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Impingement syndrome of the shoulder

x-ray, spur, acromion, subacromial  impingement shoulder

Here you can read:
What is an impingement of the shoulder ?
Who is affected by a shoulder impingement ?
Types of shoulder impingement:
How does a shoulder impingement develop ?
How to treat a shoulder impingement:


What is an impingement of the shoulder ?
Between the acromion and the "ball" of the humeral head lies the tendon of the rotator cuff, the muscles and a bursa. Lifting the arm those structures ( tendon, cuff, bursa ) get under pressure, because the space is to narrow. Pressure on these structures causes inflammation and pain. The most affected structure is the supraspinatus tendon. If the supraspinatus is impinged long enough, the situation can result into a tear of this tendon and / or a shoulder stiffness.
The shoulder roof consists of a bony shoulder hights, which is the acromion ( bony part of the shoulder blade ) and a ligamentous shoulder roof, which is the coracoacromial ligament. Nevertheless, the sliding mechanism of the tendon is disturbed - e.g. due to a hooked acromion, an acromial spur, a calcium deposit or an inflammed bursa. This is called the "classical or subacromial impingement".


Who is affected by a shoulder impingement ?
Impingement is mostly seen in people of the 5th decade, women and men are affected similar.
Types of shoulder impingement:
Within the last ten years several other impingement types were recognized at the shoulder. For example the posterosuperior or the anterosuperior impingement in overhead athletes. Shoulder instabilities can also cause impingement complaints.


Signs and symptoms of a shoulder impingement:
The most common problem is shoulder pain. Especially, while lifting the arm in and above shoulder level during daily activities, like throwing in sports, serving balls in sports, cleaning windows and so on. Sometimes its a sudden pain while lifting and reaching movements. It can radiate into the arm, typically until the ellbow ( not down to the hands ). A few people have a history of longlasting sporting activities like tennis, swimming, volleyball, baseball, and so on.
How does a shoulder impingement develop ?
A calcium deposit may cause the impingement. Other people are suffering from a hooked acromion. Borders of a cuff tear may cause the narrowing. Osteophytes at the acromion or acromioclavicular joint can irritate the subacromial space. These osteophytes may be responsible for a rotator cuff tear, if they persist long enough. Another cause may be a tight coracoacromial ligament, that is pressing on the biceps tendon and the pulley complex. To find out what´s wrong, is the job of your physician.


How to treat a shoulder impingement:
Treatment is depending on the cause of the problem. Most of the time e.g. physiotherapy, sports rest, injections, drugs will be successfull.
If there are still problems and pain persists - an operation has to be discussed. Most of the operations are performed to decompress the subacromial space: a hooked acromion will be bevelled arthroscopically. First, the subacromial bursa will be removed and than a precision burr is used to cut off the bony spurs and prominences.
If the coracoacromial ligament is to firm, it will be cut endoscopically. Also, calcium deposits can be removed with the scope very precisely.
If an instability is the cause of the problems, stabilizing operation techniques will be the method of choice. Rotator cuff tears will be sutures arthroscopically or in a mini open repair, depending on their size, age, position and tissue quality.
These are the most common operation techniques for the impingement syndrome of the shoulder. It is the aim to create enough space in the subacromial area.


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