 Diagnosis (Shoulder) |
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Doctors |
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Rehabilitation |
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Service |
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 Impingement syndrome |
Remodelling and repairing
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Pain in the shoulder area is now a very common and ever increasing problem, largely due to the ambitions of activity that people nowadays have way into old age. The cause of the complaints is not usually to be found within the scope of a degenerative process of wear and tear in the head of the humerus and joint socket, i.e. in the actual shoulder joint itself. It is considerably more often the case that the surrounding soft tissue, in particular the subacromial space between the acromion and the rotator cuff, is the cause for the sometimes torturous, mobility related pain. There is a narrowing of the space below the acromion and an inflammatory swelling of the synovial bursa. We refer to this mechanical conflict problem as narrowing or mechanical impingement syndrome. The mechanical attribute implies that all functional aspects are significant and must be taken into account and addressed within the scope of the physiotherapeutic treatment. |
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| Localisation of narrowing under the acromion (side view) The tendons of the rotator cuff on the left |
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| The synovial bursa between tendons and the acromion on the right |
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Long-term and intensive stresses and strains such as working above head height or overhead sporting activity (e.g. tennis) can lead to irritation and inflammation of the synovial bursa below the acromion. If the space available below the acromion is reduced, the pain becomes chronic, which also means that the dynamic balancing of the humeral head is compromised. A viscous circle arises whereby the tendons of the rotator cuff situated beneath the synovial bursa first become inflamed and later may tear due to the constant, irritating mechanical changes.
The cause for this mechanical conflict situation may on the one hand be a genetically pre-determined reduction of space, which is further reduced by bony deposits as the individual gets older (usually from 40 years of age onwards). On the other hand, it is possible that the volume of soft tissue may increase (synovial bursa, tendons of the rotator cuff) underneath the bony acromion, which also leads to a mechanical conflict problem. The cause of the latter may be major deposits of calcium in the tendons of the rotator cuff, existing fractures in the head of the humerus or several other things. Bony spur formations on the front of the acromion, which form as a result of tractional strains on the adjoining ligament structure over time, are often not seen until special x-ray images are taken. These make it possible to evaluate the narrowing problem both qualitatively and quantitatively. A precise transformation of the bony narrowing into the ideal acromion shape is then possible using the arthroscopic treatment method. |
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Pain is felt principally when raising the arm to the side or in overhead positions. Pain at night – projected to the side of the upper arm – is a characteristic sign. The use of anti-inflammatory medication, injections in the synovial bursa and gentle physiotherapeutic treatment techniques can in some circumstances ease the pain in the early stages. However, in cases of severe mechanical narrowing, there is a very high chance that the complaints will worsen as a result of physiotherapeutic treatment techniques. The risk of enlarging a possibly existing tear in the rotator cuff increases, as does the potential risk of stiffness in the shoulder (frozen shoulder). Many patients report experiencing waves of pain and later a loss of strength. The latter may just be the result of pain reduction,
i.e. an inhibition of more or less intact tendons and muscle groups by the pain in the foreground. On the other hand, the noticeable loss of strength may well reflect an existing tear in one or more of the tendons. Patients often don’t visit us until a very late stage, when the problem has already endured for years and sometimes up to two or three tendons of a total of five in the rotator cuff are torn. Even at this stage, thanks to the most modern arthroscopic technology, we have a high chance of achieving a satisfactory result, i.e. a largely pain free and functionally clearly improved situation. |
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| Classification of the shapes of the acromion. Correlation to the incidence of the disorder. |
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| Arthroscopic decompression. Widening of the acromion forms an ideal space. |
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Arthroscopy doesn’t just make it possible for us to assess and correct degeneration, inflammation or accompanying traumatic injuries and damage all at the same time. It also makes it possible to correct classical mechanical problems of narrowing with the aid of motorised burrs and cutting / sucking instruments. The inflamed, altered and often adhered synovial bursa is removed or freed. Early functional physiotherapeutic treatment commences the first day after surgery, and a new and healthy synovial bursa regeneration is formed which, after only a few weeks, facilitates the normal lubricating function of the synovial bursa between two muscle or tendon groups. |
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