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

Development mechanism

Mechanism of development
The shoulder joint is one of the most complex structures of the human musculoskeletal system. The glenoid cavity is formed by the clavicle and the acromion process of the scapula, and contains the head of the humerus.

The spherical shape of the joint provides a significant range of movements of the upper limb in various planes, including rotation (shoulder rotation). Increasing the depth of the glenoid cavity and increasing the stability of the shoulder joint is provided by a lip made of connective tissue localized around the cavity, as well as a cuff formed from the glenohumeral ligaments and muscles that provide rotation of the shoulder (rotators).

Under the acromial process of the scapula there is a muscle located, which is one of the most vulnerable structures of the shoulder. The result of its damage is rotator cuff syndrome or impingement syndrome.

Causes

Subacromial impingement syndrome is a polyetiological pathological condition. This means that compression of the subacromial muscle of the shoulder joint can be caused by a significant number of provoking factors, which include:

• Congenital or acquired (as a result of injury or a destructive pathological process) anatomical features of the acromial process of the scapula. The curved, hook-shaped shape of this structure causes mechanical compression of the subacromial muscle, which increases even when the arm is raised up for a short time.
• The appearance of pathological bone outgrowths (osteophytes) in the area of ​​​​the junction of the acromial process of the scapula with the clavicle, which leads to compression of the muscle.
• A chronic inflammatory process in the shoulder joint, leading to an increase in the thickness of the connective tissue bursa in the area of ​​the posterior surface and cuff.
• Previous injuries in which there was a violation of the integrity of the tubercle of the humerus or the acromion process of the scapula. Tissue regeneration is often accompanied by the formation of callus, which compresses the subacromial muscle.
• Congenital decrease in the strength of the ligamentous apparatus.
• Pathological decrease in the tone of the striated muscles of the shoulder area due to paralysis, myasthenia.
• Rupture of the connective tissue structures of the ligamentous apparatus of the shoulder, which often accompanies dislocation of the humerus with its head coming out of the glenoid cavity.
• Pathological reduction in size (“wrinkling”) of the joint capsule of the shoulder.

After determining the factor that provokes rotator cuff syndrome, treatment necessarily includes measures aimed at eliminating its subsequent effects.

Kinds

Kinds

With the development of a pathological process against the background of an initial change in the anatomical relationship of the shoulder structures, a primary disease occurs. If compression of the rotator muscle occurs due to a previous injury or pathological process, then secondary subacromial syndrome is diagnosed.

Diagnostic measures

In order to diagnose impingement syndrome, the doctor performs a series of special tests. The essence of the technique is that the doctor sets the patient’s hands to a certain position, thereby causing compression of the subacromial structures. If a person has IS, then a characteristic pain syndrome will arise, and if it does not exist, then the patient will not feel any discomfort. Only after this, the specialist refers the patient for additional diagnostics.

Modern diagnostic methods make it possible to accurately determine the location of the lesion

If the subacromial conflict was caused by tendinitis or bursitis, then you can conduct a visual examination, interview the patient and find out the characteristic symptoms, and also order a series of confirmatory tests. At the same time, the doctor conducts a full interview with the person and finds out where he works, as this may be directly related to the development of the disease.

It is imperative to undergo an X-ray examination to determine the structure and structure of the acromioclavicular joint and clarify the shape of the acromion. If your doctor suspects a rotator cuff tendon tear, it is recommended that you undergo a magnetic resonance imaging scan. MRI allows you to get the most accurate picture of the pathological process; for this, the influence of magnetic waves is used.

The computer screen displays information in the form of a picture, on which tissue sections of any level of complexity are visualized. Using this procedure, you can examine the structure of tendons and bones. This manipulation is completely painless, since it does not require the introduction of injection solutions into the victim’s body.

There are situations when it is necessary to administer a contrast agent. It is injected into the tissues adjacent to the joint and is displayed very well on an MRI image. In addition, contrast can be used during x-rays. If the patient has osteochondrosis, then it is difficult to determine the source of pain (cervical spine or shoulder); for this, a local anesthetic solution is used, which is injected into the bag.

In the initial stages of the disease, moderate physical activity can be used.

Symptoms

Subacromial shoulder syndrome has quite characteristic clinical symptoms, which include several symptoms:

• Pain caused by raising the arm up. At first it has an unexpressed intensity, but as the disease progresses it can intensify and disturb a person at rest (including during sleep).
• Painful sensations during palpation of the shoulder joint. However, they can spread to the supraclavicular region and down the arm.
• Limitation of mobility in the joint affected by the pathological process, which is often accompanied by intense pain.

Subsequently, subacromial impingement syndrome of the shoulder joint is manifested by thinning (atrophy) of the muscles and ligaments of the shoulder with a pronounced decrease in their tone and strength.

Symptoms of the pathological process

A characteristic symptom of impingement syndrome is pain in the shoulder joint. Such urges are observed when the position of the hand changes, for example: raise the limb forward or move it to the side. Some patients experience sleep disturbances because pain prevents them from sleeping, especially in the lateral position on the side of the affected joint. Symptoms of IS are very varied.

They may overlap with other pathologies, but sharp pain at the moment when a person tries to take something out of the back pocket of his trousers indicates precisely this disease. Over time, the pain only intensifies, the motor amplitude of the shoulder joint decreases, and severe muscle weakness appears. At the location of the joint, you can notice a slight swelling; upon palpation, discomfort is felt, which does not leave the patient even during movement.

In a certain category of patients, pain makes itself felt when lowering the arm from a raised position. If a person cannot raise his arms and feels very weak, then this is a sign that the rotator cuff is damaged. All of the above signs will help the doctor make the correct diagnosis, and in order not to waste precious time, it is better to do this in combination with diagnostic procedures.

Diagnostics

Diagnostics

Additionally, to identify the disease and differentiate it from other pathological conditions, the Neer impingement test is performed, the essence of which is to inject lidocaine into the subacromial process bursa. If compartment syndrome is present, pain after injection is reduced.

Impingement syndrome of the shoulder joint - treatment without surgery

Conservative therapy is prescribed for minor changes in the structures of the shoulder and mild compression of the subacromial muscle. It includes several activities, which include:

• Providing functional rest for the joint.
• The use of non-steroidal anti-inflammatory drugs to reduce the severity of inflammation in tissues.
• Direct injection of glucocorticosteroids (hormonal drugs with a pronounced anti-inflammatory effect) into the area of ​​the acromion process, which is prescribed in a short course no more than once a week.
• Physiotherapeutic procedures, which include magnetic therapy, ozokerite, mud baths, electrophoresis with anti-inflammatory drugs.
• Therapeutic exercise (PT), which is carried out to gradually restore the functional state of the shoulder joint, as well as reduce the degree of compression of the subacromial muscle.

Conservative treatment can be prescribed as monotherapy or to prepare the patient for surgery.

How is an MRI of the shoulder done?

• MRI
• Ultrasound

MRI tomograph:

Siemens Magnetom C

Type:

Open (expert class)

What's included in the price:

Diagnostics, interpretation of images, written report from a radiologist, recording of tomograms on CD + free consultation with a neurologist or orthopedist after an MRI of the spine or joint

Ultrasound machine

HITACHI HI VISION Avius

Class:

Expert (installation year 2019)

What's included in the price:

Diagnostics, interpretation of images, written diagnostic report

Preparation

During a tomography of the shoulder joint, the patient can wear his own clothes, as long as they do not have brooches, rivets, metal buttons, zippers or other fasteners. In some clinics in St. Petersburg, examinees are given special disposable underwear to minimize the possibility of metal elements getting into the magnetic resonance imaging scanner. The MRI procedure of the shoulder does not particularly regulate food intake, but in the case of MRI diagnostics with contrast, doctors recommend not eating food for several hours before this study. This will help avoid nausea and other unpleasant sensations when a contrast agent is administered. Contrast testing in people with kidney failure will require consultation with a primary care physician or nephrologist and possibly a blood test for creatinine. For young children, MRI examinations are sometimes performed under anesthesia or sedation. The tomography procedure requires the patient to remain completely still, and this is very difficult to achieve in children. If your child is scheduled for an MRI under anesthesia, preparation will include a series of tests, a consultation with a pediatrician or neurologist, and dietary restrictions before the test. As a preventive measure, women are not recommended to undergo tomographic diagnostics during pregnancy in the first trimester. People who are overweight or have large body dimensions should, when scheduling an MRI of the shoulder, clarify the weight and size restrictions that this tomograph model can handle. A closed-type tomograph in a person with phobias can cause a panic attack, so if you suffer from claustrophobia, you can take sedatives an hour before the diagnosis or choose an MRI of the shoulder joint on an open tomograph[/anchor].

Impingement syndrome of the shoulder joint - surgery

Surgical intervention is prescribed by a doctor if there is severe compression of the subacromial muscle or if there is no desired effect after 4 months of conservative therapy. The main purpose of the operation is to release the pinched muscle (subacromial decompression), for which plastic surgery (acromioplasty) of the tissues and structures of the shoulder joint is performed.

This type of surgical intervention is performed using 2 main techniques:

What determines the price of a shoulder tomography?

The price of an MRI of the shoulder joint is largely determined by three factors: the power of the tomograph, the qualifications of the personnel and the need to use contrast. A good way to reduce diagnostic costs without losing the quality of the examination would be to use the MRI service at night, when the maximum discounts apply.

What determines the cost of tomography?

Tomograph power

Applying Contrast

Personnel qualifications

Promotions and discounts

operation

operation

In modern medical clinics, arthroscopy is the technique of choice, since it does not lead to significant tissue trauma. This shortens the duration of the rehabilitation period and also minimizes the possibility of complications.