What does "impingement syndrome" mean?
Shoulder impingement syndrome, also known as rotator cuff tendinitis, occurs when the tendons of the rotator cuff – especially the supraspinatus tendon – get pinched or constricted in the restricted space between the head of the humerus and the acromion bone. Here, there is a narrowing of the space under the acromion (called the subacromial space), which can irritate, inflame and damage the tendons – causing pain and impairing shoulder function.
How does impingement syndrome happen? Causes and risk factors
Various factors can influence the development of impingement syndrome: there is limited space beneath the acromion, meaning that if there is any joint dysfunction or degeneration happening, the tendons can get pinched, particularly during certain movements. Trauma or inflammation in the shoulder area can be accompanied by swelling and structural changes that further constrict the subacromial space, making the tendons likelier to get pinched.
Illustration of a healthy shoulder with subacromial space
Illustration of a shoulder with a narrowed subacromial space
If there is any shoulder muscle imbalance, in particular between the muscles that pull the upper arm upwards, centring it in the shoulder joint (supraspinatus muscle) and those that pull it downwards, it can put unhealthy strain on the shoulder. In addition, poor posture, such as a depressed shoulder girdle, can also contribute to impingement syndrome developing.
Certain sports or occupational activities with frequent overhead movements can trigger impingement syndrome -- especially throwing movements, such as when playing handball or volleyball, but also repetitious arm movements at work, can overstrain the shoulder and cause symptoms.
How do you prevent impingement syndrome?
To prevent impingement syndrome, we aim to strengthen the shoulder muscles to take the load off our tendons and joints. Exercises for the shoulder joint and the rotator cuff are helpful.
Before engaging in sports or occupational tasks that involve extensive arm movements, it is important to warm up thoroughly beforehand. This promotes blood circulation, increases joint mobility and reduces the risk of injury. Targeted exercises can help to optimise movement sequences, and avoid putting inappropriate strain on the muscles.
Other preventative measures:
- Avoid overstraining the joint: Constant excessive strain on one side should be avoided. Taking regular breaks and varying the movements you do can help to minimise excessive strain.
- Good posture: An ergonomic workplace set-up, and having a good upright posture in everyday life, help prevent impingement.
- Regular exercise and stretching: Regular physical activity and stretching exercises support and maintain joint mobility. Good joint flexibility can reduce the risk of pinching and inflammation.
If your symptoms persist, please seek medical advice in order to take further measures if necessary.
Symptoms and signs of impingement syndrome
Symptoms of impingement syndrome are pain on certain movements, with impaired shoulder mobility. Symptoms may vary from patient to patient.
Typical signs include:
- Pain in the shoulder: The most prominent symptom is pain in the shoulder area, especially when moving the arm in certain directions, and in certain arm positions. Typically, the pain increases with overhead movements or when lifting heavy objects.
- Pain when lying down: Patients with impingement syndrome often experience pain when lying on the affected shoulder. This can cause difficulty sleeping.
- Restricted shoulder mobility: Impaired shoulder mobility due to impingement syndrome is especially evident when moving the arm overhead and/or to the side, when rotating the arm, or when moving the arm in a combination of directions.
- Crunching sound: An audible crunching sound during shoulder movements may indicate friction between tendons and bones.
- Loss of strength in the affected arm: A loss of strength in the affected arm is a result of either taking a protective posture or of an injured tendon, leading to the muscles weakening.
- Signs of inflammation: Redness, swelling and localised feeling of heat in the shoulder area may be signs of an inflammatory reaction.
If symptoms persist or increase, a medical examination needs to be done – to give a more exact diagnosis and initiate appropriate treatment.
Diagnosing impingement syndrome: How is it diagnosed?
Impingement syndrome is usually diagnosed by a combination of clinical examinations and diagnostic scans. This includes taking the patient's medical history, a medical examination, and testing of pain responses. This allows an accurate diagnosis to be made and the severity of impingement syndrome to be assessed.
Imaging methods for diagnosing impingement syndrome
X-rays can show structural abnormalities, bone spurs, or osteoarthritis that can trigger impingement syndrome. Tendons and other soft-tissue structures can be assessed using ultrasound examinations. Magnetic resonance imaging (MRI) provides detailed images of the shoulder structures, including the tendons, ligaments and muscles. These scans allow an accurate assessment of inflammation, tears or impingement.
Therapy and treatment of impingement syndrome
Treatment for impingement syndrome can vary depending on the severity of the symptoms, and the causes. It includes conservative measures as well as surgical interventions. Common treatment options include:
Conservative measures
- Physiotherapy: Targeted exercises can strengthen the shoulder muscles and improve mobility.
- Medication: Anti-inflammatories (NSAIDs) can relieve pain and inflammation.
- Cold and hot presses: To relieve pain and treat muscle tension.
- Ergonomic adjustments: Optimising the workplace.
Minimally invasive procedures
- Hyaluronic acid injections: These can help the tendons glide more smoothly and reduce inflammation.
- Needling: Needle treatments can dissolve limescale deposits in the shoulder.
Arthroscopy
In advanced cases, an arthroscopy may be necessary. This removes lime deposits, or clears the area around tendons, to reduce the pressure.
- Subacromial decompression: This arthroscopic surgery removes excess tissue to increase the space under the acromion.
- Repair of tendon tears: If any of tendons have ruptured, surgical repair may be necessary.
Post-operative care and rehabilitation
- Physiotherapy after the intervention, to restore full shoulder function.
- Continuing exercises and prevention: Long-term measures and ergonomic adaptations.
The choice of treatment depends on the severity of the symptoms, the cause of the person's impingement syndrome, and individual factors. Early diagnosis and appropriate treatment help relieve pain and maintain shoulder functioning. The consultation in the individual case is done by the doctor who is treating the person.
Rehabilitation exercises for impingement syndrome
Learn why physiotherapy and targeted exercises are essential for recovering from impingement syndrome. Expert tips and practical advice help support the healing process and prevent relapses.
What kind of doctors treat impingement syndrome?
Orthopaedists and specialised sports doctors are often the first point of contact. Early diagnosis and targeted treatment are crucial to recover successfully.
medi products for impingement syndrome
What aids or devices can help me during treatment? From special supports to ergonomic aids – find out what products can help you cope with everyday life better despite having impingement syndrome.
