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Impingement syndrome of the rotator cuff

PHS = periarthritis humeroscapularis = Shoulder-arm syndrome, impingement syndrome = entrapment of tendons cap)

The term "PHS" generally summarizes shoulder pain, which can have a variety of causes:

1. Supraspinatus syndrome (entrapment of the supraspinatus muscle tendon under the acromion)
2. Calcific tendinitis (calcification in the tendon fibers)
3. Rotator cuff tear
4. Frozen shoulder
5. Tenosynovialitis bicipital (inflammation of the paratenon of the biceps tendon)

Points 1 to 3 are most often responsible for complaints and will be discussed in detail.
The rotator cuff tear is a topic of its own - see below.
The impingement syndrome can cause the following complaints:
Night pain, shoulder pain in case of head movements and the return of the arm behind the rump, pain radiates into the outer side and to the center of the upper arm (pain while combing hackles and apron binding)

What causes this pain?

The tendon of the rotator cuff and bursa (between the tendon and the acromion) slide between the humeral head and the acromion during an upward movement of the upper arm.
If there is a hooked acromion or a very thick band (ligament coracoacromial) between the ball (acromion) and coracoid, then there is insufficient space for the tendon and bursa to slide between the humeral head and the acromion.
It comes to the so-called impingement, that is the entrapment of the soft tissues between the humeral head and the acromion.
With each movement, there is damage to the soft tissue, starting with swelling of the tendons cap, followed by hemorrhage and inflammation. This grave situation is followed by a hardening of the tendon (fibrosis). As a consequence, even large calcium deposits can form in the tendon. Calcium deposits may also form without the "impingement", ie under normal space. The cause therefore is unknown.

The final stage occurs when the severely damaged tendon cap tears due to normal daily movements or due to a more or less severe accident - the rotator cuff tear occurred.

Impingement of the tendon and bursa when lifting the arm.

Treatment principle

 

The arthroscopic surgery is preceded by a systemized clinical examination, furthermore, special X-rays and an MRI take place.

We refrain from a painful and not entirely risk-free arthrography (air and contrast medium injection into the joint).

The goal of arthroscopic surgery is to make room for the necessary gliding of the sinews cap.

First, using a 5-mm skin incision the shoulder joint itself is examined in order to find and resolve any damage in the joint, for example, a subluxation (partial dislocation).

The arthroscope is then inserted into the bursa under the acromion (subacromial bursa) (there is no further incision required) and the bursa (if calcified or inflamed) is removed using an air knife (4.5 mm diameter). This requires a second 5 to 8 mm wide incision. Any calcium deposits are also removed.

Left: Before the operation, there was a large calcium deposit in the tendon cap.

Right: State after arthroscopic decalcification.

 

Aftercare

This operation, which does require a lot of experience and patience from the surgeon, is not very stressful for the patient and the pre-existing pain usually disappears immediately after surgery, hardly the case with other operations. Therefore, under ideal conditions, it can be performed ambulant or briefly stationary.

Passive therapy begins on the first day after surgery, active therapeutic exercise on the third day.

The full range of movability is achieved usually two to three weeks after surgery.

In general we use a motorized splint (CPM).

Ability to work

Office work after three to five days.

Hard physical work after about six weeks.

Sports Ability

Swimming and less stressful sports after about three weeks.

Overhead sports only after three months.

Results

Good results can be achieved in 96 percent of the cases, the patients are either painless or have minimal pain even under heavy strain. Even in these operations we use radiosurgical probes with success.

Complications

This surgery has a very low complication rate, and has a very low risk. Theoretically, very rarely, infections or wound healing disturbances can occur. Eventually, the pain may persist even after the surgery, or even intensify. Possibly muscles, ligaments or nerves could be injured during surgery. Our patients so far have experienced no such complications.

Left: Arthroscopic view under the acromion: massive impingement with the periosteum abrading on the acromion.

Right: After smoothing and after the removal of the bone spur (acromio plasti), there is now plenty of space for the rotator cuff and no impingement any longer. The pain is gone.