Impingment syndrome of the shoulder joint: treatment, causes, diagnostics
Impingment-syndrome of the shoulder joint is an unpleasant and rather complicated disease that brings a lot of pain and discomfort. In addition, the patient becomes significantly limited in his movements. Consider what is a disease.
Features of the disease
So, this syndrome is characterized by infringement of tendons of the cuff, which is responsible for the rotation of the shoulder. It occurs in professional athletes who are engaged in swimming or throwing, the elderly. This pinching occurs in the subacromial space.
If this situation repeats repeatedly, over time there is inflammation of the tendons. This contributes to some thickening of the ligaments, which, in turn, are jammed even more, causing new bouts of severe pain and other symptoms. If the pathology is left without attention, then its development will lead to prompt intervention or other serious consequences.
It is very important in time to eliminate the consequences of any injuries of the shoulder girdle. Untreated fracture or ligament rupture may contribute to the development of the presented disease.
Signs of the pathology of
Impingment syndrome of the shoulder joint is characterized by certain symptoms. You can call such signs of pathology:
1. Pain sensations, which become more pronounced over time. And if at first discomfort is felt only during movement, then afterwards and constantly.
2. In case of illness the patient can not raise his hand up and to the side.
Impingment-hip joint syndrome is characterized by the same symptoms. It should be noted that the signs allow you to contact the doctor at an early stage of the disease. It is impossible to delay the visit to a specialist.
Causes of the appearance of the
pathology Impingment syndrome of the shoulder joint arises under the influence of several factors. It should be noted:
- Excessive load( especially in athletes).
- Inflammatory pathologies of bone tissue or muscles.
- Pathological structure of the joint.
- Injuries( sprain and ligament rupture, shoulder fracture).
Naturally, the concomitant diseases can also contribute to the development of pathology: diabetes mellitus, bone problems. In this case, the patient should be constantly under the supervision of a doctor.
Diagnostic features of
In order to correctly identify the impingement syndrome of the shoulder joint, you should always contact the doctor. He should not only take into account your complaints, but also conduct palpation of the affected area, collect anamnesis of the patient. In addition, other methods of investigation can be applied.
Basically, laboratory tests here can give very little information. Although they help to establish the cause of the development of pathology. The specialist should prescribe radiography, MRI and computed tomography. Such a survey will help not only to establish a correct diagnosis, but also to determine the degree of development of the disease. Thanks to this diagnosis, the doctor can prescribe an effective treatment.
Naturally, in the case of pathology, treatment of the shoulder joint should begin. All about joints is very useful to know. Thus, you can protect yourself from the appearance of any serious problems with the locomotor apparatus.
If you have an impingement syndrome of the shoulder joint, treatment should be started only after consultation with the doctor. First of all, therapy should be conservative. However, it only helps in cases that have not been cleared up. For example, a specialist will prescribe you anti-inflammatory oral medications and ointments for external use( Voltaren).Naturally, there must be a treatment that helps to eliminate pain. For this, analgesics are used. If the pain is repeated periodically and is very strong, then the patient is put a blockade in the joint bag. At the same time, such drugs as "Diprospan", "Depo-Medrol" are used.
Please note that the blockade can not be used too often. The injection is done once a week. In total it is allowed to put no more than three blockades a year. Naturally, the load on the shoulder should be significantly reduced. Sometimes the joint has to be immobilized. The agent "Ibuprofen" will help to remove the inflammatory process.
In general, treatment of impingement syndrome of the shoulder joint with medications is quite effective and allows you to get rid of the pathology within 2 months. However, there are cases when the pills do not help. Then the patient is assigned an operation.
Surgical operation: is it necessary?
If you have impingement syndrome of the shoulder joint, treatment should be comprehensive. In complicated cases, surgery can be applied. The procedure is called arthroscopy. During the operation, the restoration of the integrity of muscles and tendons, elimination of osteophytes is performed.
The space under the acromion increases. Sometimes a patient removes part of the joint bag or clavicle. Surgical treatment of impingement syndrome of the shoulder joint is done with a rather complicated technique, so you should carefully choose a clinic before you intervene.
The operation is done through small incisions, which after wound healing are almost invisible. Naturally, such an intervention in a good clinic is not cheap. However, you should not joke with your condition and conduct experiments on the body.
Application of physiotherapy
Treatment of impingement syndrome of the shoulder joint can be performed by electrophoresis, ultrasound, and magnetic therapy. These methods can have a positive effect: to remove the inflammatory process, block the pain. However, the patient will also have to attend sessions of physiotherapy and massage. This will help to develop the joint, to maintain its optimal mobility.
Physical exercises should be simple enough and have a minimum load on the joint. Otherwise, the joint condition may worsen. Massage should be done by a specialist. Moreover, it is unlikely that you will be able to do all the procedures yourself. Receptions of massage will help restore the functionality of muscles and ligaments.
If such methods do not yield results for several months, an operation can be applied.
Rehabilitation Features of
Subacromial impingment syndrome is an unpleasant and complex disease that requires a certain period of patient recovery. Especially if he had an operation. After surgical intervention, if it was carried out correctly and successfully, after a few weeks you can start the rehabilitation process. Before this, the joint will be immobilized by means of a special tire.
The first time after surgery, the ligaments and tendons should be minimally stressed. This will help protect tissue from re-injury and even rupture. How much the hand will be without movement, the doctor who conducted the intervention should determine. This will require radiography.
Next, the patient will need to engage in light physical exercises aimed at developing the joint. The intensity of such charging should be determined by a rehabilitator. Perform the exercises should also be supervised by a specialist. In a few weeks, gymnastics can be done at home.
Physiotherapy will also be useful if you have an impingement syndrome. The shoulder joint( treatment lasts long enough) can be further processed by ultrasound, which removes postoperative edema and inflammation. In addition, the patient will undergo additional myostimulation.
During recovery, the patient should eat well, so that the body receives all the necessary minerals and elements. This will help to recover faster.
How to prevent pathology?
Very often people who have problems with articulations of the bones of the upper body are diagnosed with "impingment syndrome".Shoulder joint, the treatment of which must necessarily be complex, is quite complex in its structure. Naturally, it is best not to fight the disease, but to warn it.
For this, try to exercise regularly. Normal charging will be enough. If you have a sedentary lifestyle, then do the gymnastics several times a day. Preventing the disease will also help proper nutrition and the absence of bad habits. Try to avoid falling and getting any injuries of the shoulder girdle. If they have occurred, they should be treated quickly until they are fully recovered.
It is necessary in time to identify and eliminate any inflammatory processes that occur in the body. If you suffer from some incurable disease that can contribute to the development of the pathology presented, then try to closely monitor your own health.
That's all the features of the emergence, development and treatment of the presented disease. Be attentive to your health.
Impingment-syndrome of the shoulder joint is pain. Sometimes - tolerable, less often - strong and exhausting, but almost always - sudden and inexorable. This pathology is rather difficult to call rare, but, nevertheless, it is practically unknown to the majority of domestic doctors. And the point here is not so much the unwillingness of many doctors to waste time learning something new, but rather in a certain stiffness of thinking common to many Aesculapius.
Formally impinged syndrome is known in medicine for more than 100 years( the first reports about it refer to 1872), but in those days it was called "shoulder-scapular periarthritis."However, because of the imperfection and inaccuracy of instrumental diagnostic methods of the XIX century, a clear explanation of the mechanisms of the occurrence of pain was not found then. A century later( in 1972), pathology received its modern name( in the Russian-language literature one can find variants of the form "impidgement syndrome" or even "impeachment syndrome"), but the majority of practicing doctors still use the old name.
The essence of the problem
The shoulder joint is one of the most complex mechanical devices created by nature. It consists of a multitude of elements, exactly fitted one under the other. Unfortunately, over time, the perfect interaction between them is disrupted, and the system begins to malfunction, which we perceive through painful attacks. One of the most probable "problem" places is the subacromial space.
This is a narrow( no more than 7 mm) crevice, formed from above by the acromial process, and from below - the head of the humerus. With age, due to the accumulation of salts, a reduction in the amount of lubrication and a general decrease in joint mobility, the subacromial space decreases, severe friction occurs, and a distinct painful pain occurs, which is called impingment syndrome.
The only point that needs additional clarification concerns the age structure of the pathology. Logic suggests that such changes are more common among the elderly, but in practice, impingement syndrome occurs even in 30-40 year old patients. Therefore, a common misconception, according to which the problems with joints - the destiny of the elderly, - must be recognized as false. Therefore, when the first symptoms appear( when the problem can be effectively controlled by conservative methods), one should consult a doctor, and not postpone treatment until better times. Which, as practice shows, can come much faster than you think.
Impingment syndrome( IP) can be triggered by a variety of diseases. Some of them are widespread( especially in developed countries), others with some reservations can be called rare:
- adhesive capsule( "frozen shoulder");
- arthrosis of the shoulder and acromioclavicular joints;
- calcification of the tendon of the supraspinatus;
- osteochondrosis of the spine, localized in the cervical region.
But if you drop the theory and focus on the practical side of the issue, it turns out that the incidence of IP is more dependent on the characteristics of professional activity( painters, carpenters, plasterers, athletes) than from the age of patients. In other words, impinged-ment syndrome is, rather, a professional, rather than a senile disease.
syndrome There is no generally accepted classification of IP, especially if the bracketed professional is a highly specialized language. Most practitioners share an "impediment syndrome"( after all, such writing also has a right to life) into two conditional groups:
1. Primary IP.Occurs because of mechanical irritation of the supraclavicular muscle due to:
- post-traumatic deformity( acromial or key-shaped processes, large tubercle of humerus);
- trauma of tendon rotational cuff;
- osteophyte of the lower part of the acromioclavicular joint;
- is a congenital change in the shape of the acromial process.
2. Secondary integrated circuit. Due to the narrowing of the podkromialnogo space caused by:
- rupture of the rotator cuff or the biceps tendon of the shoulder;
- violation of the integrity of the ligaments of the acromioclavicular joint;
- congenital weakness of ligaments;
- by thickening of the rotator cuff or bursa( consequence of ossification or chronic bursitis);
- paralysis or muscle weakness;
- by displacement of the large bump of humerus( usually as a result of trauma).
1. First( hemorrhage and edema)
- age: less than 25 years;
- prediction: good( with adequate therapy - complete healing);
- treatment: conservative.
2. The second( tendonitis and fibrosis)
- age: 25 to 40 years;Forecast: conditionally favorable;
- treatment: complex( acromioplasty with simultaneous drug therapy).
3. Third( rupture of cuffs and bone spurs)
- age: over 40 years;
- prediction: adverse( persistent disability);
- treatment: only surgical.
- acute pain that occurs with certain types of movement of the hand( an attempt to get something out of the back pocket of the trousers, in women - unfastening the bra);
- snapping in the problem joint, appearing when the hand is lowered;
- painful sensitivity on palpation;
- raising hands in a vertical position provokes an increase in unpleasant sensations;
- increasing joint stiffness;
- atrophy of the supraspinatus, subacute and deltoid muscles.
1. A group of specific tests( several exercises to identify joint stiffness).
2. Injection of lidocaine directly into the subacromial bag( Nir diagnostic test).If the patient notes a temporary decrease in the strength of the pain, the impingement syndrome is confirmed.
Differential diagnosis of
- calcification of the tendon( usually the supraspinatus);
- neuropathic abnormalities of the suprathmal nerve;
- arthrosis of the shoulder and acromioclavicular joints;
- adhesive capsulitis;
Diagnosis of femoroacetabular conflict( hip joint impingement)
Clinical examination and special diagnostic tests by a physician. Diagnostic tests should be performed by a doctor who has certain skills, a good knowledge of anatomy and experience in carrying out on a large number of patients. Diagnostic informativeness of some tests is very high and allows with 80-90% confidence to suspect femoroacetabular impingment before applying X-rays or MRI diagnostics.
The most sensitive is the impegment test - the emergence of flexion pain and internal rotation of the thigh.
Additional tests can serve as:
Apprehension test ( test for anticipation of danger) - pain during extension and external rotation.
FABER test - the patient lies on his back, his legs are bent at the knees, the soles of the soles touch each other. The doctor slightly presses on his knees, trying to bring them closer to the bed. Then the vertical distance from the knees to the bed is measured. The test is considered positive if the vertical distance from the knee to the bed on the affected side is greater.
Asymmetry of external rotation - on the damaged side the outer rotation will be smaller.
MRI study of in addition to the signs that we see on radiographs helps us evaluate the presence of free fluid in the joint cavity, as well as damage to the soft-tissue components of the joint.
What is the treatment of femoroacetabular conflict( hip joint impingement)?
Treatment of hemorrheic acetabular conflict can be both conservative and operative. Conservative treatment is the patient's compliance with the regime of painless loads, anti-inflammatory treatment in case of exacerbation, taking chondroprotectors and undergoing a course of physiotherapy. A very good clinical effect is produced by intraarticular injections of platelet-enriched plasma into the hip joint( "growth factors", PRP).
However, the main method of treatment of femoroacetabular impingment is surgical intervention, since only in this case, it is possible to get rid of the causes of the conflict and their consequences forever. To date, the most modern method of surgical treatment of femoroacetabular conflict is arthroscopy of the hip joint. With the help of arthroscopy, we can perform the following manipulations: remove the build-up on the neck of the femur by performing the plastic surgery of the femoral neck, resection of the overhanging edge of the joint cavity, sew or remove damaged parts of the joint lip, treat articular cartilage, remove the exostoses and cysts formed and t.
In case of untimely or inadequate treatment, femoroacetabular conflict leads to early development of arthrosis of the hip joints, and this is a more serious disease, the result of which can be the replacement of the affected joint by an artificial one.
What affects the results of arthroscopy and hip joint?
For qualitative performance of arthroscopy of the hip joint and obtaining the most successful results, 3 conditions are necessary:
Sufficient level of equipment for arthroscopy.
It is necessary to have a full set of expensive high-tech equipment: a camera with 30 and 70 degree optics, a light source, a pump, a shaver with different attachments, an ablator, a monitor, an image intensifier, a traction table. The absence of at least one of the above makes it impossible to perform arthroscopy of the hip joint qualitatively.
An experienced orthopedic surgeon.
Hip arthroscopy is a technologically more complex operation than, for example, arthroscopy of the knee and even the shoulder joint. We can say that this is aerobatics, even for an experienced orthopedic surgeon who deals with joint arthroscopy.
Arthroscopy of the hip joints in our clinic:
In our clinic arthroscopy of the hip joints is conducted by Sergienko Ruslan Alekseevich - the leading specialist of Ukraine in the field of arthroscopic surgery of the hip and shoulder joints: over 18 years of work, thousands of performed arthroscopes and cured patients.
He studied arthroscopy and endoprosthetics in the best orthopedic clinics in Europe: Hungary( 1999), Spain( 2002, 2009, 20013), Holland( 2003), Austria( 2007, 2011), Great Britain( 2009), France( 2008, 2009, 2010,2011, 2012), Germany( 2010, 2011).
We use the most modern arthroscopic equipment of the world's leading manufacturers: Stryker, De puy. Some, has no analogues in Ukraine and is used only in our clinic, for example, the Vapr Vue vaporizer. This allows our specialists to conduct operations at the highest level and ensure the most successful results of treatment.
The capabilities of our equipment allow you to record all the actions of the surgeon and record the progress of the operation on video. This serves as an additional guarantee of high quality of treatment and allows you to be sure of successful operation. At the end of the treatment, the patient, if desired, can receive a disc with a videotape of his operation as a gift.
Complete set of equipment for arthroscopic hip joints in our clinic:
Diagnosis and treatment of bursitis or tendonitis
The shoulder joint is a fairly complex motor part of the human musculoskeletal system. If all parts forming the joint function normally, then the movements in the joint are free and completely painless. Many people cause bursitis in the shoulder. Bursitis is the inflammation of the joint bag of the shoulder joint. Another source of pain can be inflammation of the tendons of the muscles. This disease is called tendonitis. Many reasons can lead to the development of inflammation in the joint bag or tendons. One of these causes is impinged - syndrome. This syndrome arises from the friction of the tendons of the muscles of the rotator cuff about the scapula, the acromion that forms the upper part of the shoulder joint.
Usually, there is a sufficient gap between the acromion and the rotator cuff, so that the tendons move freely under the acromion when moving in the shoulder joint. However, whenever you raise your hand, there is a slight compression of the tendons and joint bag between the head of the humerus and the acromion. This phenomenon is called impingment. The phenomenon of impingement occurs to a greater or lesser extent when raising a hand from any healthy person.
The development of clinically pronounced impingement is facilitated by daily work with raised hands, with constant execution of throwing movements. Often the impingement syndrome manifests clinically when irritation or damage to the rotator cuff tendons occurs. Impingement syndrome is promoted by any conditions leading to a narrowing of the gap between the acromion and the tendons of the rotator cuff. A common cause of this narrowing is bone spurs - outgrowths in the form of thorns, coming from the acromial-clavicular junction.
The acromioclavicular junction is the joint between the scapula and the clavicle, located directly above the joint bag and the rotator cuff. In some cases, this gap is narrowed due to hypertrophied acromion. Another reason for the narrowing of this space is the abnormal slope of the acromion down.
In the early stages of development of impingement syndrome, the main complaint of patients is diffuse dull pain in the shoulder. The pain is worse when you raise your arm. Many patients note that pain prevents them from falling asleep, especially if they lie on the side of the affected shoulder joint. The pathognomonic symptom of impingement syndrome is the onset of acute pain in the patient when trying to reach the back pocket of the trousers. In later stages, the pain is aggravated, the joint stiffness may appear. Sometimes in the joint there is a clicking at the time of lowering of the hand. Weakness and difficulty in raising hands up can indicate a rupture of the tendons of the rotator cuff.
Diagnosis of the disease in our center
Diagnosis of bursitis or tendonitis caused by impingement syndrome in our clinic is based on an analysis of the symptoms of the disease and physical examination. Radiography of the shoulder joint is performed to detect abnormal or hypertrophic acromion or bone spurs near the acromioclavicular joint. If a rupture of the rotator cuff is suspected during examination, then magnetic resonance imaging is performed.
Carrying out the diagnosis and treatment of this disease, we use only professional equipment and are based only on our own many years of experience. A registration for a consultation with one of our specialists is carried out by phone( 495) 741-15-10.In addition, for greater comfort of patients, we organized the possibility of correspondence on-line consultation, through feedback forms.
At the first stage of treatment in our clinic, as a rule, conservative therapy is prescribed. The duration of conservative therapy is on average 4-6 weeks. During this time, most patients have pain in the shoulder, and its function is restored.
If after a course of conservative therapy the patient is worried about shoulder pain, an arthroscopic operation is performed. Through a mini-incision into the cavity of the shoulder joint, an arthroscope is inserted, through which the contents of the shoulder joint are visualized from the inside.
In this way, bone spines are found that can narrow the gap between the acromion and the rotational cuff and damage the cuff tendon, the acromion region that also narrows this gap. Through mini-incisions, special instruments are introduced into the cavity of the shoulder joint, which remove part of the acromion, bone spines, which leads to an expansion of the gap between the acromion and the rotational cuff.
arthroscopy of the shoulder joint, in the image on the left is visible part of the acromion, in the image to the right - the end of the operation, the acromion is resected
. Registration for the consultation by phone:( 495) 741-15-10
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