Impingement syndrome

Impingement syndrome / painful arc syndrome

A quite common injury of the shoulder is the shoulder impingement syndrome, also called painful arc syndrome. In case of the impingement syndrome, the rotation as well as the abduction of the upper arm is restricted and accompanied by severe pain.

Symptoms impingement syndrome / painful arc syndrome

The symptoms of the impingement syndrome are quite similar to those of shoulder arthritis. Often the painful arc syndrome comes along with shoulder pain and restricted range of motion if the upper arm is abducted in an angle of 70-130°, or if the arm is rotated inwards or outwards. Overhead work or lying on the affected shoulder can be very painful.

The symptoms of shoulder impingement syndrome in short:

  • restricted range of motion in terms of abduction or internal or external rotation
  • pain during abduction, internal or external rotation
  • pain while working over head or lying on the affected shoulder

Causes impingement syndrome / painful arc syndrome

The impingement syndrome can have different causes partially reinforcing themselves. Like the word impinge indicates, certain anatomic structures dash against each other, which cooperate closely. Affected are rotator cuff and corresponding bursa, shoulder joint (acromioclavicular joint) and the long biceps tendon above the shoulder joint.
If one of the aforementioned structures swells due to wear and tear, a relative narrowing emerges because the space downwards and upwards is limited – downwards by the bony joint parts, upwards by the roof of the shoulder (acromion) and the AC joint (acromioclavicular joint). As a consequence, the bursa inflames and pain starts.

Diagnostics impingement syndrome / painful arc syndrome

The diagnosis impingement syndrome or painful arc syndrome necessitates a comprehensive orthopedic examination. Often imaging procedures like MRI or X-raying are used to differentiate different diseases that may cause similar or the same symptoms like the impingement syndrome. The best method to differentiate between different injuries is MRI. MRI enables us to visualize very different structures during one examination like muscles, ligaments, tendons, cartilage and bones. If it is necessary, we do also apply a well-tolerated contrast agent to improve the visibility of certain structures.

In some cases, it may be necessary to perform a shoulder arthroscopy, during which an endoscope is inserted through small incisions to visualize the different structures of the shoulder enlarged. If indicated, a subsequent arthroscopic surgery is possible directly after the arthroscopic examination.

Therapy impingement syndrome / painful arc syndrome

If the impingement syndrome is not sufficiently treated conservatively by painkilling drugs also reducing the swelling, physiotherapy or local corticoid injections, the impingement syndrome may be become chronic. Soft tissue and tendons are permanently clamped and irritated sometimes causing a tendon to tear. In case conservative treatment fails, arthroscopic surgery, also called keyhole surgery, is indicated.

During minimally invasive shoulder arthroscopy, an endoscope is inserted through small skin incisions. With the help of the endoscope, the surgeon is able to see the damaged shoulder structures enlarged at a monitor. In addition to that, surgeons are also able to operate through the endoscope and repair or remove damaged structures of the shoulder. Shoulder impingement syndrome and the accompanying pain and restricted range of motion can be treated this way.

After arthroscopic surgery, physiotherapy and rehabilitation should follow in order to improve strength and range of motion.

Read more about minimally invasive shoulder arthroscopy