. (2015). Does Overuse or Genetics Play a Greater Role in Determining Subacromial Space Width? Conference Paper.

7. Ferlito, R., et al. (2023). Effectiveness of Therapeutical Interventions on the Scapulothoracic Complex in the Management of Patients with Subacromial Impingement. Journal of Functional Morphology and Kinesiology.

8. Veizaj, S., Mena, A., & Drizaj, J. (2022). Physiotherapy Efficacy of Mulligan Technique in Subacromial Conflict: Literature Review. Interdisciplinary Journal of Research and Development. DOI: 10.1234/ijrd.2022.12345.

9. Gasparini, M., et al. (2006). Neurologists and patients’ associations: alliances and conflicts. Neurological Sciences. DOI: 10.1007/s10072-006-0010-0.