Shoulder & Acromioclavicular Impingement Syndrome

The rotator cuff muscles pass through a narrow area called the acromion process, part of the scapula and the head of the humerus. Additionally the coracoids process, another part of the scapula is in this area. There are three main tendons: the biceps, pectorals major and supraspinatus tendons that pass through this area, directly into the shoulder joint. Arthritic spurring of any of the involved boney structures or thickening of the coracoacromial ligament can add to impingement, causing further shoulder pain. Inflammation of the subacromial bursa will also add to the impingement, further making the pain worse. Impingement syndrome is frequently seen with repetitive activities such as weight lifting or racquet sports.

Symptoms of impingement syndrome include pain in the shoulder girdle, particularly laterally. There can be loss of strength and even frozen shoulder syndrome. Raising the arm above the head typically makes the pain worse. Lying on the affected arm at night will also exacerbate the pain.  Diagnosis is quite simple, based on a careful history and physical exam. Rarely plain
x-rays may be helpful, to look for A-C joint separation or degenerative changes.

Treatment of this condition is usually conservative. Anti-inflammatory medications, ice and some physical therapy can all be helpful. Corticosteroid injections may provide relief and reduce inflammation. Resting the joint, avoiding activities can also help relieve pain. Less commonly surgical decompression of the impingement can be accomplished with arthroscopic surgery.

PRP therapy is an ideal treatment modality as it avoids surgery and additional medications. Platelet rich plasma is a concentration of the body’s own blood healing components. The PRP is injected into the subacromial bursa or into the sprained muscles or tendons. The three step phase of inflammation, proliferation and remodeling begin – taking up to 6 weeks for full benefit. Depending on the severity of the injury a second treatment may be needed at 4 weeks. Patients may experience mild pain, which can be control with ice packs and Tylenol products for the first week. Pain relief can be seen in as little as 1-2 weeks. With stem cells migrating into the area, they differentiate into appropriate tissue such as muscle, tendon or ligament. Remodeling then occurs which contours the tissue to the proper shape and strengthening of the tissue also occurs. Recovery time is very short as compared to surgery and lengthy, time consuming rehabilitation is not necessary. If you have persistent shoulder pain, before or after surgery, PRP may be a reasonable treatment option for you. Ask your doctor.