Shoulder tightness syndrome (impingement)
Shoulder impingement syndrome refers to a painful condition at the acromion where the upper tendon of the rotator cuff becomes "pinched". It is often accompanied by inflammation of the bursa.
Anatomy of the shoulder joint
Because the shoulder (unlike the hip) has no bony stability, it needs muscles, tendons and ligaments to hold the joint together. The upper tendon must pass under the acromion as it runs from the shoulder blade to the humeral head in order to pass over the humeral head to its outer side, where it is attached to the bone. There is an anatomical constriction with only approx. 12 mm clearance between the acromion at the top and the humeral head at the bottom. A bursa lies between the tendon and the acromion to protect the tendon from the hard bone.
Causes
The shoulder joint also undergoes ageing processes that change the joint. There are various causes that can lead to impingement syndrome.
An excess bone can grow on the bone of the acromion or the glenohumeral joint and put pressure on the tendon underneath. A bursa can become inflamed and swell, taking away space from the tendon. The tendon itself can also swell due to overloading or an accident and rub against the acromion. Finally, it is also possible that the functional control of the muscles no longer works properly, so that the humeral head is not guided correctly in the joint during movement. The elevated position reduces the space available for the tendon.
Symptoms
Bottleneck syndrome is painful. It often causes movement-dependent pain when lifting the arm, e.g. when you want to take your garage ticket from the machine or hang up the washing. However, pain can also occur at rest, especially if inflammation is present. This can also affect sleep. Lying on the affected side is then usually no longer possible.
Diagnosis
First of all, a specialist needs to question and examine the patient, as other problems are often present or the rotator cuff tendon is already torn. The X-ray image shows the position of the bones in the joint and also possible calcifications. An MRI is almost always used. It shows the important soft tissues of the shoulder, such as the tendons and the bursitis, but also the condition of the muscles.
Conservative treatment methods
In many cases, conservative treatment is possible. First and foremost, the shoulder pain is treated with painkillers and then correct and gentle movements are learnt in physiotherapy. Occasionally, however, the pain is so severe that it has to be treated with cortisone infiltrations.
Surgical treatment methods
Operations on the shoulder have developed enormously thanks to minimally invasive arthroscopy and many shoulder problems have been better understood and treated thanks to arthroscopy. This method is also often used for impingement syndrome. During surgery for shoulder impingement syndrome, the constricting overbone on the acromion is removed and the often inflamed bursa is removed. The tendon often also has to be reattached to the bone. Sometimes the shoulder-corner joint also has to be removed. If only the shoulder tightness is treated, the operation is not very complex. The arm can be used again quickly and the physiotherapy for rehabilitation does not take very long. If, on the other hand, a tendon has to be fixed to the bone, then 6 weeks of rest are required afterwards (but no immobilisation). Rehabilitation therapy takes several months in this case. The operations are not stressful for the body as a whole.
Prospects of success
The vast majority of patients who are correctly diagnosed and operated on are symptom-free or have little pain for many years. The function of the shoulder may remain slightly restricted, for example during strenuous overhead work. Strength is also sometimes slightly reduced in direct comparison to the opposite side, but the arm is significantly more mobile and stronger than before the operation. Impingement surgery alleviates discomfort for years. However, this operation does not protect against degenerative processes that can affect the shoulder joint.
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PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.