Your doctor will perform an orthopedic evaluation of your shoulder that will consist of three parts: medical history, physical examination, and diagnostic tests. After carefully reviewing the results, your doctor will discuss treatment options with you. Your doctor may recommend that you have an injection of cortisone to reduce inflammation and control the pain. In addition, your doctor may refer you to a physical therapist who will guide you through a series of exercises that will help keep your shoulder strong and flexible and reduce the irritation from impingement. If the impingement is advanced or severely debilitating, surgery may be necessary. The goal of any surgery to reduce the effects of impingement will be to increase the amount of space between the acromion and the rotator cuff tendons, which will then allow for easier movement and less pain and inflammation. The first thing that an orthopaedic surgeon will do is remove any bone spurs that are rubbing on the rotator cuff tendons and bursa. A small part of the acromion may be removed (see Acromioplasty) as well to give the tendons even more space and allow them to move without rubbing. In addition to the impingement your doctor may discover other problems such as Osteoarthritis in the acromioclavicular (AC) joint. In this case it may be necessary to remove the end of the clavicle, this is called a resection arthroplasty. These procedures may be performed arthroscopically or through an open incision.
