HC Chang Orthopaedic Surgery | Singapore

Shoulder pain with overhead activities in a person above 45 can be from impingement syndrome.  This is a condition where the top of the arm bone (humeral head) rubs against a bony spur under the overhanging bone called the acromion. The acromion is part of the shoulder blade.

It can affect someone who does a lot of free-style swimming, tennis serves, badminton smashes etc.

The best x-rays to diagnose the bony spur include the AP and Supraspinatus outlet view.

This is an AP view of a right shoulder with shoulder impingement syndrome:

Anteroinferior Acromial Spur of the Shoulder

This is the Supraspinatus outlet view X-ray of a right shoulder showing a large bony spur. This is a typical Bigliani type 3 acromion with a hook.

Subacromial Impingement by Type 3 Spur

A high degree of suspicion for rotator cuff tendon tear should be borne in mind if the patient has a lot of rest pain, night pain or weakness of the affected shoulder.

This is the MRI scan of the right shoulder of this patient with shoulder impingement syndrome. 

The MRI shows a full thickness tear of the supraspinatus tendon. 

Full thickness Tear of Supraspinatus Cuff Tendon

In those with rotator cuff tendon tear of a longer duration, the muscle belly may undergo disuse atrophy (wasting).

This MRI shows the supraspinatus muscle atrophy.

Supraspinatus Muscle Atrophy

The treatment for this patient will include:

1. Arthroscopic removal of the bony spur i.e. arthroscopic subacromial decompression.
2. Arthroscopic repair of the shoulder tendon.

For more information on shoulder pain, please contact us at 683 666 36 or email us at hcchang@ortho.com.sg

Do visit our website at www.ortho.com.sg