What is impingement (build-up of scar tissue)?

A common cause of shoulder pain, impingement occurs when structures within the shoulder (such as tendons and bones) rub together. Generally, external impingement occurs, where the rotator cuff intrudes into the sub-acromial space.

The space between the acromion and the rotator cuff is filled with the sub-acromial bursa, a fluid-filled sac that allows the shoulder to move properly. Any unusual impact on the rotator cuff can cause shoulder pain and impingement.

Conditions that can impact the function of the rotator cuff, and potentially cause impingement include:

  • Rotator cuff strain
  • Rotator cuff tears
  • Calcification
  • Wear and tear of the rotator cuff caused by overuse and sports like tennis and swimming.

What are the symptoms?

Symptoms of impingement include:

  • Shoulder pain
  • Swelling
  • Stiffness
  • Weakness
  • Difficulty lifting the arm

What are the treatment options?

Your orthopedic doctor will check your shoulder for tenderness, and check the function and strength of your arm and shoulder. He will rule out other potential conditions such as arthritis before proceeding. Your doctor may also use X-rays, ultrasound or magnetic resonance imaging (MRI) to check for abnormalities.

Some non-surgical treatments include:

  • Anti-inflammatory medication
  • Sport physiotherapy
  • Cortisone injections
  • Rest

If all treatment options have been exhausted, and there is no pain relief, your orthopedic surgeon may recommend shoulder surgery. The surgical procedure will help to create more space for the rotator cuff. Your surgeon will remove a part of the acromion as well as the inflamed part of the bursa. In this case, Dr Pirjol will conduct arthroscopy, during which he will insert a camera into your shoulder joint. Images will then be displayed on screens as he guides small surgical tools with the use of a monitor.


Dr Gabriel Pirjol is based at St Augustine’s Hospital in Durban and also consults and operates from Gateway Hospital in Umhlanga, Westville Hospital and Malvern Medicross.


Telephone : +27 31 202 5463

Email :

Address : Suite 24 Chelmsford Medical Centre
St Augustine's Hospital
107 J B Marks Road
Berea, 4001