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          Subacromial Impingement

           Subacromial impingement of the shoulder refers to pain in and around your shoulder.

           What is the subacromial space
           The subacromial space of your shoulder contains the subacromial bursa and part of your rotator cuff muscles and tendons. The roof of the                         subacromial space is formed by the bony acromion. Impingement can present due to inflammation of the bursa and can often be caused by a                     bony spur (outgrowth) of the acromion or in some cases by an outgrowth from the AC- Joint (Acromio-clavicular). 

           How does subacromial impingement present
           Subacromial Impingement can have an insideous onset, however can also be associated to minor injuries and tendon tears in your shoulder.
           Pain usually present during activities when you are lifting your arm forewards or sidewards. Subacromial impingement might however also                           present as pain during the night, especially when you sleep on your side.
           The symptoms of subacromial impingement can sometimes be "mimicked" by other conditions, for example frozen shoulder or refered pain from             the spine.

           How is subacromial impingement diagnosed
           Firstly you will have general shoulder examination to identify the source of your pain and some special clinical tests to confirm the diagnosis of   
           subacromial impingement. Then a x-ray of your shoulder can identify bony spurs or shapes of the acromion which are associated with 
           subacromial impingement. It will also show your gleno-humeral and acromio-clavicular joint which can be assessed for signs of osteoarthritis.
           Sometimes further radiological examinations in form of an Ultrasound or MRI Scan might be necessary.

           How is subacromial impingement treated
           The first line treatment of subacromial impingement may consist of a steroid injection into the subacromial space and physiotherapy exercises.
           In case your symptoms persist despite the conservative managment, a subacromial decompression may be indicated. This is a keyhole         
           (arthroscopic) procedure which is usually performed under general anaesthetic and as a daycase procedure.

           What happens after my subacromial decompression surgery
           Once you recovered of the anaesthetic and are comfortable you will be discharged home with a supply of painkillers. The Physiotherapist will see               you before you leave the Hospital and advice on exercises you can do yourself at home. For the first couple of days your shoulder will be                 
           immobilised in a sling which you can discontinue as soon as you feel comfortable. 
           You should usually be able to return to sedentary work after 2 weeks and manual work after 6 weeks.