At Home with Chris Jessen 2018 - 159
MEET THE EXPERT
Mr Richard Heasley,
FRCS (Tr & Orth),
is a consultant
in the shoulder.
He trained and
undertook his fellowship in the
north west of England.
Mr Heasley treats shoulder problems
including impingement syndrome,
rotator cuff tears, shoulder instability
(dislocation), arthritis and frozen
shoulder. He undertakes both
arthroscopic (keyhole) surgery and
shoulder replacement surgery.
that is most commonly involved in
shoulder dysfunction. Its role is to
abduct the arm, which essentially means
to lift the arm away from the body.
In impingement syndrome, the
supraspinatus tendon becomes irritated
and inflamed, causing painful symptoms.
How is impingement
Typically, the diagnosis of impingement
syndrome is based on the pattern of
clinical symptoms described above.
However, the doctor will often request
an X-ray of the shoulder to look for any
other conditions that could be causing
the pain, such as arthritis. He or she
may also ask for the patient to have an
ultrasound scan to further assess the
rotator cuff and ensure there is no
tendon tear causing the symptoms.
How is it treated?
Initial treatment of impingement
syndrome involves basic measures,
such as painkillers, anti-inflammatory
medication and avoidance of any
actions or factors that produce the pain.
If these measures are unsuccessful,
the next step is a corticosteroid injection
into the space around the tendon,
to relieve the pain and inflammation,
and a course of physiotherapy. The
majority of patients will improve
with these measures and not require
any further treatment. However, a
proportion will only have temporary
or incomplete relief and may therefore
What does surgery entail?
The surgical procedure is called
arthroscopic subacromial decompression.
This is keyhole surgery to inspect the
SURGERY IS UNDERTAKEN THROUGH TWO OR
THREE INCISIONS, AS A DAY-CASE PROCEDURE
USUALLY UNDER GENERAL ANAESTHETIC
joint and increase the space for the
tendon to move in. It is achieved by
clearing any inflammation from around
the tendon, releasing a thickened
ligament and shaving away any
prominent bony spur.
The surgery is undertaken through
two or three small incisions, each of
which is less than 1cm in size, as a
day-case procedure and usually
under general anaesthetic.
Patients will typically wear a sling
for two or three days afterwards, before
mobilising the shoulder under the
supervision of a physiotherapist.
The vast majority of patients with
impingement syndrome who require
surgery experience good results
and significant relief of symptoms.
FOR MORE INFORMATION