Shoulder impingement syndrome (subacromial syndrome) is a pathological condition in which the tendons of the rotator cuff of the shoulder and biceps muscle during movements are pinched between the acromion and the head of the humerus. The disease is manifested by increasing pain, increasing restriction of movements, and a decrease in the strength of the shoulder muscles. Due to the traumatization of tendons, their degeneration occurs over time, which causes a rupture. Pathology is diagnosed on the basis of a survey, examination, X-ray results, MRI and CT. At the first manifestations, the restriction of loads, blockades, physiotherapy is shown. In the following, operations are required – subacromial decompression and acromioplasty.
M75.1 Shoulder rotator compression syndrome
Shoulder impingement syndrome, or subacromial syndrome, is one of the most common causes of pain in the shoulder joint in adults. Clinically significant forms are more often diagnosed in men over 40 years of age engaged in heavy physical labor. At a young age, pathology sometimes occurs in athletes. Due to the gradual onset and insignificant severity of the pain syndrome in the initial stages, patients often seek help only after the development of gross complex joint changes, which negatively affects the results of treatment.
Shoulder impingement syndrome is a polyethological disease. The main reasons for the development of pathology are:
- congenital features of the location and shape of the acromion;
- the presence of osteophytes in the acromioclavicular joint;
- thickening of the muscle located along the anterior edge of the acromion;
- post-traumatic deformation of the bones of the upper arm;
- arthrosis affecting the acromioclavicular joint;
- chronic bursitis;
- inflammatory process in the area of the rotator cuff;
- ossification of the tendons of the muscles that make up the rotator cuff;
- instability of the shoulder joint.
Due to congenital or acquired anatomical features, the subacromial space decreases or the exit opening through which the supraspinatus muscle passes narrows. As a result, during the movements, the shoulder head collides with the acromion, which leads to the infringement of the tendons. Constant traumatization causes inflammation and the development of degenerative changes. The surrounding structures are involved in the process, the pathology becomes complex.
Taking into account the changes in the rotator cuff of the shoulder, there are 3 stages of shoulder impingement syndrome:
- Stage 1. Hemorrhages form in the tissues, local tissue edema occurs while maintaining the integrity of the tendons.
- Stage 2. Morphological examination of tendons reveals signs of chronic inflammation, fibrous changes. Tears are possible.
- Stage 3. Osteophytes are formed in the area of the surrounding bone structures. Soft tissues are degeneratively altered. A slight or moderate load can cause a tendon rupture.
Initially, patients note discomfort in the shoulder joint against the background of intense physical exertion. After a rest, unpleasant sensations disappear. Subsequently, discomfort is replaced by pain, which appears mainly during rotation and withdrawal of the shoulder. In athletes, shoulder soreness is observed when throwing a ball, pressing a barbell in a prone position.
The pain syndrome first develops after a moderate load, then it is noted when trying to raise the arm above the head, then it begins to bother with any movements, significantly limits the ability to work. At the final stage, night pains are possible. The movements are accompanied by crunches and clicks. The front part of the joint swells. Muscle strength decreases. Stiffness is formed.
Constant pain and a decrease in the volume of movements lead to a deterioration in the quality of life and a decrease in working capacity. In the final stages of the disease, patients experience difficulties with self-care. Due to the constant traumatization and chronic inflammatory process, the surrounding anatomical structures suffer. Bursitis and tendovaginitis develop, possible ruptures of degeneratively altered tendons, the development of arthrosis.
The diagnosis of shoulder impingement syndrome is carried out by an orthopedic traumatologist. The specialist interviews the patient to study the anamnesis of the disease, finds out when and under what circumstances the pain first appeared, how often they bother, how long they last. Clarifies whether the patient has had injuries to the shoulder joint, whether he suffers from diseases of this anatomical zone. Then the doctor conducts an external examination, assesses the mobility of the shoulder, identifies pain points, performs stress tests. The following techniques are used to confirm the diagnosis:
- Shoulder x-ray. A basic study with a rather low informative value. It allows to exclude some pathologies, to determine the size of the subacromial space, to detect osteophytes and calcification sites in soft tissues.
- Shoulder CT. It makes it possible to detail the information obtained during radiography. The specialist simulates a three-dimensional image of the affected area and studies it from all sides. In the course of the study, the deformation of the acromion is revealed, the volume of the subacromial space is estimated.
- Shoulder MRI. It is prescribed for a detailed study of soft tissue structures: rotator cuff, biceps tendon, articular lip. Detects even minor defects (tears) signs of degeneration and inflammation.
At the initial stage of subacromial syndrome, conservative treatment is indicated, including the following measures:
- Protective mode. In case of pain, rest is recommended. It is necessary to limit the load on the limb, avoid movements during which compression of the rotator cuff occurs.
- NSAIDs. The patient is prescribed anti-inflammatory medication. With pain syndrome, drugs are taken orally by the course. In the future, it is advised to use local remedies.
- Blockades. With persistent pain syndrome resistant to conservative therapy, blockades of the subacromial space with glucocorticosteroids are performed. Sometimes platelet-rich plasma is injected to stimulate regeneration.
- Physical therapy. Physical therapy is indicated during the rehabilitation period after the disappearance of pain. Provides improvement of muscle function, preservation of joint mobility. It is carried out with a gradual increase in the load.
- Physical therapy. Depending on the phase of the disease, electrophoresis, laser therapy, magnetotherapy, shock wave therapy, and electromyostimulation are prescribed.
Surgical interventions are indicated at stages 2 and 3 of shoulder impingement syndrome. They are carried out using arthroscopic equipment. The following techniques can be used:
- Stage 2. Anterior acromioplasty and subacromial decompression with the intersection of the beak-acromial ligament are more often performed.
- Stage 3. Before restoring the volume of the subacromial space, bone growths are removed, plastic surgery of altered tendons is performed.
In the presence of bursitis, the inflamed bag is additionally excised. In the postoperative period, analgesics and antibiotics are prescribed. After reducing the edema, recovery measures begin. Exercise therapy, massage, physiotherapy, kinesiotaping are used.
With an adequate choice of treatment method, taking into account the severity of the subacromial syndrome, the prognosis is favorable. In the early stages, the progression of the disease can be significantly slowed down, however, conservative therapy does not eliminate the cause of the shoulder impingement syndrome, so full recovery is impossible. The results of operations with this pathology are good, the elimination of pain syndrome and an increase in the volume of movements is noted in 85% of patients.
Primary prevention includes accurate restoration of the position of fragments in fractures of the bones of the upper arm and upper humerus, timely adequate treatment of soft tissue injuries. Patients with an established diagnosis of shoulder impingement syndrome should follow the doctor’s recommendations and receive prescribed treatment.