Widening the space beneath the acromion is definitely the first step. This can be performed as an open procedure or by arthroscopy. But if treatment is limited to widening this space and acromioplasty (widening the shoulder roof), there is a risk of only solving the problems temporarily. The causes of the bottleneck, e.g. a loosened RC or bone fragments that have risen or tendon calcification, also need to be treated to ensure a lasting improvement.
Unfortunately, since the arthroscopic approach tends to involve widening of the roof only, improved centring is rarely achieved by this method.
Impingement surgery - i.e. the actual "space creation" - is therefore useful only as part of reconstruction, which is designed to restore problem-free sliding of the rotator cuff beneath the acromion. Accordingly, follow-up management will be based on the type of reconstruction, e.g. suturing of the RC or restoration (internal fixation) of the bone. In view of this, "impingement syndrome", which has been an overused diagnosis in recent years, is now evaluated differently and we regard it more as a complex of signs and symptoms (signs of disorders, injuries).