York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement


Subacromial impingement/bursitis refers to a condition in which the rotator cuff tendons are pinched between the humeral head and the acromion process of the shoulder blade. The bursa is a fluid filled sac located between the rotator cuff tendons and the acromion process. The intermittent pinching may lead to inflammation and/or partial tearing of the rotator cuff tendons. The bursa also become inflamed and irritated with pinching; this condition is called “bursitis.” Over time, some patients may develop bone spurs on the bottom of the acromion process, which may lead to more severe symptoms.


  • Sharp pain on the front and outside of the shoulder with overhead activity
  • Shoulder weakness due to pain

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination and x-rays to make the diagnosis of outlet impingement. Dr. Welch may also consider an MRI to evaluate the rotator cuff. Most patients with impingement can be treated successfully without surgery with a dedicated physical therapy program. Physical therapy focuses on restoring the natural mechanics of the shoulder, with particular emphasis paid on posture and strengthening certain muscles around the shoulder blade. Other non-surgical treatment options include a course of anti-inflammatory medications, activity modification, as well as injections. The most common type of injection that Dr. Welch recommends is a steroid injection. A steroid is a powerful anti-inflammatory medication that can significantly reduce pain. In those patients with severe impingement/bursitis who do not recover with the above-mentioned treatment options, Dr. Welch may recommend surgery.

During surgery, Dr. Welch uses a minimally invasive, arthroscopic approach to remove the inflamed bursal tissue and any bone spurs on the undersurface of the acromion process. Dr. Welch also carefully visualizes the rotator cuff. In those patients with significant injury to the rotator cuff, Dr. Welch may clean the edges of the rotator cuff tissue or repair the tissue if it is torn extensively.