In medicine, a constriction syndrome is the painful pinching of muscles and tendons in a joint. It most commonly affects the shoulder joint.
What is constriction syndrome?
Crowding syndrome is also known as impingement syndrome. It involves restrictions in mobility and function of the affected joint, which are associated with pain. The reason for this is a constriction of muscles and tendons. As a result, the space within the joint is no longer sufficient for certain movements. Impingement syndrome primarily affects a person’s shoulder. In most cases, impingement syndrome is due to an injured or degenerated rotator cuff. The impingement prevents the affected person’s arm from being raised above the level of the shoulder. However, constriction syndrome can certainly occur in other joints, such as the hip joint. Affected by the narrowing are the acetabulum as well as the femoral head. In rare cases, impingement syndrome also occurs at the ankle joint. About ten percent of all German citizens are affected by an impingement syndrome. Thereby, the syndrome predominantly manifests itself in men and women who are older than 50 years.
Causes
The causes of a bottleneck syndrome turn out differently. In most cases, degenerative changes in the bony musculoskeletal system are responsible for the development of the syndrome. Athletes such as swimmers, javelin throwers or handball players are particularly affected. The signs of wear and tear are further promoted by the permanent overhead movements. However, it is not uncommon for certain occupational groups to suffer from impingement syndrome as well, so that it is now considered an occupational disease. This mainly affects professions that involve overhead work, such as welders or painters. Other triggers for impingement syndrome include deposits of calcium in the joint bodies or tendons. Even a congenital form of impingement syndrome is possible. This involves deformities of the joint head, the acromion or the glenoid cavity that result in an unfavorable shape in the joint. Another risk factor for a bottleneck syndrome is an imbalance of the muscles. This is predominantly seen in bodybuilders. One-sided or exaggerated training not infrequently disturbs the sensitive balance of the rotator cuff.
Symptoms, complaints and signs
The symptoms of a tightness syndrome depend on the affected body part. For example, patients suffer from acute pain at the shoulder, which increases with exertion and decreases with rest. The pain appears deep in the joint and becomes so severe at night that the patient can no longer lie on the affected side. In addition, the arm can hardly be lifted and often hangs loosely. It is not uncommon for the painful movement restrictions to increase as the condition progresses, and the shoulder joint loses more and more stability. In the case of a narrowing syndrome in the hip joint, the complaints are gradual. Thus, only sporadic pain occurs, which, however, intensifies during physical activity. Not infrequently, their radiation into the thigh takes place. In addition, the pain becomes more intense when the patient turns the affected leg inward.
Diagnosis and course
If narrow-leg syndrome is suspected, an orthopedist who specializes in conditions of this type should be consulted. An experienced physician can usually make the diagnosis after describing the symptoms and examining the body. In addition, constriction syndrome is one of the most common orthopedic conditions. When taking the patient’s medical history, the orthopedist usually wants to know where and in what situations the pain occurs, how long it has lasted, whether there are limitations in movement or strength, whether there are any shoulder injuries, and whether the patient also suffers from pain at night. Also of interest is the patient’s occupation and what sports he or she participates in. During the physical examination, the orthopedist checks the patient’s movements and whether there are any disorders. Special clinical function tests take place to confirm the diagnosis. These include the shoulder grip, the neck grip, the supraspinatus test, the impingement test according to Neer or the Hawkins test. The course of a bottleneck syndrome depends on the triggering cause.In most cases, the patient has to be very patient. It can take weeks or even months for the symptoms to improve. Sometimes complications from impingement syndrome, such as tears of the rotator cuff tendon or inflammation of the bursa under the acromion, are also possible.
Complications
As a rule, constriction syndrome results in disorders of the joints and their mobility, with the shoulder joint being particularly affected. In this case, the patient suffers from restricted movement and also pain. The complications depend mainly on the timing of the treatment. In most cases, the pain occurs when the affected person lifts his arm, moving his shoulder. The pain is often unbearable, so that these movements can no longer be performed. Physical activities or sports activities are usually no longer possible due to the constriction syndrome. There is a reduced quality of life. If treatment is not started early, the complete musculoskeletal system can also be damaged. The treatment itself is carried out through various therapies and the administration of painkillers. In order to avoid further disorders, the affected person is not allowed to put any more weight on his shoulder. If the usual therapies are not successful, surgical interventions can also reduce the suffering. This means that the constriction syndrome can be treated relatively well, and there is no need to worry about further complications afterwards. Life expectancy is not reduced by bottleneck syndrome.
When should you see a doctor?
If shoulder or joint problems increase for no apparent reason, a doctor should be consulted. If there is a restriction in range of motion, there is reason for concern. If there is poor posture of the body or one-sided physical strain due to the symptoms, it is advisable to consult a doctor. The symptoms can lead to permanent damage to the skeletal system, which should be corrected at an early stage. If accustomed occupational or athletic activities can no longer be performed as usual, a visit to the doctor is necessary. In the case of pain or sleep disturbances, a doctor is needed as soon as they occur repeatedly or last for several days. Consultation with a physician is required before taking a pain medication. Side effects may occur and should be discussed and clarified in advance. In case of emotional or mental problems due to the discomfort and limitations, a visit to the doctor is recommended. If mood swings occur, general well-being declines, or behavioral problems occur, a therapist is needed. A depressed emotional state, apathy and a general feeling of malaise should be discussed with a doctor. If complaints such as inner restlessness, headaches or listlessness persist over a longer period of time, the risk of suffering additional mental illnesses increases. A visit to the doctor is therefore necessary in order to develop timely solutions to the emerging problems.
Treatment and therapy
Treatment of constriction syndrome usually needs to be individualized and may include several options. If conservative therapy takes place, the patient receives pain medication as well as physical therapy. He must also take it easy on himself. This means that he should avoid heavy physical work and sports. Acetylsalicylic acid or ibuprofen are administered to relieve the pain. If conservative therapy does not lead to improvement, surgery may be appropriate. The goal of surgery is to correct the mechanical narrowing by altering the structures. Surgical intervention is particularly recommended for younger patients. As a rule, only minimally invasive procedures such as arthroscopy are used. With the help of an endoscope, the surgeon thereby provides the affected joint with more freedom of movement again.
Outlook and prognosis
Crowded joint syndrome promises a positive prognosis. Patients who receive comprehensive treatment for the condition and adhere to the physician’s instructions regarding rest and physical therapy usually recover within a few weeks to months. Late sequelae rarely occur with the bottleneck syndrome. Only in the case of severe illnesses associated with fractures, signs of wear and tear and other complications can the therapy last longer.In individual cases, the syndrome develops into a chronic condition that permanently limits those affected. Older patients in particular often do not fully recover from the bottleneck syndrome. The bottleneck syndrome has no influence on the life expectancy of the patients. However, the condition promotes further diseases of the joints, tendons and bursae. This can limit the quality of life over a longer period of time and, if necessary, also lead to severe complications. The orthopedist in charge can determine the prognosis on the basis of patient discussions and physical examinations. The course of the disease provides information about the prospects of recovery and also indicates the risk of any complications. If the therapy is continued closely and supported by self-help measures, the prospect of recovery is given in healthy patients without concomitant diseases or other physical or mental complaints.
Prevention
Preventing constriction syndrome is possible only to a limited extent. Good posture, sufficient exercise, regular exercise of the rotator cuff, and relaxation of the shoulder muscles are recommended. Caution is advised with high-risk sports such as tennis, handball, javelin throwing, swimming or volleyball.
Aftercare
In constriction syndrome, the options for aftercare are usually severely limited. In this case, direct medical treatment by a medical professional is usually necessary first in order to properly and completely treat the syndrome. Since the syndrome cannot heal on its own, the affected person is always dependent on treatment by a physician. This is the only way to prevent further complications. In most cases, the bottleneck syndrome is treated with the help of a surgical intervention. There are no particular complications. The affected person should rest and take care of his body after the operation. They should refrain from exertion or other stressful activities in order not to put unnecessary strain on the body. Stress should also be avoided in general, although a healthy lifestyle on the part of the affected person can have a positive effect on the further course of the disease. In some cases, patients with bottleneck syndrome are also dependent on the help and support of friends and family to cope with everyday life. In this case, intensive and loving care has a particularly positive effect. Reaching out to other patients with bottleneck syndrome can also be useful in this regard.
This is what you can do yourself
When mobility and function of a joint are impaired, affected persons should always consult a doctor promptly. What the patient himself can contribute to the therapy of the bottleneck syndrome depends on its causes and the specific symptoms. The bottleneck syndrome often occurs in occupational groups that work overhead. These include craftsmen such as bricklayers, painters and carpenters, but also employees in the metalworking industry. Members of a high-risk group should consult a physician, preferably an experienced orthopedic surgeon, at the first sign of narrow-leg syndrome. If the suspicion of a bottleneck syndrome is confirmed, a number of behavioral adjustments are usually required. Often, the affected joint must be rested for a longer period of time. Depending on the occupation performed and the severity of the symptoms, this may mean that certain activities may no longer be performed, longer breaks from work may be required, or the affected person may have to take a complete break for a longer period of time. Since bottleneck syndrome is recognized as an occupational disease in Germany, patients are relatively well covered financially. In any case, affected persons should immediately seek advice from their health insurance company as well as from their trade union or works council. If the doctor prescribes physiotherapy, it is important that the patient actually starts it and implements it consistently. Regular training of the rotator cuff is important to prevent further degeneration of the musculoskeletal system.
