Treatment for rotator cuff impingement syndrome or subacromial impingement syndrome includes both non-surgical and surgical treatments. Treatment for this injury usually begins with non-surgical treatment, and more than 2/3 of patients with rotator cuff impingement syndrome can significantly improve their symptoms with physical therapy alone. In the elderly and in patients with large acromion spurs, the results of physical therapy can be poor. 1. Non-surgical treatment, the majority of patients can significantly improve their symptoms with initial non-surgical treatment. (1) Exercise therapy: The purpose of exercise therapy is to strengthen the rotator cuff tendons, restore the mobility lost due to pain and inflammation by pulling, and restore the position of the humerus under the acromion to a better state in order to reduce the compression of the bursa. The main activities are: (2) Anti-inflammatory drug therapy: It can relieve pain and reduce inflammation. Many patients with rotator cuff tears improve significantly in function with physical therapy and medication for pain control. This is especially true and relevant for the elderly and those patients with less demanding shoulder joints. (3) Steroid injections If symptoms do not improve with physical therapy and medication, your doctor may recommend a steroid injection into the subacromial bursa. Cortisone or similar steroids are often used in combination with local anesthetic medications to control pain and bursal inflammation. Steroids should be used with caution. More than 2-3 steroid applications in a few months may damage rotator cuff tendon tissue. Steroid injections are also not suitable for diabetic patients. 2. Surgical treatment: Non-surgical treatment of rotator cuff impingement syndrome is usually very effective in most patients. However, in a small percentage of patients, after 6 months of non-surgical treatment, surgery is indicated. The shoulder joint should be re-examined and re-evaluated to rule out the presence of other conditions. The surgical treatment is subacromial decompression, which expands the space between the rotator cuff and the acromion. Depending on the surgeon’s preference, subacromial decompression can be accomplished through minimally invasive arthroscopic surgery or open surgery. Both methods remove scar tissue and bone spurs, and if a rotator cuff tear is found at the time of surgery, it can be repaired at the same time if needed. With arthroscopic treatment, a small fiberoptic scope is inserted into the shoulder joint. Often, the surgeon can diagnose and repair the injury through the arthroscope without making a large incision. 3.What are the complications of the surgery? The chance of complications from surgery is usually very low. Common complications include infection, hemorrhage, nerve damage, and shoulder stiffness. Pre-operative antibiotics can reduce the incidence of post-expansion infection, and the rate of infection is slightly lower in arthroscopic surgery than in open surgery. The likelihood of hemorrhage or nerve injury is extremely low. Postoperative shoulder stiffness is a major complication of rotator cuff impingement surgical treatment.