Impingement syndrome or bottleneck syndrome is a disorder of joint mobility. Because this occurs mainly in the shoulder joint, it is also referred to as shoulder tightness syndrome, humeral head tightness syndrome, or rotator cuff tightness syndrome. Degenerative changes or injuries lead to a narrowing of the joint body, which affects soft tissues such as tendons, muscles and bursa and can cause inflammation. The earlier the dysfunction is detected and treated, the better the chances of recovery from impingement syndrome.
What is impingement syndrome?
Impingement syndrome (tightness syndrome) is a condition that takes years or decades to develop. In this case, the first symptoms appear quite early, but they are often ignored or even misdiagnosed. The shoulder joint is one of the most mobile joints in the human body, but it is also one of the most susceptible to injury. Unlike other joints, whose stability is provided by bones, tendons, ligaments and muscles are the fixators here. Together, these soft tissue parts form the so-called rotator cuff, which ensures that the humeral head is fixed in the joint socket. This anatomical arrangement is very susceptible to constriction between the head of the joint and the socket, as well as to dislocation of the arm. Tendons, ligaments and nerves are affected. The constant friction during movement can lead to inflammation. Impingement syndrome is associated with very severe pain.
Causes
The main cause of impingement syndrome is wear and tear, so-called degenerative changes of the bony musculoskeletal system. It is found mainly in athletes such as handball players, javelin throwers, but also in swimmers. Constant overhead movements promote the signs of wear and tear. Impingement syndrome is now also recognized as an occupational disease, since it occurs much more frequently in people who perform overhead work (painters, welders, etc.). However, calcium deposits in the tendons or calcium deposits on the joint body can also promote impingement syndrome. Furthermore, there is a congenital variant if, for example, the acromion, the glenoid cavity or the joint head are deformed or have an unfavorable shape. The bottleneck syndrome is also favored by a muscular imbalance, as is often the case with bodybuilders, for example. Excessive and especially one-sided training throws the sensitive rotator cuff system out of balance, which further accelerates the symptomatology of impingement syndrome.
Symptoms, complaints, and signs
The leading symptom of impingement syndrome at the shoulder joint is the painful arc, also called painful arc. This involves a painful restriction of motion when the arm is raised laterally. The pain occurs mainly between 60° and 120° elevation of the arm. In the case of inflammation of the bursa of the acromion (in technical language: bursitis), or recurrent irritation of tendons due to entrapment, pain can occur even at rest, and may also occur at night. At the beginning of the disease, the pain is mainly triggered by exertion, such as working overhead. At rest, a subtle pain is felt in the joint. As the disease progresses, lying on the affected side is no longer possible. The shoulder is increasingly held against the body in a protective posture. The affected person can no longer lift the arm to the side. If the hip joint is affected by a narrowing syndrome, the change is noticed only very slowly. The first sign is often a deep groin pain. The pain generally occurs with hip flexion and is aggravated by additional internal rotation of the leg. Physical work may also aggravate the symptoms, causing the pain to radiate from the groin to the thigh.
Diagnosis and course
Impingement syndrome is diagnosed by an orthopedic surgeon. Extremely limited range of motion is found. Splaying the arm or even lifting it triggers severe shoulder pain. In some cases, the patient is no longer able to lift the arm above the head. Ultrasound and MRI are used in further diagnostics. Here, inflamed bursae (bursitis) can be detected, as well as bony changes.X-rays provide further information on the narrowing or constriction between the condyle and the acromion. The narrowed subacromial space or the collision of the condyle and glenoid cavity can be seen clearly, especially in images in which the affected arm is spread apart. Since impingement syndrome is a gradual disease, it can often take years before the first symptoms become noticeable. If the impingement syndrome is treated in time and, above all, adequately, most patients experience a significant improvement within several months. Even with already advanced defects of the bony musculoskeletal system as well as the soft tissue, a good course can be predicted. The prerequisite for this is that the cause (sport, occupation, etc.) is eliminated and continuous therapy is ensured. If the complaint recurs again and again, it is referred to as chronic impingement syndrome.
Complications
Impingement syndrome causes a variety of joint discomforts, resulting in severe movement disorders. Due to the movement restrictions, it is not uncommon for psychological complaints to lead to depression. As a rule, impingement syndrome can be treated relatively well if it is detected at an early stage. The affected person usually suffers from severe and often stabbing pain in the shoulder. This pain can also occur in the form of pain at rest, leading to sleep complaints, especially at night. The movement of these regions is also severely restricted, so that many everyday activities cannot be carried out easily or are always associated with severe pain. In most cases, treatment of impingement syndrome does not lead to further complications. However, these can occur if treatment is initiated late and irreversible consequential damage has already formed. The affected person must undergo various therapies to alleviate the symptoms. Often the treatment takes several months until a positive course of the disease is achieved. It may not be possible to fully load the respective regions even after treatment.
When should one go to the doctor?
If mild but persistent discomfort persists in the shoulder area, a doctor should be consulted in the next few weeks. If the pain suddenly increases in intensity and may be accompanied by restricted movement, sufferers should see a doctor within the next few days. Acute complaints that are noticed for the first time when lifting weights or doing sports should be clarified immediately. If no treatment is given, the symptoms of impingement syndrome can increase in intensity and also cause emotional upsets in those affected. For this reason, a doctor should be consulted at the first signs of the syndrome. People who frequently engage in sports or lift heavy loads at work are particularly susceptible. The risk groups include, above all, bodybuilders, painters, welders and people with congenital deformities of the acromion, glenoid cavity or condyle – anyone who counts themselves in one of these groups should have the symptoms mentioned clarified by a doctor immediately. In addition to the family doctor, a sports physician or an internist may be consulted.
Treatment and therapy
Impingement syndrome is usually treated conservatively. The rule is that the sooner adequate treatment is started, the better the chances of recovery. The respective treatment method depends on the stage of the impingement syndrome. In principle, the first step is to rest the shoulder, with the focus here on eliminating the cause, whether sports-related or occupational. Other conservative treatment methods include physiotherapy, cryotherapy, acupuncture, shock wave therapy and matrix therapy. These therapies are supported by medications that have both analgesic and anti-inflammatory effects. ASA, diclofenac (as an ointment or tablet) and cortisone preparations are used, for example. If there is no improvement after several months of intensive therapy, surgery is unavoidable. Depending on the clinical picture, a so-called acromioplasty is performed. However, surgery alone is not enough. Intensive conservative follow-up therapy and elimination of the cause are necessary measures for successful treatment of impingement syndrome.
Outlook and prognosis
Shoulder pain is present in impingement or tightness syndrome. Because these can have multiple causative factors, careful diagnosis is essential. An orthopedist should decide whether physiotherapeutic measures are sufficient or whether the impingement syndrome requires surgery. Treatment can only be successful if the muscular imbalances caused by the impingement syndrome are also treated. If this is not the case, it worsens the prospects for permanent pain relief. Further overloading can lead to permanent shoulder stiffness or tendon ruptures. An important measure in tightness syndrome is to release the adhesions that are present on the rotator cuff. In addition, the prognosis improves if muscular mobility is restored at the same time. Self-treatment is out of the question because it could worsen the prognosis due to incorrect strain. However, the movement sequences suggested by the physiotherapist are suitable for further practice at home. Practicing too much, however, can lead to undesirable results. Properly performed exercises should be done with warmed muscles, slow movements and gentle stretching. If the shoulder continues to be overworked despite impingement syndrome, it can lead to microtears in the shoulder tendons. These hairline tears can lead to tendon attachment or detachment with further stress. Tendon rupture takes a relatively long time to heal. It worsens the prognosis by quite a bit. The healing process is aided by a gentle exercise program.
Prevention
Impingement syndrome can be prevented by avoiding one-sided stresses. Furthermore, it is important, especially for those at risk (sports, occupation), that prophylactic physiotherapy, as well as special training of the shoulder muscles is performed. Due to the insidious process of the disease, impingement syndrome is often diagnosed too late. It is therefore all the more important to pay attention to the warning signals of one’s own body and to regularly attend preventive medical check-ups, so that a possible impingement syndrome can be successfully treated.
Follow-up care
In impingement syndrome, there are usually very few, if any, special aftercare measures available to those affected. In this case, a very early diagnosis should be made to prevent further worsening of the symptoms or to prevent further complications. There can be no self-healing. The further course of this disease depends very much on its severity, so that no general prediction can be made about it. Those affected by impingement syndrome are dependent on the measures of physiotherapy. Many of the exercises can also be performed at home, which may accelerate the healing process. Likewise, it is often necessary to take various medications to alleviate the symptoms. The affected person should always pay attention to a correct dosage and to a regular intake of the medication. In severe cases, surgical intervention may also be necessary. After such an operation, the affected person should in any case rest and take care of his body. They should refrain from stressful or physical activities. The help and support of one’s family and friends can also speed up the healing process.
This is what you can do yourself
Impingement syndrome (tightness syndrome) is a painful condition in the shoulder area that is treated either with surgery or conservatively, depending on the severity and the patient’s wishes. In both cases, it is important that the patient himself contributes to the quickest and, above all, most complete recovery possible through active participation in everyday life. To relieve acute pain, cooling is a valuable aid in most cases. The cold pack not only relieves the pain caused by the irritation or the operation, but also counteracts classic signs of inflammation such as swelling or redness through its anti-inflammatory properties. Targeted physiotherapy is indispensable. However, it is not enough to perform the exercises together with a therapist over a limited number of appointments. Only consistent continued practice at home ensures healing success. The exercises have several functions. On the one hand, they loosen adhesions in the tissue that have formed due to the inflammation or as a result of the operation.On the other hand, they mobilize the joint again. It is also important to compensate for existing muscular imbalances. Only in this way can the tightness between the acromion and humeral head, which triggers the impingement syndrome, be prevented in the long term. A stretching exercise for the shoulder may also be incorporated now and then if the shoulder seems to be somewhat restricted in its mobility again after a strenuous professional activity or sport.
