Shoulder impingement

In the condition known as impingement syndrome, the upper tendon of the rotator cuff is pinched during movement. When the arm moves, the head of the humerus hits up against the acromion. As a result, the tendons running along there are pinched, which in turn restricts the mobility of the arm and shoulder. It is often accompanied by bursitis.

Symptoms

At first, there is slight pain in the shoulder. The pain occurs when working with the arms overhead or when raising the arm to the side. The mild pain can turn into intense pain if you make jerky movements. The pain is particularly severe when you raise your arm to the side at an angle of 60 to 120 degrees.

However, pain can also occur during rest, especially if there is inflammation present. This may also affect sleep. It usually becomes impossible to lie on the affected side.

Causes

The structure of the shoulder joint differs from that of other joints. The muscles and tendons of the rotator cuff are responsible for the stability of the shoulder joint. Above the tendons, there is a space about one centimetre high towards the acromion. For various reasons, this space can become too narrow, which causes the tendons to be pinched.

Potential reasons behind the narrowing of this space include the formation of a ganglion cyst on the acromion or the acromioclavicular joint, swelling due to bursitis, or swelling of the tendon, which then rubs against the acromion. Disruptions to the function of the muscles can also cause the humeral head to be guided incorrectly within the joint during movement. This change in position limits the space available for the tendon.

Diagnosis

An interview and examination is carried out by a shoulder specialist, as in most cases there are other clinical pictures present, such as a tear of the rotator cuff.

X-rays can be used to assess the position of the bones in the joint and to identify possible calcification. An MRI scan is carried out to examine the soft tissues in the shoulder and tendons and the condition of the muscles. This helps to inform the diagnosis.

Treatments

Conservative therapies

To begin with, shoulder pain is treated with painkillers.  With the help of physiotherapy, the patient learns sequences of movement that relieve and protect the joint. Very severe pain is treated with cortisone injections.

Surgical treatment

Thanks to minimally invasive joint endoscopy (arthroscopy), there have been great advancements in shoulder surgery. Arthroscopy and the knowledge gained from it mean that many shoulder problems can be better understood and treated.

Arthroscopy is also used in the surgical treatment of impingement syndrome. During the procedure, the ganglion cyst is flattened or removed from the acromion and the acromioclavicular joint, and the inflamed bursa is removed. The tendon is then reattached to the bone and function restored.

Aftercare

If just the shoulder impingement is treated, the operation is not very complex and the strength can quickly be regained in the arm.

However, if a tendon has to be fixed to the bone, a rest period of six weeks is required after the procedure. However, immobilisation is not necessary.  Rehabilitation therapy lasts a few months.

Physiotherapy begins a few days after the operation. The affected arm is moved under supervision to prevent knots and adhesions. The treatment can last between three and six months, depending on the treatment.

FAQs

When does shoulder impingement require surgery?

If the condition has not improved after six months at the latest with conservative therapy, surgery will be required to alleviate the symptoms.

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