Impingement syndrome of the shoulder: causes, symptoms and treatment
Impingement syndrome of the shoulder joint
The joint of the shoulder includes the shoulder blade, shoulder bone and collarbone, rotator cuff — supraclavicular, subclavian, small round and subscapularis muscles. When lifting the hand cuff presses the head bone to the shoulder blade cavity.
The scapula — acromion — forms the upper part of the joint. Joint capsule located between the scapula bone and tendons of the cuff.
It protects the bone and tendons from friction.
What is impingement syndrome
Usually there is a distance between the acromion and the cuff rotation to the tendon to pass freely under it. But every time when lifting the hands is observed compression of the tendons and bag replacement.
This phenomenon is called impingement syndrome of the shoulder joint.
It is observed to some extent while raising his hands … The manifestation of the expressed syndrome favourable permanent actions with your hands.
Often the syndrome occurs in lesions of the tendons of the cuff. The appearance of the violation trigger condition, causing a reduction in the distance between the acromion and the tendons. Often its cause is a bone spur clavicular articulation.
In some cases, the gap narrowed due to an enlarged scapular process, incorrect tilt it down.
Impediment the subacromial impingement syndrome of the shoulder joint — lesions of structures located near the subacromial bags, manifested by violation of motion of the joint of the shoulder.
This defeat – a common cause of shoulder pain in adults. The pain is the result of pressure of the blade on the joint capsule by a show of hands.
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The causes that trigger the syndrome
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The disease has specific causes:
- neurodystrophic changes in the tendons due to osteoarthritis of the cervical, spondylosis or displacement of vertebral joints;
- soft tissue damage due to cyclic or one-time large loads;
- injuries involving torn tendons, bleeding;
- disease (heart attack, angina, tuberculosis, diabetes, TBI, Parkinson’s disease);
- individual operation (mastectomy).
- long cooling;
- congenital arthropathy.
In tissues with insufficient blood supply to formed foci of necrosis, which subsequently scar and calciphilous and inflamed.
Impingement syndrome of the shoulder is observed among young athletes and middle-aged persons. Most susceptible to swimmers, volleyball players, tennis players.
Also high risk of the disease in people whose work involves constant show of hands. The pain may also occur due to minor trauma or for no particular reason.
Symptoms and signs
In the early stages of lesion complaint of patients is a dull ache in the shoulder, increasing when lifting hands, not giving to sleep.
At advanced stages the pain increases, reduces the mobility of the joint, there is a clicking when lowering the hands.
Weakness and difficulty lifting the limbs can talk about tendon rupture.
Diagnosis of impingement syndrome is based on the analysis of the manifestations of defeat, and the conduct of research.
The doctor will ask about the nature of your work, since the violation is very often connected with the professional activities. May be an x-ray of the joint to determine the affected acromion or bone spurs.
If, upon inspection of a suspected rupture of cuff rotation, you will require a magnetic imaging.
Arthrogram is assigned to the gap of the cuff. During the procedure a special composition is injected into the joint . Draining it from the glenoid cavity confirms the gap. In some cases, it is not clear what caused the pain.
Injection of local anesthetic in the bag of the joint helps to determine the source of pain. If the pain disappears after the injection, it caused due to bursitis or tendonitis. When the pain triggered by the irritation of the nerves, this is not observed.
The main goal of treatment is to neutralize the pain and restore the joint.
Begin treatment with conservative therapy.
It consists of nonsteroidal drugs (Voltaren), gentle treatment for the affected limb, physiotherapy, massage. When severe pain is used blockade with corticosteroids (Diprospan).
These tools are extremely effective in neutralizing the pain, removing the swelling and inflammation. The action of glucocorticoids takes several months. To restore mobility in the joint in the acute period of useful exercises.
With the subsiding of pain, they added strength training to develop the muscles of the shoulder. The course of conservative treatment — 6 weeks. During this period, many people go pain, normal operation of the joint.
If after this method of treatment of a person does not leave the pain, a specialist may advise to perform the operation. The aim of the intervention is to increase the distance between the blade bone and rotary cuff.
Specialist removes bone spikes that reduce the gap and acting on the tendon.
Impediment shoulder syndrome is often accompanied by osteoarthritis clavicular joint.
Therefore, the intervention of the syndrome, combined with the operation to neutralize osteoarthritis of the joint. This procedure is called a resection arthroplasty.
Its meaning is to relieve the pain, caused by friction of the articular ends of the acromion and clavicle. Subsequently, connective tissue fills in the distance between the process and the clavicle, forming a false joint.
In some cases, arthroscopic intervention is carried out. The arthroscope is inserted into the joint through an incision. The contents of the joint is seen on the monitor. In this way the doctor can detect the plot of the acromion reducing the gap.
Through another incision, introduced the special tools and carried out the removal of the blade bone.
Rehabilitation after surgery
Well-executed procedure makes it possible to quickly begin rehabilitation to prevent complications and reduce the recovery time.
After the procedure the arm is immobilized in a designated position for a few weeks via a bus. This reduces the risk of re-rupture, creates the conditions for healing of the tendon. Duration of immobilization is determined by the doctor who did the surgery.
Already from the first weeks after intervention, patients should do exercises to develop the shoulder joint. But their intensity and consistency should be determined by surgeon and competent physiotherapist.
Exercises aimed at the normalization of range of motion in the shoulder, to prevent the occurrence of contractures, increase endurance of muscles of humeral belt. Exercises are selected individually and are executed under the supervision of experienced instructors. Part of the exercises prescribed to the patient to perform at home.
Physical therapy includes:
- magnetotherapy treatment;
- ultrasonic effect with the introduction of medicines;
In General, timely treatment increases chances of recovery. Note that running violation is treated harder and often causes serious complications.
Paralysis, weakness of voluntary movements and the limitations worsen the prognosis and can cause disability.
The main steps in prevention:
- the elimination of permanent injury synovial Bursa;
- the use of protective masks during physical activity;
- small lesions — treatment of the wound with antiseptics, the use of antibacterial dressings;
- timely treatment of infectious diseases.
Most people can be cured without surgery, especially in the early stages. All patients should consult a specialist as early as possible. The success of treatment depends on the timing of its application.