As a rule, the treatment of impingement syndrome is started with conservative therapy, i.e. an attempt is made to cure the disease without surgery in order to cause as little stress to the patient as possible. First of all, it is essential to immobilize the arm and not to expose it to unnecessary stress. In addition, the shoulder joint can be cooled with the help of ice packs, which relieves pain and often helps to contain the inflammatory processes a little.
If these measures are no longer effective, the next step is to start using medication. Painkillers from the group of anti-rheumatic drugs, such as ibuprofen, can be used to counteract both the pain and the inflammation. Drugs that can be injected directly into the affected joint have a greater effect.
Cortisone is often used for this purpose. Cortisone is a very effective anti-inflammatory drug, but it has a rather strong effect and is associated with many side effects, so it should not be used lightly and, if at all, then only temporarily. In addition, physiotherapy and physical therapy are very useful in case of an impingement syndrome.
However, these should always be carried out under the supervision of a doctor or a trained physiotherapist in order to avoid causing even greater damage to the joint. Techniques that are helpful here are mainly special stretching exercises and muscle building. The strength in the shoulder should be restored and movement restrictions are ideally minimized.
In addition, certain mobilizations of the joint can also have a direct anti-inflammatory effect, as they stimulate the blood circulation of the affected tissue and thus also regeneration processes. However, it should be noted that these exercises can only have a positive effect if they are performed consistently, correctly and above all regularly over a longer period of time. If all of the above mentioned treatment options do not have the desired effect of freedom from pain or at least considerable relief, surgery must ultimately be resorted to.
There are several alternatives, which must be weighed against each other depending on the severity of the disease and the individual condition of the patient. The least invasive and most complex is the arthroscopic procedure. Only very small incisions are necessary, through which the surgeon inserts a camera into the joint, with the help of which he can directly identify bony structures that lead to constrictions and remove them with a small device if necessary.
With this variant, the operation can normally be performed on an outpatient basis, i.e. the patient can leave the hospital on the day of the operation. In the case of more pronounced clinical pictures, an open therapy is usually preferable. In this case, larger bone spurs can be removed and at the same time any existing adhesions can be removed.
If necessary, the surgeon can also remove parts of the joint and/or smooth joint surfaces. With this method, however, a larger incision of about 4 cm in length must be made, which means a longer stay in hospital. The most drastic variant is the so-called subacromial decompression.
The purpose of this operation is to widen the joint space in order to treat the existing impingement syndrome and prevent a relapse. Depending on which structures of the joint were responsible for the symptoms, bone parts, tendons or parts of bursae can be removed during this procedure. After each type of surgery, extensive physiotherapy is prescribed, whereby it is important to find a good balance between overloading the joint too early and immobilising it for too long, both of which can have a long-term negative effect on the healing process.
The more extensive the intervention, the slower mobilisation of the joint should be started and the longer it usually takes to regain completely normal mobility and freedom from pain in the affected shoulder. The English word “impingement” means “collision” in German. The name for the syndrome comes from the fact that different components within a joint collide and lead to entrapment or even degeneration of tendons and/or joint capsule.The term is mostly used when this process takes place in the shoulder joint, but in principle it can be used for all joints of the body.
The syndrome is accompanied by pain and more or less pronounced movement restrictions and should therefore be treated as soon as possible. As a rule, treatment of impingement syndrome begins with conservative therapy, i.e. attempts to cure the disease without surgery, in order to place as little stress on the patient as possible. First of all, it is essential to immobilize the arm and not to expose it to unnecessary stress.
In addition, the shoulder joint can be cooled with the help of ice packs, which relieves pain and often helps to contain the inflammatory processes a little. If these measures are no longer effective, the next step is to start using medication. Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to counteract both the pain and the inflammation.
Drugs that can be injected directly into the affected joint have a greater effect. Cortisone is often used for this purpose. Cortisone is a very effective anti-inflammatory drug, but it has a rather strong effect and is associated with many side effects, so it should not be used lightly and, if at all, then only temporarily.
In addition, physiotherapy and physical therapy are very useful in case of an impingement syndrome. However, this should always be carried out under the supervision of a doctor or a trained physiotherapist in order to avoid causing even greater damage to the joint. Techniques that are helpful here are mainly special stretching exercises and muscle building.
The strength in the shoulder should thereby be restored and movement restrictions are ideally minimized. In addition, certain mobilizations of the joint can also have a direct anti-inflammatory effect, as they stimulate the blood circulation of the affected tissue and thus also regeneration processes. However, it should be noted that these exercises can only have a positive effect if they are performed consistently, correctly and above all regularly over a longer period of time.
If conservative therapy does not lead to pain relief, surgical treatment may be considered. Various options are available.
