Impingement

Abstract

The impingement syndrome is a common disorder of the||| shoulder girdle. The causes for this syndrome may be anatomic changes in the||| coracoacromial arch, also within the ultrastructural regions, on the one hand,||| or changes in the biomechanics which have developed for various reasons, on the||| other. Diagnosis is based on roentgenograms using the appropriate technique. In||| large-scale-studies, sonography has proved to be an extremely sensitive||| screening method for differential diagnosis of rupture of the rotator cuff.||| Magnetic resonance imaging might gain in value in the diagnosis of impingement||| as regards differential diagnosis of rupture of the rotator cuff because this||| technique--when employed appropriately--allows exact viewing of the soft tissue||| and the anterior part of the acromion. In the majority of cases conservative||| treatment is the method of choice. Methods of treatment are sonography,||| galvanization, and application of heat. Physiotherapy should not be initiated||| until pain relief has been achieved by other measures. Infiltration therapy is||| of considerable value in the management of pain due to impingement. Application||| of cortisone into the subacromial space must also be considered critically. As||| regards conservative therapy, only few evidence-based publications provide||| information on the effectiveness of different treatment regimens. Surgical||| therapy is only indicated in cases of pain resistant to the conservative||| therapy for a certain period. Furthermore, only an outlet impingement can be||| treated successfully by surgical decompression. The surgeon decides on the||| surgical method--open surgery or arthroscopy. Of course, arthroscopic methods||| are less invasive; however, up to now the superiority of one of the surgical||| methods over the other could not yet be proven by mid-term clinical results.||| Other surgical methods such as wedge osteotomy in the region of the spina||| scapulae are still in the experimental stage. By surgical and conservatives||| methods, good and even excellent results can be achieved in about 80% of the||| cases. The question remains as to why 20% of the patients show unsatisfactory||| results. One explanation might be that factors such as pathologic changes of||| the muscular balance and an altered microstructure of the tendons of the||| rotator cuff are rarely taken into consideration and Neer's concept of||| decompression is overestimated. Further research will be required in the field||| of biomechanics but clinical research on treatment concepts should also be||| undertaken to develop more differentiated strategies of||| treatment.