Impingement syndrome in combination with bursitis

Inflamed bursa also frequently contribute to the development of impingement syndrome in the shoulder. This is then referred to as bursitis. The bursa is located in the shoulder area to provide the tendons with a kind of sliding bearing so that they do not rub against the bone and thus suffer damage.

The inflammation of the bursa in the subacromial space (bursitis subacromialis) is usually due to degenerative wear processes of the supraspinatus tendon due to the above mentioned reasons. The inflammation of the bursa leads to it no longer fulfilling its actual task (the protection of the tendon) and becomes sticky. The supraspinatus tendon is now no longer protected by the bursa, but is instead constricted and further damaged.

If this inflammation persists, the damage to the tendon can lead to a rupture. The medium-term consequence of this process would be a so-called “frozen shoulder” – the shoulder becomes completely immobile due to the inflammation process. This must be prevented.

When the arm is moved upwards or when the orthopedic surgeon tests for impingement, the typical tests are positive, since the inflammation and entrapment of the supraspinatus tendon has caused a symptomatic constriction under the acromion. The therapeutic approach here is to eliminate the inflammatory process. This can be done conservatively by injecting steroids and using ibuprofen or Voltarene.

In addition, physiotherapy that is increased step by step is recommended in order to regain full mobility of the shoulder. If therapy fails, surgical removal of the inflamed bursa and soft tissue is recommended.If necessary, parts of the supraspinatus tendon may have to be removed as well, as these are so damaged by the chronic irritation and inflammation that they are no longer strong enough. In this case a reconstruction or a muscle transfer operation is indicated.

Clavicle
Acromion (shoulder roof)
Space between humeral head and acromion
Humerus (upper arm bone)
Shoulder joint (Articu- latio glenohumerale

This disease is a wear-related (degenerative) change in the so-called supraspinatus tendon. This alteration is the result of a tightness in the area of the arm’s rotating shoulder muscles, known as the rotator cuff, and the bursa (= bursa subacromialis) lying on top of it. The pain is the result of the constriction between the head of the humerus and the acromion and ligamentum acromio-claviculare above it.

The distance between the head of humerus and the acromion is usually determined by means of an X-ray or magnetic resonance imaging. In the context of the determination, the shoulder height is referred to as the acromio-humeral distance, the distance between the head of humerus and acromion, which ideally should be greater than 10 mm. This 10 mm distance is regarded as the minimum dimension, which should prevent crushing of the soft tissues in between, i.e. the rotator cuff and the subacromial bursa.

If this area is smaller, the probability of the occurrence of impingement syndrome increases. Lateral lifting of the arm (= abduction) is achieved by pulling the rotator cuff, particularly through the supraspinatus muscle. During this movement, the head of humerus slides under the acromion, with the result that both the rotator cuff itself and the bursa (bursa subacromialis) slide under the acromion.

This process is considered normal physiological, so that there is usually enough space for these displacements. If, however, there is not enough space for various reasons, the so-called impingement syndrome, the subacromial narrowing syndrome, occurs. The problem here is that the constant rubbing of the rotator cuff against the acromion can cause permanent damage to the rotator cuff, which in its final state can also result in a complete tear of the cuff. Depending on the cause and localization of the impingement, a distinction is made between various forms in the shoulder region, which, however, require a more precise knowledge of the shoulder anatomy.