A distinction is made between primary and secondary shoulder impingement syndrome. Primary shoulder impingement is a bony narrowing of the subacromial space, either due to a subacromial spur or osteoarthritis in the acromioclavicular joint or a relative narrowing of this space under the acromion due to inflammation of the rotator cuff or bursitis.
Secondary forms of impingement mainly involve misalignments of the shoulder or spine or instability problems in athletes. With these conditions, the underlying cause must of course be treated.
In primary impingement, the disease occurs in the area of the acromion. This stressed joint area is subject to constant heavy strain, so that painful functional disorders are widespread.
The classic symptoms of impingement syndrome of the shoulder are pain, especially at night, as well as unnatural joint noises and pinching during certain movements. This usually results in restricted mobility and varying degrees of weakness in the arm.
The diagnosis is best made by a clinical examination by an experienced doctor. In addition, X-rays are taken to confirm the diagnosis, an ultrasound examination is carried out and, if necessary, an MRI scan is ordered. It is important to find out through further diagnostics whether there is also an injury to the so-called rotator cuff.
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Treatment is initially conservative, i.e. medication with pain-relieving and anti-inflammatory tablets is used. Physiotherapy is also helpful. Injections into the bursa may also be carried out. Shock wave therapy can also be helpful. If the treatment is not successful, acromioplasty is usually the only option.
While this procedure used to be rare and performed using an open technique (chiseling off the acromion and cutting the so-called coracoacromial ligament), this procedure is now routinely performed endoscopically.
During this procedure, an arthroscopy of the shoulder joint is first performed to rule out intra-articular injuries and diseases of the joint. This is followed by a so-called bursoscopy (endoscopy of the bursa), which is partially removed endoscopically and the acromion - i.e. the roof of the shoulder - is exposed. This space is relieved by acromioplasty.
A probe is inserted through a small incision in the skin, i.e. the bony substance on the front, underside and outside of the acromion is removed using precision cutters so that the space under the acromion is widened. It is also possible to remove the acromioclavicular joint endoscopically or to remove osteophytes (bone growths) endoscopically at the outer end of the collarbone.
The chances of success for this procedure are extremely high. As it is a minimally invasive procedure, the operation is associated with a low risk. In addition to the general risks(thrombosis, embolism, infection), the following have been described: Fractures of the acromion if too much bone is removed, persistence of symptoms if too little bone is removed. Postoperative bleeding and damage to nerves, blood vessels and muscles are extremely rare.
The procedure is performed either as an outpatient or short inpatient procedure and is followed by intensive physiotherapy aftercare.
With a generally tight budget, the patient's own initiative is of course also required here. The affected shoulder joint is not immobilized after the operation, but heavy physical exertion should be avoided for 3 to 4 weeks. Exercise and overhead work should also be avoided in the first few weeks.
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