Impingement

Impingement

If you look at the osseous channel through which the Rotator Cuff runs, it is easy to see how damage to the muscle tissue can occur through exertion. Like a rope fraying when mountain climbing, the muscles can also suffer small injuries if constantly pulled over a sharp edge while moving. This usually happens when the acromion has a steeper downward slope due to genetics or if it becomes narrower due to degenerative changes. 

The body attempts to heal these damaged fibres (see also healing phases), which is typically accompanied by swelling and pain in the initial stage, the inflammation phase.Due to the swelling however, the already narrow osseous channel is made even narrower, resulting in a kind of pinching of the muscle (impingement) that hurts when rotating the arm inwards and outwards, when lifting the arm, and especially when lying on the affected shoulder at night. See also PDF download

This is also called impingement syndrome. A painful inflammation of the bursa in the shoulder is a common complaint of this syndrome. In most cases, the symptoms can be effectively treated with anti-inflammatory drugs and physiotherapy. In some chronic cases, the bursa can become calcified (Bursitis calcarea, which can result in persistent pain. This generally responds very well to shock wave therapy (ESWT) in combination with physiotherapy. In unresponsive situations, infiltration with a painkiller and a small dose of cortisone can be helpful (however, this should not be done more than 2-3 times). If all of the above-listed therapeutic measures fail to heal and provide pain relief (or if the acromion is severely restricted), Dr. Gabler recommends an arthoscopic operation (Arthroscopy) to mill the acromion to create space and clear out the calcium deposits.