Initial treatment of SIS generally involves conservative measures such as physical therapy and pain-relieving medications. Most patients benefit from a course of physical therapy focused on stretching the shoulder and strengthening the rotator cuff and scapular muscles, as well as postural exercises to address the position of the shoulder blade.
Doctors often prescribe a course of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Another anti-inflammatory option may be to inject a local anesthetic and cortisone into the shoulder. Platelet-rich plasma injections are a more recent treatment that some patients consider, though many insurance plans do not cover them.
For patients whose pain doesn't respond to conservative measures, our orthopedic surgeons have expertise in shoulder impingement. As with any kind of surgery, there are risks and possible complications, so we generally explore these options only if nonsurgical therapies have failed.
In the most common surgical treatment, a minimally invasive procedure called subacromial decompression, the goal is to relieve the compression on the rotator cuff and bursas by creating more space between the humeral head and the acromion. Performed with an arthroscope (an endoscope for use in joints), the surgeon passes a tiny camera and slender instruments through a small incision and removes the portion of the acromion causing impingement along with some of the bursas. If the shoulder has other conditions needing repair (such as a rotator cuff tear), the surgeon may address these at the same time.
To facilitate healing, patients usually use a sling for the first one to two weeks after surgery. During that time, they shouldn't drive. After this period, they begin a physical therapy program, focusing first on regaining passive range of motion and later on active range of motion. Between six and eight weeks after surgery, patients can progress to strengthening exercises, and a full return to activities is generally achieved three to four months after surgery.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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