Impingement syndrome (bottleneck syndrome)

The Impingement syndrome or Bottleneck syndrome is a disorder of the mobility of joints. Since this mainly occurs in the shoulder joint, it is also referred to as the shoulder bottleneck syndrome, the raised humeral head or the rotator cuff syndrome. Degenerative changes or injuries lead to a narrowing of the joint body, which affects soft tissues such as tendons, muscles and bursa and can become inflamed. The earlier the dysfunction is recognized and treated, the better the chances of recovery from the impingement syndrome.

What is Impingement Syndrome?

The main symptom of the impingement syndrome on the shoulder joint is the painful arc, also known as the painful arc. This results in a painful restriction of movement when lifting the arm sideways.
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The Impingement syndrome (bottleneck syndrome) is a disease that develops over years or decades. The first symptoms appear quite early on, but they are often ignored or even misdiagnosed.

The shoulder joint is one of the most flexible joints in the human body, but it is also one of the most prone to injury. In contrast to other joints, whose stability is ensured by bones, tendons, ligaments and muscles are the fixators here. Together, these soft tissue parts form the so-called rotator cuff, which ensures that the head of the humerus is fixed in the joint socket.

This anatomical arrangement is very susceptible, so that narrowing between the joint head and socket can occur as well as so-called dislocations, the dislocation of the arm. Tendons, ligaments and nerves are affected. The constant friction when moving can lead to inflammation. Impingement syndrome is associated with very severe pain.

causes

Main cause of Impingement Syndrome are signs of wear, so-called degenerative changes in the bony musculoskeletal system. You can find this mainly in athletes such as Handball players, javelin throwers but also swimmers. Constant overhead movements favor the signs of wear.

Impingement syndrome has now also been recognized as an occupational disease, as it occurs much more frequently in people who work overhead in a job (painters, welders, etc.). But calcium deposits in the tendons or calcium deposits on the joint body can also promote the impingement syndrome. There is also an innate variant, if e.g. the shoulder roof, the joint socket or the joint head are deformed or have an unfavorable shape.

The bottleneck syndrome is also favored by a muscular imbalance, e.g. common in bodybuilders. Excessive and above all one-sided training unbalances the sensitive rotator cuff system, which accelerates the symptoms of the impingement syndrome.

Symptoms, ailments & signs

The main symptom of the impingement syndrome on the shoulder joint is the painful arc, also known as the painful arc. This results in a painful restriction of movement when lifting the arm sideways. The pain occurs mainly between a 60 ° and 120 ° elevation of the arm. With inflammation of the bursae of the shoulder roof (in technical language: bursitis), or recurring irritation of tendons due to entrapment, pain can occur even at rest, which can also occur at night.

At the beginning of the disease, the pain is mainly triggered by stress, such as overhead work. A subtle pain in the joint is perceived at rest. In the further course, lying on the affected side is no longer possible. The shoulder is increasingly held against the body in a gentle posture. The affected person can no longer lift his arm sideways.

If the hip joint is affected by a bottleneck syndrome, the change is only noticeable very slowly. Often the first sign is deep groin pain. The pain generally occurs when the hip is flexed and is aggravated by additional internal rotation of the leg. Physical work can also worsen the symptoms, so that the pain radiates from the groin to the thigh.

Diagnosis & course

The Impingement syndrome is diagnosed by an orthopedic surgeon. There is extremely limited mobility. Spreading the arm or lifting it triggers severe shoulder pain. Sometimes the patient is no longer able to lift his arm over his head. Ultrasound and MRT are used in further diagnostics.

Here, inflamed bursa (bursitis) can be detected, as well as bony changes. X-rays provide further information regarding the bottleneck or narrowing between the articular head and the shoulder roof. Particularly in recordings in which the affected arm is spread apart, one can clearly see the narrowed subacromial space or the collision of the joint head and the joint socket.

Since the impingement syndrome is a creeping disease, it can often happen that years pass before the first symptoms become noticeable. If the impingement syndrome is treated in good time and, above all, adequately, most patients will experience significant improvement within several months.

Even with advanced defects of the osseous musculoskeletal system and soft tissue, a good course can be predicted. The prerequisite for this is that the cause (sport, occupation, etc.) is eliminated and continuous therapy is guaranteed. If the symptoms appear again and again, one speaks of a chronic impingement syndrome.

Complications

The impingement syndrome causes various complaints in the joints and thus severe movement disorders. Restrictions in movement often lead to psychological complaints such as depression. As a rule, the impingement syndrome can be treated relatively well if it is recognized early on.

The affected person usually suffers from severe and often sharp pain in the shoulder. This pain can also take the form of pain at rest and lead to sleep problems, especially at night. The movement of these regions is also severely restricted, so that many everyday activities cannot be carried out easily or are always associated with severe pain. In most cases, there are no further complications when treating impingement syndrome.

However, this can occur if treatment is initiated late and irreversible consequential damage has already formed. The person concerned has to undergo different therapies so that the symptoms can be alleviated. Treatment often lasts for several months before the disease progresses positively. Full exposure of the respective regions may not be possible even after the treatment.

When should you go to the doctor?

If there are slight but persistent discomfort in the shoulder area, a doctor should be consulted within the next few weeks. If the pain suddenly increases in intensity and may be accompanied by restricted mobility, those affected should consult a doctor within the next few days. Acute complaints that are noticed for the first time while lifting loads or doing sports should be clarified immediately. If there is no treatment, the symptoms of the impingement syndrome can increase in intensity and cause emotional distress in those affected.

That is why you should see a doctor at the first signs of the syndrome. People who play sports frequently or lift heavy loads for work are particularly vulnerable. The risk groups mainly include bodybuilders, painters, welders and people with congenital deformations of the roof of the shoulder, the socket or the joint head - anyone belonging to one of these groups should have the symptoms clarified by a doctor immediately. In addition to the family doctor, a sports doctor or an internist can be called in.

Treatment & Therapy

The Impingement syndrome is usually Treated conservatively. The earlier you start with an adequate treatment, the better the chances of a cure. The respective treatment method depends on the stage of the impingement syndrome. Basically, the first thing to do is to protect the shoulder, whereby the focus here is on eliminating the cause, whether sporting or professional.

Other conservative treatment methods include Physiotherapy, cryotherapy, acupuncture, shock wave therapy and matrix therapy. These therapies are supported by medications that have both pain-relieving and anti-inflammatory effects. They are used e.g. ASS, diclofenac (as an ointment or tablet) and cortisone preparations.

If there is no improvement after several months of intensive therapy attempts, an operation cannot be avoided. Depending on the clinical picture, a so-called acromionplasty is carried out. However, surgery alone is not enough. Intensive conservative follow-up therapy and elimination of the cause are necessary measures to successfully treat the impingement syndrome.

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Outlook & forecast

If you have an impingement or bottleneck syndrome, shoulder pain is present. As these can have several causes, a careful diagnosis is essential.

An orthopedic surgeon should decide whether physiotherapy measures are sufficient or whether the impingement syndrome has to be operated on. The treatment can only be successful if the muscular imbalances caused by the bottleneck syndrome are also treated. If this is not the case, the chances of permanent pain relief are worsened. Further overloading can lead to permanent stiff shoulder or tendon ruptures.

An important measure in congestion syndrome is to loosen the adhesions that are present on the rotator cuff. In addition, the prognosis improves if the muscular mobility is restored at the same time. Self-treatment is ruled out because it could worsen the prognosis through incorrect stress. However, the movement sequences suggested by the physiotherapist are suitable for continuing to be practiced at home. But practicing too much can produce undesirable results.

Correctly executed exercises should be done with warmed muscles, slow movements and gentle stretching. If the shoulder continues to be overloaded despite the impingement syndrome, this can lead to micro-tears in the shoulder tendons. These hairline cracks can lead to tendons being torn or torn off with further stress. A tendon rupture takes a relatively long time to heal. It worsens the prognosis a lot. The healing process is favored by a gentle training program.

prevention

The Impingement syndrome can be prevented by avoiding one-sided stress. Furthermore, it is especially important for the risk groups (sport, job) that preventive physiotherapy and special training of the shoulder muscles are carried out. Because of the creeping process of the disease, impingement syndrome is often diagnosed too late. It is all the more important to pay attention to the warning signals from your own body and to attend the preventive medical check-ups regularly so that a possible impingement syndrome can be treated successfully.

Aftercare

With impingement syndrome, those affected usually have very few or even no special follow-up measures available. A very early diagnosis should be made in order to prevent further worsening of the symptoms or to prevent further complications. Self-healing cannot occur.

The further course of this disease depends very much on its severity, so that no general prediction can be made about it. With the impingement syndrome, those affected are dependent on the measures of physiotherapy or physiotherapy. Many of the exercises can also be done in your own home, which may speed up healing. It is also often necessary to take various medications to alleviate the symptoms.

The person concerned should always pay attention to the correct dosage and regular intake of the medication. In severe cases, surgery may also be necessary. After such an operation, the person concerned should definitely rest and take care of his body. Stressful or physical activities should be avoided. The help and support of your own family and friends can also accelerate the healing process.

You can do that yourself

Impingement syndrome (bottleneck syndrome) is a painful disease in the shoulder area, which, depending on the characteristics and wishes of the patient, is treated either with an operation or conservatively. In both cases it is important that the patient himself contributes to a quick and, above all, complete regeneration through active participation in everyday life.

In most cases, cooling is a valuable aid in relieving acute pain. The cold pack not only alleviates the pain caused by the irritation or the operation, but also works against classic signs of inflammation such as swelling or redness thanks to its anti-inflammatory properties.

Targeted physiotherapy is essential. However, it is not enough to do the exercises together with a therapist over a limited number of appointments. Only the consistent continued practice at home ensures the healing success. The exercises have several functions. On the one hand, they loosen adhesions in the tissue that have formed due to the inflammation or as a result of the operation. On the other hand, they mobilize the joint again. It is also important to compensate for existing muscular imbalances. This is the only way to sustainably prevent the tightness between the shoulder roof and the humerus head, which triggers the impingement syndron. Every now and then, a stretching exercise for the shoulder may be incorporated if the shoulder seems to be somewhat restricted in its mobility again after a strenuous job or sport.