Duration

Impingement is usually a process that develops over years. Due to the chronic inflammatory process, a narrowing under the acromion (Fornix humeri) slowly but steadily forms. At a certain point, this narrowing becomes so painful and problematic for the person affected that he or she seeks medical treatment.

With medication, physiotherapy, ultrasound, heat and cold, electrotherapy and other approaches, conservative treatment is possible. Since it takes time to remove the inflammation from the subacromial space, it can take up to 3 months to achieve complete freedom from symptoms. However, this also depends on how long the inflammation has existed and the extent of the damage that has occurred.It is quite possible that after 3-4 months of conservative therapy, surgery may be required after all. In this case, the symptoms will ideally disappear after 4-6 weeks of follow-up treatment.

Symptoms of Impingement Syndrome

If a patient is reasonably suspected of having impingement syndrome, he usually complains of moderate to severe shoulder pain in the early stages of the disease. In the early stages of impingement, the pain is almost exclusively motion-related. This is usually triggered by the so-called painful arch.

In this phenomenon, which is also known as “painful arc”, there is initially no pain when the arm is raised at a 90 degree angle. This is due to the fact that the space in the acromion is usually still sufficient and the muscles in the shoulder joint are not constricted. If the arm is lifted over an angle of about 60 degrees, the space in the shoulder area becomes increasingly narrow and pain begins.

If the arm is lifted further to the side and reaches over 120 degrees, the space in the shoulder area becomes larger again and the pain decreases again. The classic alternation between freedom from pain, pain and renewed freedom from pain when the arm is lifted piece by piece already strongly suggests the presence of an impingement syndrome, since no other orthopedic clinical picture shows such a characteristic pain development. If it is an advanced impingement syndrome, the space in the shoulder area is already so narrow that even the smallest movements in the arm area lead to pain.

Particularly pronounced impingement syndromes can also lead to so-called resting pain. Particularly typical is the pain of the shoulder at night, which is more often worse than during the day. In advanced impingement syndromes, night-time pain also occurs, especially when the patient lies on the diseased shoulder.

In this case there can also be severe pain, even if the arm is not moved. In addition to the classic arm elevation, which leads to the symptoms of impingement described above, it is also possible that pain is triggered when the arm is rotated. A rotation in the shoulder joint is understood to be an external rotation of the palm of the hand or an internal rotation.

On the one hand, the pain is described as punctual in the area of the narrowed shoulder area, but it can also extend into the upper arm in the direction of the hand or over the shoulder towards the head. In addition to the pain, movement in the arm can also be impaired. For example, in severe impingement syndrome, lifting the arm and turning it outwards is only possible to a limited extent or can no longer be performed at all. In some cases, sensitive disorders over the skin in the shoulder area are also described.