In the case of impingement syndrome, soft tissue such as a tendon or parts of the joint capsule are trapped in a joint, which is usually quite painful. Mobility is also usually restricted. Impingement syndrome can affect various joints in the human body.
It is most commonly seen in the shoulder, typically as shoulder pain. The hip or the foot (the ankle) are affected much less frequently, which is why the focus of the article is also on the impingement syndrome of the shoulder.
The shoulder pain occurs mainly with overhead movements (such as throwing sports, overhead work) and when lifting the arm to the side. The shoulder can also hurt when lying on the affected side. A restful night’s sleep is often unthinkable for many of those affected. Common causes of impingement syndrome are age-related wear and tear (degenerative processes) of the bony structures of the body or injuries to the soft tissues. These include the muscles, tendons, bursae and joint capsules.
Another name for impingement syndrome is bottleneck syndrome. The shoulder is particularly often affected because many bones, muscles, tendons and ligaments are located here in a very small space and have to work together. Shoulder pain usually occurs below the bone that forms the acromion – the so-called acromion. When the arm is raised to the side, the humeral head hits the acromion and constricts structures that run there, such as the shoulder tendons (above all the so-called supraspinatus tendon).
The affected arm and shoulder gradually lose mobility. Along with back and neck pain, shoulder pain is one of the most common orthopedic complaints. In more than 70 percent of those affected, the pain originates in the area of the acromion. Specialists also speak of subacromial impingement syndrome, subacromial pain syndrome or simply pain under the acromion.
Impingement syndrome can have a variety of causes. On the one hand, changes and signs of wear and tear of the bony structures can be behind it. The space under the acromion narrows, for example due to bone growth, wear and tear or calcium deposits in the tendon of the so-called supraspinatus (a narrow shoulder muscle).
On the other hand, soft tissues can be injured (e.g. due to a tear) or inflamed. These injuries and inflammations can affect, for example, a tendon or a bursa (bursitis). Muscles that are weak or strained on one side sometimes also lead to the ligaments and tendons of the joint capsule shortening. The shoulder is one of the most flexible joints in the human body and gets its stability primarily from well-trained, well-developed muscles.
All changes in the shoulder area can result in parts of the shoulder tendons and the bursa being trapped between the head of the humerus and the acromion when the arm is lifted – and that is painful.
Shoulder impingement syndrome is common in athletes, such as those who play throwing sports (e.g., handball, volleyball, basketball). Freestyle swimming, dolphin swimming and tennis are also prone to shoulder impingement syndrome. Anyone who trains often and intensively is usually not immune to shoulder pain.
But people who have to work a lot overhead can also suffer from bottleneck syndrome. These include painters, electricians, warehouse workers or people who replenish shelves.
Various exercises can help with shoulder impingement syndrome. The training loosens the shoulder, makes it more flexible, strengthens the muscles and relieves the pain. However, you should learn the exercises under the professional guidance of a physical therapist. Otherwise you will practice incorrect movement patterns and sequences, which may damage the shoulder even more.
You can then do the exercises independently at home or at work. Stretching, pendulum and passive movement exercises by a physiotherapist are helpful for shoulder impingement syndrome. The word “passive” means that only the physiotherapist performs the movements and exercises – the patient himself remains inactive. Some examples:
There are many other exercises for shoulder impingement syndrome with a Theraband or a fascia roll. The exercises can also be performed in different positions – lying down, standing or on all fours.
There are also many exercises for hip impingement syndrome. The same applies here: Always have a physiotherapist show you the process and the correct execution of the exercises.
An easy exercise to do for hip impingement syndrome is:
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Two strategies can be used in the treatment of impingement syndrome: without surgery (conservative therapy) and with surgery. In most cases, acute shoulder pain due to bottleneck syndrome can initially be treated without surgery. The most important measures here are:
If all conservative treatments for impingement syndrome have been exhausted and they have not brought sufficient success, surgical intervention is also possible. A special technique is used: arthroscopic subacromial decompression (SAD) or subacromial decompression. As part of an arthroscopy, doctors remove parts of the acromion, remove the bursa and thus eliminate the bottleneck in the shoulder – and thus also the cause of the pain. Afterwards, soft tissues such as tendons and bursa cannot be pinched again.
In the case of impingement syndrome, however, shoulder surgery does not always promise good chances of success. Two larger studies have shown that an operation through which surgeons remove the bottleneck under the acromion does not help any better than a “sham operation”. The test persons only thought that they were going to have an operation – in reality, doctors did not operate on the impingement syndrome of the shoulder at all. The researchers found no differences between the result of the surgical intervention (the decompression) and the sham operation. The symptoms could not be noticeably eliminated by the operation.
Therefore, always discuss in detail with your doctor what advantages an operation would bring for you personally and what disadvantages and risks a surgical procedure entails. Possible complications of a surgical procedure are wound healing disorders, blood clots (thrombosis) and nerve injuries (although very rare). In about one percent of those operated, the shoulder is stiff after the procedure. This risk is higher for women and people who have diabetes mellitus. So far it is unclear why this is so.
Therefore, weigh all the facts carefully against each other and then decide together with your doctor whether an operation would be promising. Take your time with the decision and possibly get a second opinion.
Shoulder impingement syndrome causes various symptoms, most notably shoulder pain. They mainly occur on the outside of the shoulder when raising your arm sideways or doing overhead movements. The following pain pattern is usually seen when lifting the arm:
Lying on the affected shoulder while you sleep at night often increases the pain. Some sufferers even wake up because their shoulder hurts. Another symptom of impingement syndrome is that the mobility of the shoulder is increasingly restricted.
Pain also occurs with hip and ankle impingement syndrome. In addition, the joints only have limited mobility.
The first point of contact for shoulder pain (also for other joint pain such as hip and ankle pain) is a general practitioner. If you suspect impingement syndrome, you will be referred to a specialist in orthopedics and trauma surgery. Bottleneck syndrome is an orthopedic condition.
The diagnosis “impingement syndrome” always belongs in the hands of specialists. Because it is important to differentiate the disease from other clinical pictures that are associated with similar symptoms such as pain under the acromion. These include, for example, the calcified shoulder or the rotator cuff syndrome. The treatment also depends on this.
At the beginning of the diagnosis of an impingement syndrome there is always a discussion about your medical history (anamnesis). The doctor will ask you a few questions to get an initial indication of the cause of the shoulder pain. Some examples:
This is usually followed by a physical examination. Among other things, the doctor feels the shoulder and checks whether and which area is causing pain. There are various tests for diagnosing impingement syndrome, for example:
If the suspicion of impingement syndrome has been further substantiated, imaging procedures are used. Doctors “x-ray” the shoulder and can thus get a better picture of the structures, such as the joints, bones, tendons, ligaments and bursae. The main methods are:
However, it should be noted that there is not always a direct connection between the changes in the images (ultrasound, X-ray, MRI) and the symptoms. Some people have significant changes, such as in a joint, but feel little or no symptoms. For other people, on the other hand, the opposite is true: They report severe symptoms, although imaging methods hardly show any abnormalities. The expressiveness of images alone is therefore limited. It is therefore always important to look at all test results together.
Sources
Author: Ingrid Müller, biologist
The original of this post “Shoulder pain? It could be impingement syndrome” comes from FOCUS doctor search.
