impingementsyndrom

Impingementsyndrom is a common shoulder condition caused by narrowing of the space through which the rotator cuff tendons and the subacromial bursa pass, leading to compression during arm elevation. It is often related to structural factors such as acromial shape, bone spurs, and degeneration of the rotator cuff tendons, as well as overuse in overhead sports or occupations and inflammatory conditions.

Symptoms typically include anterior shoulder pain that worsens with lifting the arm overhead, night pain, weakness, and reduced range of motion, especially during abduction and external rotation. Pain may be aggravated by reaching overhead or sleeping on the affected side.

Diagnosis is based on history and physical examination, with impingement signs such as the Neer test and Hawkins-Kennedy test. Imaging helps exclude other problems: X-ray assesses acromial morphology and bone spurs; MRI or ultrasound evaluates the rotator cuff tendons and subacromial bursa.

Treatment usually begins with nonoperative measures. These include activity modification, rest during painful periods, and a structured physical therapy program focusing on scapular stabilization and rotator cuff strengthening. Nonsteroidal anti-inflammatory drugs may reduce pain, and corticosteroid injections can provide short-term relief. If symptoms persist after several months or there is a significant rotator cuff tear, surgical options may be considered, most commonly arthroscopic subacromial decompression (acromioplasty with removal of inflamed bursa) to increase the subacromial space; more extensive repair may be needed for associated tendon tears.

Prognosis is generally favorable with appropriate rehabilitation, though some patients require surgery or may experience recurrent symptoms. Prevention emphasizes gradual training progression, proper conditioning, and addressing technique and posture to reduce repetitive overhead strain.