Subacromial impingement / bursitis

Pathology
Subacromial impingement syndrome refers to irritation of t the subacromial bursa beneath the acromion. The subacromial bursa normally reduces friction between structures during shoulder movement.

With repetitive overhead activity, anatomical variations, or degeneration, the space narrows, leading to compression (impingement) and inflammation (bursitis).

Typical symptoms include shoulder pain, especially when lifting the arm, pain between 60° and 120° of elevation (painful arc), night pain, and reduced strength.

Examination
Diagnosis is based on clinical examination and imaging.

Clinical tests (e.g., impingement signs) are often suggestive. X-rays can identify bony abnormalities (such as acromial shape or spurs). Ultrasound or MRI can confirm bursitis or associated rotator cuff pathology.

Treatment

Non-surgical treatment
Treatment is primarily conservative:

• activity modification (avoiding repetitive overhead movements)
• physiotherapy focusing on scapular control and rotator cuff strengthening
• analgesics and anti-inflammatory medication if needed
• corticosteroid injection in the subacromial space in selected cases

Surgical treatment
If symptoms persist despite adequate conservative treatment:

• arthroscopic subacromial decompression
• treatment of associated lesions (e.g., rotator cuff repair if needed)

Recovery
The prognosis is generally favorable with appropriate treatment.

Most patients improve with conservative management. After surgery, recovery usually takes several weeks to months, depending on associated procedures, with structured rehabilitation.

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