Impingement syndrome or bottleneck syndrome is a mobility disorder of joints. Since this mainly occurs in the shoulder joint, it is also referred to as shoulder constriction syndrome, elevated humerus head or rotator cuff constriction syndrome. Degenerative changes or injuries lead to a narrowing of the joint body, which can affect soft tissue such as tendons, muscles and bursae and cause them to become inflamed. The earlier the dysfunction is recognized and treated, the better the chances of healing the impingement syndrome.

What is impingement syndrome?

According to abbreviationfinder, the main symptom of shoulder impingement syndrome is the painful arc. This leads to a painful restriction of movement when lifting the arm to the side.

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 mobile joints in the human body, but it is also one of the most prone to injury. In contrast to other joints, whose stability is guaranteed by bones, here tendons, ligaments and muscles are the fixators. 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 vulnerable, so that there can be constrictions between the joint head and socket as well as so-called luxations, the dislocation of the arm. Tendons, ligaments and nerves are affected. The constant friction during movement can lead to inflammation. Impingement syndrome is associated with very severe pain.

Causes

The main cause of the impingement syndrome are signs of wear and tear, so-called degenerative changes in the bony musculoskeletal system. This is mainly found in athletes such as handball players, javelin throwers, but also in swimmers. Constant overhead movements promote wear and tear.

The impingement syndrome is now also recognized as an occupational disease, as it occurs much more frequently in people who work in a profession that involves overhead work (painters, welders, etc.). However, calcium deposits in the tendons or calcium deposits on the body of the joint can also promote the impingement syndrome. There is also a congenital variant, for example when the acromion, the joint socket or the joint head are deformed or have an unfavorable shape.

The bottleneck syndrome is also favored by a muscular imbalance, as is often the case with bodybuilders, for example. Excessive and, above all, one-sided training throws the sensitive system of the rotator cuff out of balance, which accelerates the symptoms of impingement syndrome.

Symptoms, Ailments & Signs

The main symptom of shoulder impingement syndrome is the painful arc. This leads to a painful restriction of movement when lifting the arm to the side. The pain occurs mainly between 60° and 120° elevation of the arm. Inflammation of the bursa of the acromion (technically: bursitis) or recurring irritation of tendons due to pinching can lead to pain 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. At rest, a subtle pain is felt in the joint. As the condition progresses, lying on the affected side is no longer possible. The shoulder is increasingly held in a relieving position on the body. The affected person can no longer lift his arm to the side.

If the hip joint is affected by a bottleneck syndrome, the change is only noticeable very slowly. The first sign is often a 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 aggravate the symptoms, so that the pain radiates from the groin to the thigh.

Diagnosis & History

Impingement syndrome is diagnosed by an orthopedist . There is extremely limited mobility. Spreading the arm or lifting it causes severe shoulder pain. In some cases, the patient is no longer able to raise his arm above his head. Ultrasound and MRI are used for 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 condyle and the acromion. The narrowed subacromial space and the collision of the condyle and socket can be seen particularly clearly in images in which the affected arm is spread apart.

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

A good course can be predicted even in the case of advanced defects in the bony musculoskeletal system and soft tissue. The prerequisite for this is that the cause (sport, job, 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 leads to various complaints in the joints and thus to severe movement disorders. Restricted movement often leads to psychological complaints such as depression. As a rule, the impingement syndrome can be treated relatively well if it is recognized early.

The affected person usually suffers from severe and often stabbing pain in the shoulder. This pain can also appear in the form of pain at rest, leading to difficulty sleeping, 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, the treatment of impingement syndrome does not lead to further complications.

However, these can occur if the treatment is initiated late and irreversible consequential damage has already formed. The affected person must undergo various therapies so that the symptoms can be alleviated. The treatment often lasts several months before the disease progresses positively. It may not be possible to fully load the respective regions even after the treatment.

When should you go to the doctor?

If there are slight but persistent complaints in the shoulder area, a doctor should be consulted in the next few weeks. If the pain suddenly increases in intensity and is possibly associated with restricted movement, those affected should consult a doctor within the next few days. Acute symptoms that are first noticed when lifting loads or doing sports should be clarified immediately. If no treatment is given, the symptoms of impingement syndrome can increase in intensity and also cause mental upsets in those affected.

Therefore, you should go to the doctor at the first sign of the syndrome. People who play sports frequently or who lift heavy loads professionally are particularly susceptible. The risk groups include above all bodybuilders, painters, welders and people with congenital deformations of the acromion, the joint socket or the joint head – anyone who belongs to one of these groups should have the symptoms mentioned immediately checked by a doctor. In addition to the family doctor, a sports doctor or an internist can be consulted.

Treatment & Therapy

The impingement syndrome is usually treated conservatively. It is true that the sooner you start adequate treatment, the better the chances of a cure. The respective treatment method depends on the stage of the impingement syndrome. In principle, the protection of the shoulder applies first, whereby the elimination of the cause, whether sporting or professional, is in the foreground.

Other conservative treatment methods include physiotherapy, cryotherapy, acupuncture, shock wave therapy and matrix therapy. These therapies are supported by drugs that have both analgesic and anti-inflammatory effects. ASS, diclofenac (as an ointment or tablet) and cortisone preparations are used, for example.

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 acromion plastic is performed. However, the operation alone is not enough. Intensive conservative follow-up therapy and elimination of the cause are necessary measures to successfully treat the impingement syndrome.

Outlook & Forecast

Shoulder pain is present with impingement or bottleneck syndrome. Since these can have several causes, a careful diagnosis is essential.

An orthopedist should decide whether physiotherapeutic measures are sufficient or whether the impingement syndrome needs surgery. The treatment can only be successful if the muscular imbalances caused by the bottleneck syndrome are also treated. If this is not the case, it worsens the prospects for permanent pain relief. Further overloading can lead to permanent shoulder stiffness or tendon ruptures.

An important measure in the case of bottleneck syndrome is to loosen the adhesions that are present on the rotator cuff. In addition, the prognosis improves if muscular mobility is restored at the same time. Self-treatment is ruled out because it could worsen the prognosis through incorrect loading. However, the movement sequences suggested by the physiotherapist are suitable for further practice at home. However, practicing too much can lead to undesirable results.

Properly performed exercises should be done with warm muscles, slow movements and gentle stretching. If the shoulder continues to be overloaded despite impingement syndrome, this can lead to micro-tears in the shoulder tendons. These hairline cracks can lead to tendon tears or tears if the load continues. A tendon rupture takes a long time to heal. It makes the prognosis worse. 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 important, especially in risk groups (sports, work), that prophylactic physiotherapy and special training of the shoulder muscles are carried out. Due to the insidious nature of the disease, impingement syndrome is often diagnosed too late. It is all the more important to pay attention to the warning signals of your own body and to have regular check-ups so that a possible impingement syndrome can be treated successfully.

Aftercare

In the case of impingement syndrome, those affected usually have very few or even no special aftercare measures available. A very early diagnosis should be made in order to prevent further deterioration of the symptoms or 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. In the case of impingement syndrome, those affected are dependent on the measures of physiotherapy or physiotherapy. Many of the exercises can also be performed at home, which may speed up healing. It is also often necessary to take various medications to alleviate the symptoms.

The person concerned should always ensure that the dosage is correct and that the medication is taken regularly. In severe cases, surgery may also be necessary. After such a procedure, the person concerned should definitely rest and take care of his body. Stressful or physical activities should be avoided. The help and support of one’s own family and friends can also accelerate healing.

You can do that yourself

The impingement syndrome (bottleneck syndrome) is a painful disease in the shoulder area, which is treated either with an operation or conservatively, depending on the severity and the patient’s wishes. In both cases, it is important that the patient himself contributes to the fastest possible and, above all, complete regeneration by actively participating in everyday life.

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

Targeted physiotherapy is essential. But it is not enough to do the exercises together with a therapist over a limited number of appointments. Only consistent further practice at home ensures healing success. The exercises have several functions. On the one hand, they loosen adhesions in the tissue that have formed as a result of the inflammation or as a result of the operation. On the other hand, they mobilize the joint again. Compensating for existing muscular imbalances is also important. This is the only way to prevent the tightness between the acromion and the head of the humerus that triggers the impingement syndrome. Also a stretching exercise every now and then for the shoulder may be installed if the mobility of the shoulder seems somewhat restricted again after a strenuous professional activity or sport.