pathology: impingement syndrome

yogabook / pathologie / impingement syndrome

impingement syndrome of the shoulder (subacromial syndrome)

Definition of

The term impingement of the shoulder is not used uniformly; it is usually used to describe a painful restriction of flexibility of the shoulder joint, usually due to degeneration, rupture or muscular imbalance with injury to the supraspinatus tendon, which becomes trapped. A more precise distinction must be made between two forms of impingement:

  1. internal (impingement within the shoulder joint): can be posterosuperior (PSI) or anterior superior (ASI), PSI is usually the result of overhead activities, whether sporting or manual, usually resulting in a GIRD (glenohumeral internal rotational deficit). This can lead to painful restriction of movement with loss of strength. ASI is usually triggered by adduction in endorotation; swimmers are often affected.
  2. external (impact outside the shoulder joint): must be differentiated into

Idiopathic shape abnormalities of the acromion, including an excessively long acromion, favor the development of impingement. In addition to subacromial impingement, subcoracoid impingement is also possible.

ICD M75.4

Cause

  1. (see definition)

Predisposing

– Behavior

  1. Prolonged incorrect loading: habitual lifting of the humeral head
  2. inner PSI impingement: overhead activities, professions such as painting and sports such as volleyball, handball, swimming, javelin throwing
  3. Internal ASI impingement: sports with adduction in endorotation such as swimming
  4. Smoking

– Musculoskeletal system

  1. Weakness of the lateral abductors and exorotators
  2. Limescale deposits

Diagnosis

Tests and signs:

  1. Neer sign
  2. Jobe sign: (Full Can and Empty Can variant) Irritation of the supraspinatus tendon
  3. Painful Arc Test
  4. Hawkins test
  5. drop arm sign
  6. shoulder relocation test

Reduction of pain in the painful arc by pulling the arm down externally ( caudally) indicates that it is mainly bursitis. Pressure of the humeral head in the direction of the acromion then increases the pain. If the pain increases when pulling caudally or remains the same, the suprapinatus tendon is the cause.

Symptoms

  1. Often begins with acute, bright pain when working overhead
  2. Painful restriction of movement „painful arc“: pain between approx. 70° and 130° abduction, which worsens with endorotation
  3. Rotation of the upper arm painfully restricted
  4. possibly also pain at rest and night pain
  5. Later: restricted flexibility due to adhesions and muscular dystrophy, which leads to further progression and instability

Therapy

  1. Initial immobilization if necessary. Then promote flexibility
  2. Heat or cold therapy, iontophoresis
  3. Corticosteroid infiltrations if necessary (not in the tendons). Risk of infection, CAVE for diabetics!
  4. Shock wave therapy for calcification
  5. Proprioceptive neuromuscular fascilitation (PNF)
  6. PT
  7. Specific stretching and strengthening training
  8. Posture training for the spine
  9. Elimination of existing scapular dyskinesia, strengthening of the muscles that move the shoulder blade, elimination of imbalances and flexibility restrictions
  10. conservative in about 80% of cases. There are no predictors for success.
  11. Avoiding painful movement
  12. Surgery: subacromial decompression, but in a review one year post-op does not prove superior to physiotherapeutic measures.
  13. Strengthening primarily of the exorotators of the shoulder joint and the muscles that depress the humeral head(infraspinatus and subscapularis)

DD

  1. Calcified shoulder
  2. Frozen Shoulder

Asana practice and movement therapy

The literature and online media recommend a striking number of exercises to stabilize the muscular functions of the shoulder joint: Strengthening postures for frontal adduction, straight and retroverted support exercises with and without arm bends (backward dips, lifting from support on a chair), strengthening the exorotators in various ways (dumbbells, cable pull, theraband, lying, sitting, standing), Strengthening the endorotators, biceps curls, side raises up to 90°, rowing, 45° rowing, rowing with endorotated arms, push-ups, exorotated frontal abduction at sternal level (pushing away), retroversions, stretching the pectoralis, pronated-endorotated side raises. It is also recommended to train the retractors, protractors, elevators and depressors of the scapula.

Many authors consider impingement to often have multifactorial causes. Therefore, all plausible or diagnosed causes should be addressed. Hyperkyphosis of the thoracic spine and a tendency to protraction of the shoulder blades, for example, must be counteracted. If there are muscular causes in the form of shortening, as is often seen in the pectoralis major, for example, this must be reduced by stretching and reducing tone, i.e. also by working in long sarcomere lengths as in the bar position. Other end rotators of the shoulder joint, including the subscapularis, latissimus dorsi and teres major, also tend to shorten and should be treated. Any existing scapular dyskinesia must be eliminated. All exercises and postures should be performed in such a way that the well-known impingement pain does not occur; enduring pain in no way leads to any improvement, rather the opposite.

Asanas