Shoulder Impingement Syndrome in San Antonio, TX

What Is Shoulder Impingement?

Shoulder impingement describes the pinching of the rotator cuff tendons — most commonly the supraspinatus — between the top of the humerus and the underside of the acromion, the bony roof of the shoulder. Every time you lift your arm, this space narrows. When the tendon is thickened from inflammation, the space available for that movement decreases and the tendon gets caught, producing the characteristic painful arc that most patients describe.

Impingement is one of the most commonly diagnosed shoulder conditions in my practice, and it is also one of the most over-diagnosed. Not every anterior shoulder pain is impingement. I take the time to rule out rotator cuff tear, biceps pathology, AC joint arthritis and cervical spine referral before accepting that diagnosis, because treating the wrong problem produces the wrong result.

Symptoms

Pain when lifting the arm between 60 and 120 degrees — the classic painful arc
Anterior or lateral shoulder pain that worsens with overhead activity
Night pain, particularly when lying on the affected shoulder
Weakness with repetitive overhead use
Pain with reaching across the body or behind the back

Non-Surgical Treatment

The majority of true impingement syndrome resolves with a structured non-operative program. Physical therapy focused on rotator cuff strengthening, posterior capsule stretching and scapular motor control is the foundation of treatment. I prescribe a specific program rather than generic exercises because the mechanics of impingement are addressable and correctable with targeted work.

A single subacromial corticosteroid injection is a reasonable adjunct in patients with acute inflammation that is preventing participation in therapy. I do not advocate repeated injections as a long-term management strategy — they provide temporary relief and carry cumulative tendon risks with repeated use.

When Surgery Is Appropriate

Arthroscopic subacromial decompression is indicated when a well-executed course of non-operative treatment has not resolved symptoms over three to six months. The procedure removes the inflamed bursa and creates more space for the tendon by smoothing the underside of the acromion — a process called acromioplasty. If an AC joint spur is contributing to the impingement, I address that in the same setting.

Importantly, I always examine the rotator cuff at the time of arthroscopy. A partial-thickness tear that is not visible on MRI is found in a meaningful percentage of patients who present with 'impingement,' and identifying and treating it at the time of decompression is essential to a complete recovery.

Recovery

Arthroscopic subacromial decompression is an outpatient procedure with a relatively straightforward recovery. Most patients are out of the sling within a few days and begin therapy within the first week. Return to full overhead activity typically occurs at 6 to 10 weeks. Return to competitive overhead sport takes longer and depends on the restoration of strength and neuromuscular control.

Ready to take the next step? Call (210) 878-4113 or request an appointment at sportssurgeryspecialist.com.