The following are the most important diseases or complications that may be contributed to by impingement syndrome of the shoulder: Musculoskeletal system and connective tissue (M00-M99). Chronic restriction of movement Chronic shoulder pain Frozen Shoulder (Periarthritis humeroscapularis) – painful frozen shoulder with increasing pain in the shoulder area, at rest and in motion, occurring with … Impingement Syndrome: Complications
Impingement forms are divided into those with Glenohumeral centered humeral head (shoulder joint portion of the humerus). Decentered humeral head Neer classification of impingement lesions. Stage Pathology Typical age History Therapy I Edema (water retention), hemorrhage <25 years Reversible conservative II Fibrosis (pathological proliferation of connective tissue), tendinitis (inflammation of tendons) 25-40 years Load-dependent pain … Impingement Syndrome: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes. Gait (fluid, limping). Body or joint posture (upright, bent, gentle posture). Malpositions (deformities, contractures, shortenings). Muscle atrophies (side … Impingement Syndrome: Examination
2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Rheumatological diagnostics: RF (rheumatoid factor), ANA (antinuclear antibodies), anti-citrulline antibodies – if rheumatoid arthritis is suspected (pcP).
Therapy goals Reduction of pain Increase in the ability to move Avoidance of complications Therapy recommendations Analgesia (analgesia) during diagnosis until definitive therapy according to WHO staging scheme: Non-opioid analgesic (non-acid analgesic: paracetamol, first-line agent). Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic. High-potency opioid analgesic (eg, morphine) + non-opioid analgesic. Opioids: morphine, tramadol. If … Impingement Syndrome: Drug Therapy
Obligatory medical device diagnostics. Radiograph of the shoulder, in 3 planes (true a.p., axial and shoulder according to Morrison or outlet-view) – in advanced stages, characteristic changes at the acromion (bony prominence of the scapula (shoulder blade)) and in the acromioclavicular joint (acromioclavicular joint) or a humeral head elevation (reduced distance between the humeral head … Impingement Syndrome: Diagnostic Tests
If drug therapy and physical therapy are unsuccessful and/or symptoms persist for more than 8-10 weeks, surgical therapy should be considered. Likewise, if the discomfort is occupational. Note: At a younger age (< 40 years), a traumatic rotator cuff rupture should be promptly reconstructed surgically before retraction (“pulling back”) of the tendon occurs. The following … Impingement Syndrome: Surgical Therapy
To prevent impingement syndrome of the shoulder, attention must be paid to reducing individual risk factors. Behavioral risk factors High-risk sports such as throwing/impact sports.
The following symptoms and complaints may indicate impingement syndrome of the shoulder: Early stage Acute onset of shoulder pain – worsens with exertion, especially during overhead activities Radiation of pain into the distal (“away from the body”) insertion of the deltoid muscle (triangular skeletal muscle located above the shoulder joint; it serves to elevate the … Impingement Syndrome: Symptoms, Complaints, Signs
If structural damage is absent, conservative therapy is the primary treatment! This also applies if there is only minor structural damage (e.g., partial rotator cuff rupture; small calcific deposits) that affects the balance of shoulder function. General measures Depending on the disease stage of the impingement syndrome: Relief and immobilization – no movement against the … Impingement Syndrome: Therapy
Pathogenesis (development of disease) Lateral elevation of the arm occurs due to traction of the rotator cuff (group of four muscles whose tendons, together with the ligamentum coracohumerale, form a coarse tendon cap that encompasses the shoulder joint), especially the supraspinatus tendon (attachment tendon of the supraspinatus muscle (upper spine muscle); runs just below the … Impingement Syndrome: Causes
Medical history (history of illness) represents an important component in the diagnosis of impingement syndrome of the shoulder. Family history Is there a history of frequent bone/joint disorders in your family? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). Where exactly is the pain localized? What is the character … Impingement Syndrome: Medical History