Impingement syndrome of the ankle joint

The ankle area is an important part of the musculoskeletal system. With the help of the ankle joint, body weight is rationally distributed along the foot when moving in a vertical position, high maneuverability is ensured when walking and running, and many movements become possible.

Various ankle lesions significantly reduce a person’s standard of living, harm his performance and can even lead to disability.
One of these pathological conditions is impingement.

Ankle impingement - what is it?

Three bone structures are involved in the formation of the ankle joint: the tibia, fibula, and talus. With their adequate interaction with each other, the patient does not notice any malfunctions in the joint. However, it also happens that the edge of the talus begins to hit the edge of the tibia. This happens in a state of extreme flexion or extension, and injury to the joint also helps the development of this pathology.

In medical practice, this condition is called ankle impingement.

According to MRI and radiographs, impingement of the ankle joint.

Interpretation of an MRI photo of the ankle joint

The results of MR scanning are layer-by-layer images of the studied area in three mutually perpendicular projections. A radiologist analyzes the data obtained. The specialist records and describes in the conclusion any deviations from the norm. Preparing results takes from 15 to 60 minutes.

The patient receives a response in the form of a document and information carrier. The radiologist gives explanations and can recommend which doctor to see, but does not make a diagnosis, prescribe treatment or make prognoses. Copies of the description can be sent by email if you indicated it when filling out the documents. The patient can pick up the original on any other day, but in this case there is no opportunity to communicate with the doctor.

Causes of the disease

Infringement of the joint capsule along with the synovial membrane in the ankle area leads to the development of impingement. In places where compression occurs, osteophytes begin to grow (otherwise called bone spines), and an active inflammatory process develops.

The presence of osteophytes leads to an even greater reduction in the natural space between the talus and tibia. As a result, the joint capsule and synovial membrane suffer even more, the severity of the inflammatory process increases, and the pain syndrome intensifies.

There are three main reasons that contribute to the development of the pathological condition:

the presence of a congenital predisposition in patients;
suffered and improperly treated injuries of the ankle joint;
the presence of a chronic inflammatory process provoked by other factors.

Any of the reasons can contribute to negative changes in the joint. As a result, the person will experience symptoms of the disease and will suffer significantly.

Causes, development mechanism

Shoulder impingement syndrome most often develops in representatives of the stronger sex over 40 years of age. This is due to the fact that men are more likely than women to engage in sports and heavy physical labor. These factors influence the condition of the shoulder joint. Persons whose profession is associated with stereotypical movements associated with raising their arms up are at particular risk.

In this position, there is a constant “collision” between two bone structures: the head of the humerus and the acromion. The result is impingement of the rotator cuff. Tendons are constantly injured, and tissue degeneration develops over the years, which can cause serious problems, including their rupture. The hooked shape of the acromion increases the risk of impingement.

With constant damage to the tendons, a chronic focus of inflammation is formed. As a result, bone tissue grows. Osteophytes form on the surface of the acromion, which reduces the space in which the tendons move. Injury to the rotator cuff occurs even with movements of lesser amplitude, and the sharp edges of osteophytes additionally injure the ligamentous apparatus. If this vicious circle is not broken, irreversible changes occur.

Types and degrees of impingement

There are two main types of impingement syndrome: anterior and posterior.

Anterior impingement is mainly a consequence of traumatic injury to the ligaments of the ankle. Any instability of the joint, even if it is very weakly expressed, contributes to its injury in the position of extreme extension.

According to statistics, athletes mostly suffer from anterior impingement. In them, the disease is provoked by frequent high load on the front part of the joint, which causes permanent damage. First of all, with this disease, the amplitude of extension of the joint decreases.

Posterior impingement is often associated with the anatomical features of the ankle structure and injuries. The posterior type of impingement is characteristic mainly of ballet dancers. Indeed, during this dance, a person is forced to walk a lot on his toes, which leads to strong flexion of the ankle joint in the back and, as a result, to injury.

The existence of posterior impingement is often forgotten, although in fact the disease can lead to serious impairment of joint function.

The disease can also be divided into several degrees:

I degree – characterized by the presence of a spur up to 3 mm in size on the tibia, called the synovial degree;
II degree – osteochondral, the size of the spur exceeds 3 mm;
III degree – exostoses with or without fragmentation can be identified, a spur also appears on the talus;
IV degree – changes characterizing arthrosis develop.

Stages and symptoms

The disease develops gradually. Three main stages can be distinguished:

The first stage is typical for young people experiencing constant stress on the glenohumeral joint. Trauma to the ligaments causes hemorrhages and swelling. Patients complain of pain when moving. There are no irreversible changes at this stage; the problem is solved with the help of complex conservative treatment.
At the next stage, fibrous changes in the tendons form and an inflammatory process develops. These changes are already irreversible, so the only way to help is surgery.
At the last stage, pathological growths of bone tissue appear. In the absence of timely medical care, the disease ends in tendon rupture.

The process begins with the appearance of pain. It usually occurs at rest. Unpleasant sensations are localized mainly on the outer side of the glenohumeral joint. Abduction of the arm to the side is significantly limited, and in the advanced stage it is impossible. When collecting anamnesis, the doctor is able to establish a connection between the occurrence of symptoms and injury or intense exercise.

Impingement syndrome of the right shoulder joint is typical for people in certain professions where the main load falls on the right arm. Accordingly, if a person is left-handed, he develops impingement syndrome of the left shoulder joint.

Symptoms

The early stage of the disease is always characterized by pain. The pain is characterized by patients as dull, occurring mainly when trying to make certain movements. As the pathology progresses, the following symptoms may also be noted:

limitation of joint mobility;
changes in the patient’s gait and impaired ability to support the limb, which are mainly caused by pain;
gradual decrease in limb tone;
swelling around the damaged joint;
joint deformation in the last stages.

Symptoms are usually quite severe. Depending on the type of disease, pain may be increased by requests to bend or straighten the limb sharply to the limit.

Diagnostics

If a patient suspects ankle impingement, the doctor always begins by examining the affected area. First of all, he may ask the patient to make flexion and extension movements in the joint to assess the mobility of the joint. In this case, it will be necessary to clarify whether the patient experiences pain with such movements. Often a stress test is performed in which the patient is asked to squat and asked if there is any pain. If there is a suspicion of a posterior type of disease, then instead of asking you to squat down, you may hear a request to stand on your toes.

The patient must be given an x-ray. On an x-ray, the doctor will easily see osteophytes - bone growths that appear due to the inflammatory process. Additionally, a photograph is taken in a stress position. On it, the doctor will determine whether there is a bone collision.

MRI is not a mandatory test for diagnosing the disease. Its implementation is recommended if it is necessary to carry out differential diagnosis with other pathologies or in the initial stages of pathology.

Treatment

The treatment method depends on the stage of the disease. Tactics are determined only after a comprehensive examination of the patient.

Conservative therapy

Impingement syndrome at the initial stage is treated conservatively. A prerequisite for recovery is limiting hand movements. This applies to those movements that lead to pinching of muscle tendons. This event allows you to eliminate permanent trauma and create optimal conditions for the restoration of the ligamentous apparatus.

The introduction of anti-inflammatory drugs and glucocorticosteroids into the joint cavity (paraarticular) is widely used. In this way, it is possible to create the concentration of drugs in the affected area necessary for a therapeutic effect in the shortest possible time.

Physiotherapeutic methods of treatment are widely used: magnetotherapy, ultrasound, exposure to an electric field. These factors have an anti-inflammatory effect, improve microcirculation and stimulate regenerative processes in tissues.

The complex of procedures also includes physical therapy classes. Special exercises prevent the development of contractures and allow you to restore range of motion of the hand.

Conservative therapy is a long process that requires organization and patience. The above procedures last for 3-4 months. If a visible result cannot be achieved, the issue of surgical intervention is decided.

Surgical treatment

In leading clinics, doctors use the most advanced technique - arthroscopy surgery. Through small incisions, optics and instruments are introduced into the affected area. This manipulation allows you to remove bone growths, correct the shape of the acromion process, and restore the integrity of the ligamentous apparatus with minimal damage to healthy tissue.

Modern equipment in the hands of a doctor who thoroughly masters the technique makes it possible to restore the function of the shoulder joint even in the most difficult cases. Modern surgery gives a chance even to those patients whose arm has not worked for several years.

After surgery for impingement syndrome, immobilization of the limb is necessary. The next stage is rehabilitation using exercise therapy, physiotherapy and massage.

Features of treatment

First of all, it is necessary to direct efforts to eliminate the causes of the disease. In the initial stages, conservative methods are used, and in case of ineffectiveness or in later stages, surgical methods are used.

Conservative methods

Therapy should begin as soon as the first symptoms of pathological changes in the joint appear. It is the early start of treatment that saves you from the need to solve the problem surgically!

Conservative therapy includes:

carefully limiting the load on the affected leg;
the use of means that will limit movement in the joint, preventing it from getting into a painful position;
ideally, limb rest is recommended if possible;
select special orthopedic shoes, with the help of which it will be possible to limit movements in the affected joint;
select non-steroidal anti-inflammatory drugs, under the influence of which the degree of inflammation and, as a consequence, the severity of symptoms will decrease;
provide cold compresses to the leg, which also reduces the severity of inflammation, physiotherapeutic procedures;
in case of severe inflammation that cannot be controlled with NSAIDs, steroid drugs are prescribed.

Surgery

Today, impingement surgery can be performed arthroscopically. This approach is characterized by less trauma and, as a result, faster recovery after surgery.

During arthroscopic surgery, the doctor removes osteophytes that impinge on soft tissue, which only further inflames the damaged joint. The cartilages involved in the pathological process are also processed, already dead damaged tissues are washed out, and the tendons involved in the process are released.

Although arthroscopy is an operation characterized by low trauma compared to open operations on the joints, it is better to see a doctor with the first symptoms of the disease and undergo conservative therapy than to lie down on the operating table!

Impingement syndrome of the right shoulder joint: symptoms, treatment and prevention

Impingement syndrome of the shoulder joint is a serious disease, but if treatment is started on time, the disease does not pose a threat.

In the article you will find how the disease develops, causes and treatment, prevention and diagnosis of shoulder impingement syndrome. Also in the article you will find traditional medicine treatment and exercises that should be performed regularly. And I think you will also be interested in learning about the symptoms of shoulder impingement syndrome.

This information will be useful to anyone who is faced with this disease. The article also contains videos in which the doctor will give you the advice you need and, I hope, in which you will find answers to your questions.

Impingement syndrome of the shoulder joint - characteristics

The beautiful name “impingement syndrome” is associated with acute pain that significantly reduces the quality of life in a joint: the shoulder, and sometimes in others, for example, in the hip, ankle. This disease is especially common among athletes and those engaged in heavy physical labor.

The shoulder joint is a complex and no less unique system of components that mechanically interact with each other. The movable base of the scapula, humerus, and clavicle allows the human shoulder to perform a variety of mechanical movements.

With the help of tendons, the minor, subscapularis, supraclavicular and subclavian round muscles are attached to the scapula and bone of the shoulder, which interact only with the help of a rotator cuff formed by other tendons. Sometimes it happens that friction occurs between the acromion (scapular process) and these tendons of the rotator cuff, resulting in a pain syndrome that is commonly called impingement syndrome of the shoulder joint.

This process, called impingement syndrome, occurs in a large number of people due to compression of the tendons and joint capsule between the head of the humerus and the acromion when raising the arm in a vertical position.

Impingement syndrome, which is clinical in nature with the appearance of a painful syndrome, is characteristic of people whose professional activities are directly related to long-term static postures. These are positions that imply a fixed holding of the hand in a raised position.

Among the most common professions in which this disease can occur are: painters, plasterers, athletes, carpenters. In general, a similar shoulder joint syndrome can be caused by various conditions in which the gap between the coraco-acromial arch (rotator cuff tendons and acromion) decreases.

Shoulder impingement syndrome is painful. Sometimes it is tolerable, less often it is strong and exhausting, but almost always it is sudden and inexorable. It is quite difficult to call such a pathology rare, but, nevertheless, it is practically unknown to most domestic doctors. And the point here is not so much the reluctance of many doctors to spend time learning something new, but rather a certain ossification of thinking characteristic of many doctors.

Formally, impingement syndrome has been known in medicine for more than 100 years (the first reports of it date back to 1872), but in those days it was called “scapulohumeral periarthritis.” However, due to the imperfections and inaccuracy of instrumental diagnostic methods of the 19th century, a clear explanation of the mechanisms of pain was not found then.

A century later (1972), the pathology received its modern name (in Russian-language literature you can find variants like “impeachment syndrome” or even “impeachment syndrome”), but most 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 many elements, precisely adjusted to one another. Unfortunately, over time, the ideal interaction between them is disrupted, and the system begins to malfunction, which we perceive through pain attacks. One of the most likely “problem” places is the subacromial space.

This is a narrow (no more than 7 mm) gap formed above by the acromion process, and below by the head of the humerus. With age, due to the accumulation of salts, a decrease in the amount of lubrication and a general decrease in joint mobility, the subacromial space decreases, strong friction occurs and a distinct pain attack occurs, which is called impingement syndrome.

The only point that needs further clarification concerns the age range of the pathology. Logic dictates that such changes are more common in older people, but in practice, impingement syndrome occurs even in 30-40 year old patients.

Therefore, the common misconception that joint problems are the lot of old people must be recognized as false. Therefore, when the first symptoms appear (when the problem can be effectively dealt with using conservative methods), you need to consult a doctor, and not postpone treatment until better times. Which, as practice shows, can come much faster than you think.

Risk factors

Impingement syndrome (IS) can be caused by a variety of diseases. Some of them are widespread (especially in developed countries), others, with some reservations, can be called rare:

adhesive capsulitis (“frozen shoulder”);
suprascapular nerve neuropathy;
arthrosis of the shoulder and acromioclavicular joints;
cholecystitis;
calcification of the supraspinatus tendon;
osteochondrosis of the spine, localized in the cervical region.

But if we discard the theory and focus on the practical side of the issue, it turns out that the incidence of IS depends to a greater extent on the characteristics of professional activity (painters, carpenters, plasterers, athletes) than on the age of the patients. In other words, impingement syndrome is more of an occupational disease than an aging disease.

There is no generally accepted classification of IP, especially if we leave out the professional, highly specialized language. Most practicing doctors divide “impingement syndrome” (after all, such a spelling also has a right to life) into two conditional groups.

Primary IS. Occurs due to mechanical irritation of the periosteal muscle due to:

post-traumatic deformity (acromial or clavicular processes, greater tubercle of the humerus);
rotator cuff tendon injuries;
congenital changes in the shape of the acromion process.

Secondary IC. Caused by a narrowing of the subacromial space caused by:

tear of the rotator cuff or biceps tendon;
violation of the integrity of the ligaments of the acromioclavicular joint;
congenital ligament weakness;
thickening of the rotator cuff or bursa (a consequence of ossification or chronic bursitis);
paralysis or muscle weakness;
displacement of the greater tubercle of the humerus (usually as a result of trauma).

Causes

When you raise your arm, the tendons and joint capsule between the head of the humerus and the acromial process of the clavicle (acromion) are always slightly compressed. This regularly recurring condition is called impingement (in English impingement and actually means “blow”, “collision”).

Under certain circumstances, soft tissues can become pinched, irritated, inflamed, damaged, and here we are talking about painful impingement syndrome. Due to the narrowing of the space under the acromion, there is not enough space for the normal functioning of all the structures located there. The situation becomes even more complicated in cases of non-standard shoulder shape and the presence of bone processes.

The supraspinatus tendon, which is located directly under the acromion and is part of the rotator cuff, which covers the head of the humerus, especially often suffers from compression. Therefore, impingement syndrome is often directly associated with damage to the important rotator (or rotator) cuff.

This disease is the most common cause of pain in the shoulder joint, which occurs depending on movements or body position, including at night. Those suffering from the syndrome are often unable to move their arm upward (the most painful sensation is at an angle of 60 to 120° - the so-called “painful arc”), and can hardly put on a shirt or wash their back. Ultimately, impingement syndrome, that is, the severe pain associated with it, significantly limits the functioning and mobility of the entire affected joint.

There are two types of subacromial impingement syndrome, that is, affecting the shoulder joint: primary (outlet) and secondary (non-outlet). In the first case, the sub-shoulder space is narrowed due to mechanical reasons, such as the presence of a bony process in the joint or a strongly sloping shoulder.

In the second case, possible causes of impingement syndrome include chronic inflammation of the periarticular bursa (bursitis), damage to the long biceps tendon, rupture of the rotator cuff, or biomechanical disorders such as muscle stiffness or imbalance. With muscle imbalance, we are talking about functional impingement syndrome of the shoulder.

Thus, the occurrence of problems is based on various reasons, among which the most common are pinching, damage, wear, cracks, inflammation of muscles and tendons. If the causes are not hereditary (the special structure of the shoulder joint), then, as a rule, they have their origins in the type of human activity, which is characterized by constant physical overloads placed on the upper part of the body.

This risk group includes athletes, especially tennis players, handball players, volleyball players, basketball players, as well as representatives of certain working professions - painters, plasterers and others.

Symptoms

The shoulder is made up of a complex system of interconnected tendons, and crowding under the acromion can cause pain when moving the arm in certain ways. The pain occurs when the tendons are pinched or ruptured due to heavy loads and intensifies when raising the arm above the head. If inflammation persists, other symptoms may appear. Constant irritation of the synovial bursa between the rotator cuff and the acromion leads to night pain, which is quite severe and painful for the patient, which disturbs sleep and the person cannot sleep on the inflamed shoulder.

In addition to pain, there is a restriction in movement in the shoulder joints as long as the symptoms persist. This condition is referred to as secondary shoulder stiffness or frozen shoulder. Inflammation of the tendons leads to excruciating and long-term chronic pain.

Signs of the presence of the disease in its early stages are aching pain in the shoulder, which can appear even during sleep. Then the painful sensations intensify, and limited movements gradually appear.

When you raise or abduct your arm at the shoulder, you may feel unpleasant clicking, snapping, or crunching sounds. As a result, the muscles in this area weaken and lose tone. With further stress, the tendons may rupture, the pain will become unstable, and the joint will become almost immobile.

Impingement syndrome of the shoulder at the very beginning develops as inflammation of the tendons, then dense scar connective tissue appears in the area of inflammation - fibrosis, and as the disease progresses, fibrosis is replaced by calcium deposits.

In a healthy person, this gap is wide enough for the supraspinatus muscle to move freely, but with impingement syndrome, the gap narrows. This narrowing makes it difficult for the muscle to work and creates conditions for its microtrauma.

In a sense, anatomy itself created the prerequisites for the emergence of this pathology. Indeed, oddly enough, the development of impingement syndrome depends on the shape of the acromion, and the shape is different for all people.

However, if you think about it, the question arises: if the cause of impingement syndrome of the shoulder joint is a bent acromion, then compression of the muscle should have occurred already in infancy, why then does the disease appear only over the years?

Indeed, the shape of the acromion is an important, but not the only factor, and curvature alone is not enough for the occurrence of impingement syndrome of the shoulder joint. In general, it is worth recalling here that our body is quite resistant to the occurrence of any pathology, including this one. And in order for impingement syndrome to occur, the action of not one, but several factors is necessary.

So, the second such factor is the natural ability of bones to grow. As you know, bone can grow throughout your life. Only in childhood and adolescence does this growth ensure the “growing up” of a person.

And although an adult has grown, the ability of bones to grow has not completely disappeared - it has been preserved. Why is this necessary? Everything is very simple. For example, so that if something happens, fractures heal. Or in order to strengthen the place of increased load, just as it happens with the skin on the feet.

After all, it’s no secret that if we walk barefoot for a long time, our feet will become rough. And from a medical point of view, such coarsening means that the skin has thickened due to the growth of additional layers to protect the feet. The same thickening, in response to overload, occurs in the bones.

By the way, the growth of bone tissue is considered by people far from medicine to be salt deposition. However, science has clearly established that this is not salt at all, but a protective reaction to overload. Depending on the area of the congested area, bone growth can be extensive or localized.

It is precisely this point growth at the end of the acromion that creates something like a spike. And if with a flat acromion this is not critical, then with a hook-shaped acromion it significantly narrows the already small opening. In general, the ability of bones to grow in response to physical activity is the second factor and cause of shoulder impingement syndrome.

Thus, for the occurrence of shoulder impingement syndrome, at least two conditions are necessary: an anatomical predisposition in the form of a hooked acromion and overload of the shoulder joint.

Moreover, you don’t need to think that overload means hard physical work or sports. For example, among our patients with this diagnosis there are many people from creative professions: violinists, cellists, artists, cameramen, especially those who often shoot “from the shoulder,” etc.

In addition, you should not delude yourself into thinking that impingement syndrome occurs only in the case of a bent acromion. Long-term overload of the shoulder and intense growth of bone tissue can lead to disease even with an initially flat acromion.

In addition, it is necessary to take into account the direct connection between shoulder impingement syndrome and diseases of the cervical spine. After all, the stimulus for the formation of impingement syndrome is very often disc pathology: protrusion, disc herniation, osteochondrosis, etc.

In general, remember the golden rule more often: “a disease is easier to prevent than to treat,” and try to always follow this rule. And for this, at the slightest suspicion of impingement syndrome, contact a chiropractor.

The onset of the disease is manifested by discomfort, which is gradually replaced by episodic pain. Then the pain becomes more frequent and constant. In general, everything is increasing: from slight discomfort to constant pain.

And if the disease is not stopped in time, everything can end in surgery. Of course, an operation is not a death sentence; on the contrary, it allows one to get out of the crisis in which a person finds himself. But any operation is a large-scale undertaking and high costs.

Moreover, even the most successful operation entails restorative treatment, which can be even more difficult and more expensive than the operation itself, and without which all the results of the operation may come to nothing. That is why you should not neglect the disease, and if you or your loved ones are faced with this problem, you must do everything possible to avoid surgical treatment of shoulder impingement syndrome.

Modern approaches to gentle manual therapy, most often, make it possible to overcome the disease and treat impingement syndrome without surgery.

Diagnostics

The symptoms of impingement syndrome of the shoulder joint are clear - these are acute pain in this area when raising the arms and other movements, in a lying position on the affected side of the body. The pain can spread only to the shoulder or further, to the forearm and arm.

Often, due to the transparency of symptoms, the doctor can make a diagnosis based on the results of a routine examination of the patient and simple clinical functional tests, in which he must perform certain movements. Orthopedists encounter complaints typical of impingement syndrome very often and, as a rule, have enough experience in this area.

During the examination, the doctor often asks the patient about his daily work, since impingement syndrome is mainly an occupational disease (plasterers, installers), which also affects athletes (swimmers, shot putters, volleyball players).

To determine the source of pain, x-rays are prescribed. Additional examination using magnetic resonance imaging may be necessary. This technique can visualize bone and soft tissue and determine whether the rotator cuff is torn.

If it is not possible to determine the cause of the pain, which, in addition to inflammation in the joint, can be cervical osteochondrosis, an anesthetic is administered to help determine the source.

Treatment of shoulder impingement syndrome occurs in two stages: conservative and surgical. Conservative treatment is prescribed at an early stage of the disease, and involves taking drugs such as Voltaren or Xefocam. Sometimes, in case of severe pain, the doctor prescribes diprospan, the purpose of which is to reduce inflammation and swelling.

All necessary injections are made in the acromion area. At the same time, to improve mobility, a number of physical exercises are performed. Traditionally, during this pathological process it is customary to distinguish three stages. This classification was developed by Dr. Neer CS at the end of the twentieth century, but even now it is actively used by orthopedic traumatologists:

The first stage usually occurs at a young age, between 20 and 40 years of age. It manifests itself as moderate pain after physical activity. Swelling and hemorrhages can be detected in the rotator cuff at this stage.
As the disease progresses, a transition to the second stage is noted. The rotator cuff thickens due to constant mechanical injuries. Fibrosis develops in it, which is accompanied by inflammatory processes in the tendons - tendonitis. Typically, the second stage occurs in young and middle age - from 30 to 50 years. The best effect in this situation is demonstrated by surgical treatment.
In the absence of treatment, the disease enters the third stage. It is characterized by tears of both the rotator cuff and the biceps tendon. A formed bone spur can also be found in the joint. Since the shoulder muscles - short rotators - are degeneratively changed during this period, they become unable to provide dynamic stability of the joint.

Constant injuries lead to inflammation and degeneration of not only the joint, but also the adjacent soft tissues.
This clinical and radiological picture can be seen in patients of the middle and older age groups - 30–70 years old. Treatment of shoulder joint impingement syndrome
The disease requires individually selected therapy, depending on the underlying cause, stage of development, and duration of pain. First, conservative treatment is usually carried out, including medication and physiotherapeutic procedures. A certain effect may occur only after several weeks, and sometimes even months, so you need to be patient.

The goals of therapy are to restore joint function, return the muscles to their former strength and stability, and, of course, eliminate pain. For this purpose, both painkillers and anti-inflammatory non-steroidal drugs are used in combination with therapeutic exercises, physical therapy (treatment with cold, heat, electrical impulses, ultrasound) and sometimes manual therapy. In addition, the doctor may include glucocorticoid injections into the shoulder into the treatment plan, however, due to the risk of additional tendon damage, the number of injections should not exceed three.

In no case should you underestimate the importance of physiotherapy, especially special gymnastics, which allows you to strengthen the muscles and change the position of the head of the forearm, freeing up more space for the tendons. It is better to carry out such training daily for several months, remembering that gymnastics should not cause pain and without overdoing the duration (no more than 15-30 minutes) and intensity of exercises.

Throughout the entire treatment period, you should refrain from overloading the shoulder joint. In some acute cases, the doctor may even resort to fixing it. Is therapy possible when such a diagnosis is made? How is shoulder impingement syndrome treated? If the disease is detected at an early stage, traumatologists recommend starting with conservative methods. Progress of treatment:

First of all, it is necessary to deal with pain. For this purpose, non-steroidal anti-inflammatory drugs are used in the form of ointments, gels, tablets, suppositories or injections. If their effect turns out to be insufficient or short-lived, doctors resort to heavy artillery - hormonal drugs. This therapy gives good results with a long-lasting effect, but the risk of side effects is significantly higher.
Among the auxiliary methods, physiotherapy is widely used - treatment with a magnet, ultrasound, local administration of drugs by electrophoresis.
Regardless of which conservative method is chosen as the main one, it is necessarily complemented by physical therapy. It is aimed at strengthening the muscles of the shoulder and arm.
If conservative therapy does not produce the expected results within 3–5 months, traumatologists recommend surgery. As a rule, we are talking about diagnostic arthroscopy, during which the correction of disorders is simultaneously carried out - elimination of osteophytes, restoration of tendons, changing the shape of the acromion.

But not all patients trust traditional medicine. Some are wary of major interventions due to the risk of side effects. Is alternative therapy possible?

If conservative therapy does not bring the expected result, especially if the pain only intensifies, there is talk of surgery. Professional athletes are also often inclined to the surgical method of solving problems.

This operation is called subacromial decompression of the shoulder joint, or acromioplasty, and is designed to expand the subacromial space to restore the normal functioning of all elements in this area. However, surgery is indicated mainly for the primary (outlet) form of the syndrome, which is caused by mechanical reasons. In the secondary form, that is, in the presence of bursitis or other inflammation, acromioplasty is generally not recommended, except in some cases of rotator cuff injury.

Today, such operations are almost always performed using endoscopic, minimally invasive methods, through very small incisions. During the day, the shoulder joint is then fixed in a special way. The first two weeks after surgery require special movement exercises with the participation of a physiotherapist, starting from the third week - self-performed gymnastics.

At the same time, the rotator cuff muscles are strengthened and built up step by step. Movement is very important, especially given the risk of developing a post-operative complication called frozen shoulder. Preventing the development of shoulder impingement syndrome is very difficult. In any case, balanced physical activity contributes to the healthy functioning of all joints and muscles. When doing fitness and gymnastics, it is recommended to pay special attention to training the rotator cuff.

Usually they start with conservative treatment. You may be prescribed non-steroidal anti-inflammatory drugs such as diclofenac or ibuprofen. Rest and ice can relieve pain and inflammation. If the pain persists, cortisone injections into the joint may help.

Cortisone is a powerful drug that reduces inflammation and pain. The effects of cortisone are temporary, it effectively relieves pain and inflammation, but negatively affects articular cartilage. Your doctor may also prescribe physical therapy and exercise therapy. If there are no contraindications, then various procedures can be used to relieve inflammation, including cold and heat. Lessons with an instructor may be required.

Gradually increasing the strength and coordination of the rotator cuff and scapula muscles allows the humeral head to move directly into the center of the scapula without impinging on the tendons or bursa under the acromion. It may take four to six weeks for your shoulder to regain range of motion and function. If conservative treatment is unsuccessful, then surgery is necessary.

The operation is called acromioplasty. The goal of the surgery is to increase the space between the acromion and the rotator cuff tendons. The greater the space between the above structures, the less chance there is of impingement of the cuff tendons between the shoulder and acromion.

The surgeon first removes any bone spurs that are irritating the cuff tendons and bursa. It often becomes necessary to remove a small part of the acromion and even the acromial end of the clavicle. In patients who have a downward slope of the acromion, more bone tissue needs to be removed.

Treatment of shoulder impingement syndrome can be surgical or non-surgical. And, as we said, surgery is a last resort, it is done only when all other types of treatment have been tried and they have not worked. But this rarely happens.

Non-surgical treatment of impingement syndrome requires drug and non-drug methods. The main and main non-drug method is gentle manual therapy. Additional treatments include physiotherapy and exercise therapy.

For acute pain and severe swelling of deep tissues, treatment begins with medications. For this purpose, anti-inflammatory and decongestant medications are used: movalis, voltaren, ortofen, and in case of persistent pain - diprospan. When swelling and pain decrease, begin gentle manual therapy. This is the most effective non-surgical treatment for shoulder impingement syndrome. Manual therapy has various manual methods in its arsenal.

Each of them is aimed at a specific structure: muscles, joints, tendons, ligaments, spine. It is best to use a combination of these methods. This approach gives the highest effect and the most lasting treatment result.

As the patient recovers, special therapeutic exercises are prescribed. Usually they start with simple and gentle movements, and then gradually increase the amplitude, volume and load. And so on until the normal functioning of the shoulder joint is completely restored.

ethnoscience

Impingement syndrome of the shoulder joint can be treated using traditional medicine. But you need to understand that we are talking exclusively about symptomatic therapy - in order to reduce inflammation and pain. When treating subacromial conflict, the following are most often used:

Anti-inflammatory teas. Infusions of chamomile and yarrow, tea made from lingonberries and rose hips, and currant leaves have a good effect.
Applying cabbage or plantain leaves directly to the affected area.
Various compresses. You should be careful with this method, as it can aggravate the inflammatory process. The composition of the compress must be agreed upon with the attending physician.
Treatment with honey. It can be applied as a thin film to the affected area.

But still, traditional medicine methods are not able to replace traditional medicine and save the patient from the disease forever. They can only be used as an additional treatment.

Prevention and prognosis

With timely diagnosis and comprehensive treatment, impingement syndrome cannot be classified as an incurable disease. But due to the neglectful attitude of both patients and medical personnel towards joint diseases, some patients may develop irreversible changes in the body and permanent disability.

Therefore, we repeat, the sooner you seek help, the greater the chances of a complete cure. Also, do not neglect simple prevention methods, compliance with which will significantly reduce the likelihood of developing pathology:

minimizing the risk of shoulder injury;
during prolonged physical activity, special protective and supportive bandages should be used;
mandatory treatment of even minor shoulder wounds with antiseptics, followed by application of a bactericidal dressing.

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