Treatment of Impingement Syndrome

Impingement syndrome describes a painful pinched tendon or muscle in a joint. This sometimes leads to painful restrictions in movement. Impingement syndrome most commonly affects the shoulder joint, followed by the hip joint. It is treated with pain medications, physical therapy and surgery.

Impingement syndrome describes a painful pinching of the tendons or parts of the joint capsule (soft tissues) in the joint space. As a result, the tendons no longer slide freely in the joint space. In most cases, this leads to degenerative changes associated with limited joint mobility.

Impingement syndrome manifests itself mostly in the shoulder joint. It affects about ten percent of the German population (men and women around the age of 50 about equally often). Impingement syndrome frequently occurs in the hip joint. Less frequently, patients suffer from ankle impingement syndrome.

Different forms of the syndrome

Shoulder impingement syndrome can be divided into two forms, depending on which structures are compressed:

Primary impingement syndrome is due to changes in bony structures such as a bone spur or an excessively sloping bone roof.

Secondary impingement syndrome without outlet occurs as a result of another disease or injury that narrows the joint space. These include, for example, bursitis and damage to tendons or muscles.

Impingement patients usually suffer from severe pain with many movements for a long time. Once the cause is found, help can be provided quickly. It is the most common cause of shoulder pain in 45-61% of cases. People with jobs that require a lot of shoulder or overhead work have a higher risk of developing impingement. Overhead athletes, such as volleyball players, are also more likely to be affected. Women and men are affected at about the same rate.

Pain usually occurs in the shoulder area and may radiate to the hand. The pain is aggravated by exertion and overhead work. Symptoms vary depending on the region of the body where the syndrome occurs. Shoulder impingement syndrome is characterized by acute pain that is not felt initially but worsens over time, especially when weight is placed on the joint. Pain is particularly severe when the arm is raised above the head. At night, the pain is also so severe in many patients that they are unable to sleep on the affected shoulder, which significantly affects sleep quality.

Characteristic of impingement syndrome is that the range of motion is painful in a specific area, this is also known as the “pain arc”. The affected person raises the arms sideways upwards and feels the main pain in the arc of motion between 60° and 120°. After that, the pain subsides or disappears completely.

Possibilities of physiotherapeutic treatment

Basically, there is a possibility of both conservative and surgical therapy. Painkillers, anti-inflammatory drugs or injections are used to relieve the symptoms. The cause of impingement syndrome is more effectively treated with physiotherapeutic methods. In addition, anti-inflammatory and analgesic measures are used.

Physical therapy for impingement syndrome targets and relieves the problems caused by this syndrome, especially pain and constriction of the tendons and tissues. Specific exercises ensure that the head of the humerus no longer pinches tendons, tissues and ligaments below the acromion, creating more free space. Building up certain muscle groups in the shoulder joint provides better control and more stability. Shock wave therapy or cryotherapy may also be possible treatment approaches as part of physical therapy for shoulder impingement syndrome. Which form of treatment the affected person chooses is individual and is usually decided by the physical therapist and physician in consultation with the patient.

As already mentioned, the physiotherapeutic goal of treatment is primarily the control of pain and restricted movement as well as muscle building (especially of the rotator cuff). The main problem with impingement syndrome of the shoulder is that the distance between the acromion and the humeral head is too small, which leads to bruising and damage to the structures in between. The so-called rotator cuff of the shoulder joint includes 4 main muscles that fix the shoulder in the shoulder joint. Therefore, for successful treatment, it is important to exercise the muscle groups that pull the head of the humerus down to increase the space under the acromion. For this purpose, the physiotherapist provides the affected person with appropriate exercises that, when performed regularly, lead to an improvement in the symptoms.

It is also important to train shoulder tracking, as this is often impaired in impingement syndrome. The humerus and clavicle are primarily responsible for this. When a shoulder injury occurs, the clavicle is displaced more than is normally necessary.