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Impingement – Causes, Symptoms and Treatment
Impingement refers to the painful pinching of soft tissue structures within a joint, most commonly at the shoulder or hip. It causes pain, restricted movement, and can lead to permanent damage if left untreated.
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Impingement refers to the painful pinching of soft tissue structures within a joint, most commonly at the shoulder or hip. It causes pain, restricted movement, and can lead to permanent damage if left untreated.
What is Impingement?
Impingement is a medical term describing the mechanical compression or pinching of soft tissue structures – such as tendons, bursae, or joint labrum – within a joint. The condition is most commonly seen in the shoulder and the hip, but can also affect other joints. It is a frequent cause of joint pain and restricted mobility, particularly in active individuals and older adults.
Causes
The causes of impingement vary depending on the joint affected:
- Shoulder Impingement: Narrowing of the subacromial space due to bone spurs (osteophytes), thickened tendons, or an inflamed bursa. Often triggered by repetitive overhead activities or poor posture.
- Hip Impingement (FAI – Femoroacetabular Impingement): Abnormal bone formation on the femoral head (Cam type), the acetabulum (Pincer type), or both, leading to friction within the joint.
- General Risk Factors: Repetitive movements, athletic activity, muscular imbalances, congenital joint abnormalities, and age-related joint degeneration.
Symptoms
Common symptoms of impingement include:
- Pain in the affected joint, especially during specific movements
- Increased pain with loading or in certain positions (e.g., raising the arm above shoulder level)
- Reduced range of motion in the joint
- Tenderness to pressure around the joint area
- In advanced cases: muscle weakness and pain at night
Diagnosis
Impingement is typically diagnosed through a combination of clinical examination and imaging:
- Clinical Tests: Provocative maneuvers such as the Neer test or Hawkins-Kennedy test for shoulder impingement, and the FADIR test for hip impingement, are used to reproduce characteristic pain.
- Imaging: X-rays assess bony structures; MRI (Magnetic Resonance Imaging) provides detailed views of tendons, bursae, and labral tissue.
- Ultrasound: Can be used to evaluate tendons and bursae in real time.
Treatment
Conservative Treatment
Most patients are initially managed with non-surgical approaches:
- Physiotherapy: Strengthening of the muscles stabilizing the joint, improving range of motion, and correcting movement patterns
- Pain Management: Anti-inflammatory medications (NSAIDs such as ibuprofen or diclofenac) to reduce pain and inflammation
- Corticosteroid Injections: Local injections into the bursa or joint space for persistent symptoms
- Activity Modification: Avoiding painful movements and reducing aggravating activities
Surgical Treatment
If conservative treatment fails to provide sufficient relief after several months, surgical intervention may be considered:
- Arthroscopic Decompression: A minimally invasive procedure to enlarge the joint space and remove bone spurs or inflamed tissue
- Reconstruction: In cases with associated tendon tears or labral lesions, surgical repair may be required
Prognosis
With early diagnosis and consistent treatment, the prognosis for impingement is generally favorable. Many patients achieve significant symptom relief through physiotherapy and conservative measures. Without treatment, however, progressive damage to tendons and cartilage can occur, potentially leading to osteoarthritis.
References
- Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clinical Orthopaedics and Related Research. 1993.
- Ganz R et al. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clinical Orthopaedics and Related Research. 2008;466(2):264-272.
- Neer CS. Impingement lesions. Clinical Orthopaedics and Related Research. 1983;173:70-77.
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