ORTHOPEDICS

Subacromial impingement syndrome (impingement subacromialis)

Impingement syndrome is a fairly common disorder in the general population and is most often accompanied by typical symptoms and clinical picture.

WHAT IS COLLISION SYNDROME OR “IMPINGEMENT SYNDROME”?

Subacromial collision syndrome is a clinical condition that results from compression of the tendon apparatus of the rotator cuff and biceps due to a collision (or collision, hence the name of the disease) of a large tubercle of the humerus (bulge on the bone that catches most shoulder girdle muscles) and some coracochromic structures. port, most often due to deformation of some of these structures.

WHAT HAPPENS IN THE SHOULDER IN IMPINGEMENT SYNDROME?

Impingement syndrome is a fairly common disorder in the general population and is most often accompanied by typical symptoms and clinical picture. The essence of the development of this disorder lies in the deformation of the structure called “coracoacromial arch”. The coracoacromial arch is made up of four components:

  • Acromion
  • Acromioclavicular joint
  • Coracoacromial ligament
  • Coracoid extension


In impingement syndrome, due to the abnormal structure of some of the components of the coracoacromial arch, when the arm is raised above the head, the rotator cuff tendon and the biceps tendon become pinched between the large tubercle of the humerus and the coracoacromial arch. Because it is a repeated action that is repeated every time you raise your arm above your head, a number of microtraumas occur on the said tendons. Over time, this damage accumulates and causes typical symptoms, and the disease very often results in complete rupture of the rotator cuff tendon, which you can read more about HERE, and the long biceps tendon, which you can learn more about HERE.

PHASES OF IMPINGEMENT SYNDROME DEVELOPMENT

Given the degree of damage to the tendons of the rotator cuff and biceps and the amount of inflammatory tissue in the structures in the immediate vicinity, we distinguish three stages of the disease:

  • Stage I: typical of the younger population engaged in sports. As a result of excessive hand movements above the head, bleeding and swelling of the pinched tendons occur.
  • II. stage: typical inflammatory changes such as fibrosis and tendinitis occur. Due to repeated abnormal movement that is not treated, inflammatory changes also occur on nearby bursae (fatty tissue pads located between the tendon and its bone grip, serve to reduce friction between these structures), which further narrows the already narrowed subacromial space.
  • III. stage: there is a partial or complete rupture of the rotator cuff and biceps tendons and loss of shoulder girdle function


WHAT ARE THE SYMPTOMS OF IMPINGEMENT SYNDROME?

A typical symptom of impingement syndrome is severe shoulder pain when raising the arm above head level. Patients with impingement syndrome very often ignore the pain and attribute it to other causes, so they often contact a doctor when irreversible damage to the soft tissue structures in the shoulder occurs. A classic symptom is nocturnal pain with inability to sleep on the sick side. The range of motion is limited, primarily the internal rotation and elevation of the arms above the head (shown in the figure below).

HOW IS IMPINGEMENT SYNDROME DIAGNOSED?

Very similar to all other disorders that are included in the painful shoulder syndrome, impingement syndrome can be successfully diagnosed based on the anamnesis and clinical picture. In addition, an impingement test is often performed in which a local anesthetic is applied to the subacromial space, after which the patient is asked to raise his arms above his head. If the patient succeeds in this without pain, it is a reliable sign that the problem is in the subacromial space (which is anesthetized at that time) and a positive impingement test is established. An X-ray of the shoulder is often routinely done to rule out other conditions with similar symptoms. X-rays typically show changes in the large tubercle of the humerus that result from a chronic process.



TREATMENT OF IMPINGEMENT SYNDROME

The initial stage of the disease is successfully controlled by conservative methods that include the combined use of physical therapy and nonsteroidal antirheumatic drugs to reduce pain. Rest is recommended with avoidance of movements above head level.

In chronic patients with impingement syndrome (patients who are unsuccessfully treated with conservative methods for more than 6 months), surgery is necessary, which can be performed arthroscopically in our institution with only a few small incisions. It is a maximally sparing procedure where the trauma to the operated tissue as well as the consequences for the aesthetic appearance of the shoulder are minimal. The operation involves resection of the components of the coracoacromial arch, which successfully achieves decompression of the entire subacromial space.

Specialists employed in our institution meet with a large number of patients with this condition on a daily basis. The experience and education of our orthopedists enables them to successfully treat dozens of patients with this condition. Become one of our satisfied patients and contact us with confidence.

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