Impingement Syndrome (Impingement Syndrome, Impingement Syndrome)

Impingement syndrome is also known as constriction syndrome. It refers to the pinching of muscles or tendons within a joint, resulting in painful limitations of movement. The shoulder joint is most commonly affected by impingement syndrome, followed by the hip joint.

There are two forms of impingement syndrome:

In primary outlet impingement syndrome, changes occur in the bony structures. These manifest, for example, as a bone spur or a roof of the joint that is too steeply sloped.

In secondary non-outlet impingement syndrome, the joint space narrows as a result of an injury or other condition. Examples include damage to muscles or tendons, as well as inflammation of the bursa.

Symptoms in the Shoulder Joint

In shoulder impingement, patients experience acute, sudden-onset pain in the early stages of the condition. The pain intensifies especially during overhead activities. Those affected describe the pain as originating deep within the joint. Pain often peaks at night, making it difficult to lie on the affected side.

As the condition progresses, adhesions and scar tissue may form in the bursa around the shoulder joint. This further reduces range of motion. Due to reduced muscle activity, muscle atrophy occurs, leading to a loss of joint stability.

Symptoms in the Hip Joint

Impingement syndrome of the hip joint often begins with a gradual onset of symptoms. Initially, pain in the hip joint occurs only sporadically. As the condition progresses, the pain intensifies during physical activity and may then radiate down into the thigh.

Causes of impingement syndrome in the shoulder

The shoulder joint is the most mobile joint in the entire body. It is formed by the articular surface of the shoulder blade and the head of the upper arm. Unlike the hip joint, the shoulder joint is significantly less protected by bony structures. Four muscles arranged in a cuff-like pattern—the rotator cuff—surround the joint.

Impingement syndrome in the shoulder area results

• by damage to the surrounding soft tissues or
• a narrowing of the joint space due to bony changes.

The former is the cause of non-outlet impingement syndrome, and the latter is the cause of outlet impingement syndrome.

In impingement, muscles or tendons are pinched at the joint © alkov | AdobeStock

Causes of impingement in the hip area

The occurrence of impingement syndrome in the hip area can often be explained by a deformity of the acetabulum. It is part of the pelvic bone and has the shape of a cup-shaped socket that, together with the femoral head, forms the hip joint.

In some cases, bone spurs may form on the femoral head or the roof of the acetabulum. This results in painful restrictions of movement, particularly during internal rotation and flexion of the hip joint.

These bony changes are often the result of increased physical stress. This is why some young athletes are more prone to developing hip impingement syndrome.

Treatment options may include several approaches. Conservative treatment primarily involves physical therapy and pain medication. In addition, patients should take it easy.

However, for a permanent cure, the underlying cause of the impingement syndrome must be treated surgically.

Conservative Treatment

Conservative therapy is the treatment of choice, especially in the early stages of the condition. This form of therapy focuses on resting the affected joint. The patient should avoid stressors such as physically demanding work or sports activities.

The resulting pain can be relieved with anti-inflammatory pain relievers, such as ibuprofen. However, these cannot address the underlying cause. Physical therapy is also recommended to reduce pain.

Causal Therapy

Causal therapy aims to treat or eliminate the underlying cause of the condition. Surgery can successfully correct the structural changes and, consequently, the mechanical restriction.

Such surgery is particularly recommended for young people, as it minimizes the risk of joint stiffness.

Minimally invasive arthroscopic surgery is increasingly being used as the surgical method of choice. It has largely replaced open surgery for impingement syndrome.