Impeachment syndrome of various joints

Impingement, or impeachment syndrome - is a specific pathology, for which the contact of the bone elements forming the joint is typical. Such contact leads to a restriction of the motor function, and arises from the disturbed anatomical relationship of the articular surfaces.

Speaking of impeachment syndrome, most people have in mind the pathology of the shoulder joint. However, no less often this problem also affects the hip or ankle joints, which is due to their structural features.

Normal motor function in the joint is possible in the presence of adequate articular surfaces. When forming a bone growth on one of them, there is a motor disruption, which is most often manifested during high-amplitude movements.

[1], [2], [3]

Epidemiology

Impeachment syndrome is most often diagnosed in people actively involved in sports - mainly in young and middle age (25-45 years). The greatest risk of the syndrome is present in swimmers, volleyball players, football players, tennis players.

Impeach shoulder syndrome is often formed in people whose activities are associated with regular and prolonged raising of limbs. For example, pathology is often determined by installers, builders, climbers, weightlifters, etc.

There is also a small percentage of cases when the syndrome was diagnosed due to minor traumatic damage to the joint, or even without an obvious cause.

Men are more often ill than women. Most likely, this is due to professional characteristics and greater physical activity of the male population.

[4], [5], [6]

Causes of the impeachment of a syndrome

Like any disease, impeachment syndrome has its own initial causes:

• neurodystrophic processes in the tendons, as a consequence of osteochondrosis, spondylosis, or changes in the position of the vertebrae;
• muscle damage with regular or occasional overloads;
• trauma, accompanied by a violation of the integrity of the tendons, vessels;
• common diseases (heart failure, heart attack, diabetes, craniocerebral trauma, Parkinson's disease, tuberculosis);
• surgical interventions.

[7], [8], [9]

Risk factors

The provoking factors that contribute to the development of impeachment of the syndrome are:

• hypothermia of the joint;
• congenital form of arthropathy;
• atherosclerotic changes, osteochondrosis, endocrine pathologies;
• long and strong physical activity;
• excess weight.

[10]

Pathogenesis

Consider the pathogenetic features of the disease by the example of impeachment of the shoulder joint syndrome. Normally there is a gap between the rotator cuff and the acromion, so that there are no problems for the passage of the tendons. However, with every rise of the limb, the tendon and the joint bag are pressed down - in such a situation, they talk about impeachment syndrome.

Syndrome in varying degrees can manifest itself in almost any adult. But the expressed pathology is observed mainly at those who often conducts any actions with the arms extended upwards.

Often the syndrome develops when the cuff tendon is damaged. The problem can be formed as a result of any conditions that cause a contraction of the tendon-acromial space. For example, the common cause of this reduction is the appearance of a clavic bone spur.

In some patients, the gap is shortened by the deformation or enlargement of the scapula.

Subacromial impeachment syndrome is a structural change in the shoulder joint next to the subacromial bursa. This pathology often causes severe pain in the shoulder area, which is caused by excessive pressure of the scapula on the joint capsule at the time of the extreme vertical position of the limb.

[11], [12], [13], [14]

Symptoms of the impeachment of a syndrome

Impeachment syndrome first of all reveals itself pains in the affected joint. At the initial stage, soreness is not very pronounced: many patients describe it as a certain temporary discomfort. Gradually, during the development of the pathological process, the pain begins to bother - first with large-amplitude movements, and then - with any motor activity affected by the limb. Gradually, signs of an intraarticular inflammatory process also appear.

The first signs of impeachment syndrome may be as follows:

• acute tenderness when moving in the joint;
• clicks in the joint, especially at the time of relaxation of the limb;
• intensification of soreness with palpation of the affected joint;
• periodic pain at night;
• increased pain when performing wide-amplitude movements;
• growing stiffness in the joint;
• atrophic processes in muscles related to the affected joint.

Already with the appearance of one of the listed symptoms, you should contact the doctor. If the impeachment syndrome is recognized in a timely manner, then one can stop the disease and avoid many troubles.

[15], [16], [17]

Stages

Stage I is called reversible: swelling of the joint with internal hemorrhage is observed, in patients under 25 years of age. As a rule, at this stage, the disease can be managed with the help of conservative therapy.

II stage is called irreversible: there is a development of fibrosis and tendonitis. This stage is typical for patients aged 25-40 years. As the treatment is appropriate to use acromioplasty.

Stage III is also considered irreversible and is characterized by the formation of growths and cuff ruptures. The stage is typical for patients 40 years and older. To alleviate the condition, surgical intervention is necessary.

[18], [19], [20]

Forms

In medical practice, the following conditional classification is used: impeachment of the syndrome:

1. Primary syndrome - develops due to mechanical damage:

• against the background of post-traumatic deformation;
• with damage to the tendon;
• with osteophytes;
• with congenital disruption of the shape of the joint structures.

1. Secondary syndrome - occurs due to the narrowing of the podkroommalnogo gap, which, in turn, can be provoked:

• violation of the integrity of the tendon or rotator cuff;
• damage to the ligament apparatus;
• congenital ligament insufficiency;
• sealing bag or rotator cuff;
• spasm or weakness of the musculature;
• displacement of bone structures.

Impeachment of shoulder joint syndrome

Impeachment of shoulder syndrome occurs most often. The appearance of such a pathology of contact of articular surfaces may be accompanied by the following signs:

• diffuse aching pain in the shoulder region;
• increased pain in the vertical lift of the limb, with the arm behind the back in the direction of the buttock.

With time, movements in the joint deteriorate. There may be muscle weakness when trying to raise a hand: this usually indicates a defeat of the tendon of the rotator cuff.

A type of defeat of the anterior part of the shoulder joint is a subclavian impeachment syndrome. This form of the syndrome manifests itself when a certain position is given to the shoulder joint: pain occurs when the head of the humerus is displaced forward against the background of joint instability.

Impeachment of tendon syndrome of the supraspinatus usually results from mechanical damage to the soft tissues of the shoulder. As a rule, such pathology is inflammatory and difficult to treat.

[21], [22]

Impeachment of hip joint syndrome

When impeachment syndrome in the hip joint, there is a touch of the border of the acetabulum and the neck or head of the femur. The condition is characterized by pain in the inguinal region with irradiation to the external surface of the thigh and to the knee zone. The symptomatology is clearly manifested with a wide range of movements, when the extreme positions of the femur are reached.

Motor disorders can be different, depending on the localization of bone growths: usually flexion, extensor, rotational movements, and also the removal of the leg to the side.

Impeachment of ankle syndrome

Depending on the position of the foot at the moment of contact of the bones (extreme extension or flexion), diagnose the anterior or posterior impeachment syndrome. This condition is characterized by a violation of the ratio of different parts of the talus and tibia.

With the syndrome of anterior contact, pain is noted at the time of extreme extension of the foot. The posterior syndrome is characterized by pain in the extreme flexion. In both cases, motor problems are aggravated if the disease is not detected in a timely manner.

Impeachment of the knee joint

Impeachment of the syndrome in the knee joint is rare enough. This pathology is a violation of the knee, in which the patient feels severe discomfort and pain. Such symptoms are associated with the squeezing of the articular bursa and tendons that occurs during movement.

The most common imputation of the knee joint is associated with frequent injuries - for example, in sports.

Complications and consequences

It is believed that timely medical care significantly increases the likelihood of eliminating a problem such as impeachment syndrome. We must not forget that neglected pathology is more difficult to treat and can lead to the development of negative consequences:

• paralysis;
• impaired motor activity;
• limitation of the amplitude of movements.

Later, the treatment of a doctor adversely affects the prognosis of impeachment of the syndrome and can lead to disability.

[23], [24], [25]

Diagnostics of the impeachment of a syndrome

The main diagnostic method is arthroscopy - it is used, both for diagnosis and as a therapeutic measure. The procedure of arthroscopy is not inferior in effectiveness to open surgical intervention. Moreover, because of the reduced period of rehabilitation, healing is faster and better.

Currently, arthroscopy is actively used for impeachment of the knee, ankle, shoulder and other large joints syndrome. The procedure is performed in a hospital setting, using general or local anesthesia on a background of sedation. In the affected area, three small punctures (about 5 mm) are performed, by means of one of them a special device is inserted into the joint - an arthroscope. Other holes are necessary for the insertion of tools. After the completion of the procedure, through the same punctures, fluid is pumped out or drug solutions are injected, then the stitches are applied and bandaged.

Analyzes with confirmation impeachment of the syndrome are done only to assess the general condition of the body. As a rule, the patient is recommended to give a general blood and urine test, as well as a biochemical blood test.

• According to the results of the blood test, attention is drawn to the amount of C-reactive protein, the definilamine reaction, the increase in the number of leukocytes and the rate of ESR. Also, the level of uric acid and the level of lysosomal enzymes may increase.
• According to the results of urine analysis, it is estimated whether there are violations from the kidneys - for example, whether there is a protein in the urine.

Instrumental diagnostics helps in more detail assess the joint condition.

• US of the joint is used for differential diagnosis of injuries, rheumatological diseases, inflammatory processes, impeachment of the syndrome.
• MRI is a very informative, but relatively expensive procedure that provides a clear image of the joint structure. Magnetic resonance imaging can identify posttraumatic conditions, degenerative processes, etc.
• Radiography is performed for any joint pain, stiffness, edema in the joint area. The procedure does not last more than a couple of minutes. It may take another quarter of an hour to make pictures. X-ray helps to consider the presence of articular deformity and other pathological changes.
• Computer tomography allows you to take pictures on a "cut" in any planes. CT is able to demonstrate any tissue changes, the presence of osteophytes and the proliferation of cartilage.

[26], [27], [28], [29], [30]

Differential diagnosis

Differential diagnosis is carried out with such pathologies:

• diseases and unstable conditions of the spinal column;
• calcification in tendons;
• Neuropathology (with impeachment of the shoulder syndrome - neuropathy of the subscapular nerve);
• arthrosis;
• osteochondrosis of the spine;
• other inflammatory diseases, which can be accompanied by the irradiation of joint pain (upper lobe inflammation of the lungs, cholecystopancreatitis, etc.);
• adhesive capsulitis.

Treatment of the impeachment of a syndrome

In most cases conservative methods are used to treat imputation of the syndrome. Drugs such as non-steroidal anti-inflammatory drugs, such as Ibuprofen or Diclofenac, may be prescribed. At first to relax the painful sensations it is recommended to put a cool compress and maximum immobilization of the limb.

If the anti-inflammatory therapy is ineffective, hormonal treatment is used: the drug (for example, Cortisone or Diprospan) is administered intra-articularly - this procedure is called a glucocorticoid blockade. The blockade effectively removes pain and stops the development of an inflammatory reaction, but can cause damage to the cartilaginous tissue.

Additionally, physiotherapy and exercise therapy are prescribed without fail on the background of the maximum immobility of the joint.

Medications for impeachment syndrome

	Dosing and Administration	Side effects	special instructions
Ibuprofen	Adults take 1-2 tablets every 5 hours, but not more than six tablets per day. The course should not exceed 3-5 consecutive days.	Nausea, sleep disorders, gastritis, pancreatitis, anemia, allergic reactions.	Prolonged use of the drug may cause an increase in thrombosis, a violation of digestive processes.
Diclofenac	Introduce 1 ampoule of the drug per day, intramuscularly, for 2-3 days.	Thrombosis, hypersensitivity reactions, depression, headaches, fatigue, palpitation, abdominal pain.	The course of treatment should be the minimum possible, as well as the dosage of the drug.
Meloxicam	Enter intramuscularly 15 mg once a day, for 2-3 days.	Pain in the head, dizziness, indigestion, nausea, vomiting, diarrhea, pain at the injection site.	The drug is administered slowly to avoid the appearance of hardening at the injection site.
Nimesulide	Gel Nimesulid is applied to the affected joint area and gradually rubbed, 3-4 times a day. The course of treatment is 4 weeks.	Redness of the skin, itching, allergies.	The gel should not be combined with other external products in one area of the skin.
Diprospan	As a rule, inject 0.5-2 ml of the drug intra-articularly.	Weakness in muscles, convulsions, endocrine disorders, depression.	Intra-articular introduction of the drug is carried out only by a medical specialist. It should avoid the introduction of medication into the unstable joint and directly into the tendon.

Physiotherapeutic treatment

The use of physiotherapy in combination with conservative treatment often leads to the emergence of a sustained and lasting relief of impeachment syndrome. Of course, any method has its own indications and contraindications, so the doctor before the appointment of such treatment always assesses the general condition of the patient and the presence of other background diseases.

When imprinting a syndrome, most often recommend such physiotherapy procedures:

• drug electrophoresis (mainly with analgesics);
• magnetotherapy (especially recommended after joint injuries);
• laser therapy (helps to restore periarticular tissues and stop the inflammatory process);
• shock-wave treatment (assumes the use of acoustic low-frequency waves, which can significantly improve blood circulation in the affected joint);
• paraffinotherapy, mud therapy.

Exercise in impeachment syndrome

A special role in the improvement of the patient's condition is played by a special gymnastic complex. Immediately it is worth noting that exercises with impeachment of the shoulder joint syndrome begin to be performed only after the acute period of the illness subsides.

The patient does the first exercises under the supervision of a doctor. If there are no questions about the motor technique, then it is possible to start exercise therapy at home.

When impeached shoulder syndrome advised to perform such gymnastics:

• The "pendulum" of movement by the limb to the left and to the right;
• lifting and tilting the hands to the sides with the holding of a tight scarf or towel;
• Attempts to reach out as far as possible;
• exercises with dumbbells designed for the muscles of the rotator cuff.

When impeachment of the hip joint syndrome is performed the following gymnastics:

• They fit on their backs, bending their knees. Without detachment, the feet from the floor are withdrawn and the thighs lead, gradually widening the amplitude.
• Fit on your back, stretch your legs straight. One leg is trying to lift, making simultaneously shaking to the left and to the right movements, with different amplitudes.
• They sit on a chair, bend forward, touching the legs with the tips of the fingers on their hands.
• Standing straight, they stick to the back of the chair. Spend the mahi leg forward and back, with a gradual expansion of the amplitude.

Exercise should be done every day, without missing classes. If you follow all the advice, then rehabilitation will be much faster.

[31], [32], [33], [34], [35], [36], [37], [38]

Alternative treatment

• To eliminate acute pain, procedures are used to increase blood circulation in the affected joint. Among such procedures, the most common alcohol compresses, honey massage, ointments based on mustard or red pepper.
• To warm up the painful area, they usually use products that can retain heat for a long time - for example, a coarse salt, ozocerite, dry buckwheat or rice, boiled potatoes, paraffin. Warming up with the help of cereals or salt is carried out as follows: the ingredient is heated on a dry frying pan, poured into a tissue bag or bundle, well tied. Pouch is applied to the affected joint (through a towel or handkerchief so as not to burn), leave for 1-2 hours.
• Apply compresses based on alcohol. This allows you to achieve an analgesic, resolving and anti-inflammatory effect. To warm up the joint and reduce painful sensations, the affected area is covered with a 4-layer gauze cloth impregnated with alcohol solution. Waxed paper or cellophane is placed on top of the napkin. Next, you should tie a warm scarf or scarf. As a rule, compresses are put on at night, and they are removed only in the morning. For treatment, you can use ordinary vodka or alcohol solution, as well as alcoholic tinctures of horse chestnut, marigold, sea buckthorn.

[39], [40], [41]

Herbal Treatment

Alternative treatment for impeachment syndrome involves not only the external use of various drugs, but also taking drugs inside. So, experts advise to drink infusions of plants that have anti-inflammatory, analgesic, decongestant and chondroprotective effect. Such plants include:

• cranberry leaves;
• berries of cranberries and cowberries;
• chestnut flaps;
• bay leaf (a dozen leaves pour 200 ml of boiling water and insist for half an hour, drink a third of the glass 2-3 times a day).

In severe pain, additional lotions with cool chamomile infusions, birch leaves, calendula should be additionally applied. You can apply grated raw potatoes, freshly harvested burdock or cabbage.

Inside daily take:

• for 2 tsp. Tinctures of juniper (1 tablespoon fruit per 200 ml of vodka);
• diuretic collection;
• fresh pumpkin juice or cucumbers;
• infusion of string (1/4 cup three times a day);
• fresh celery juice (1 tbsp. Before meals);
• honey with black radish juice.

Homeopathy

Homeopathic remedies are successfully used when impeachment syndrome concurrent with traditional methods of treatment. Such drugs allow you to adjust the correct metabolic processes, reduce body weight, restore muscle tone.

Homeopathy offers a variety of drugs - both combined and "mono". Only a doctor who has the appropriate qualifications appoints them.

• Aurum - prescribe for joint pain, osteoarthritis, arthrosis, atherosclerosis. There are no side effects when using the drug. The dosage is determined by the doctor depending on the stage of the patient's syndrome and constitution.
• It is a complex preparation actively used for arthrosis, osteochondrosis, bursitis, arthritis. Patients are recommended to take the drug for two months, three times a day for 10 drops, between meals.
• Object-T is a complex agent that has an anti-inflammatory, chondroprotective and analgesic effect. The drug is taken under the tongue, three times a day, one tablet, for 6 weeks.
• Traumeel C is an effective complex preparation of homeopathy, which helps in the treatment of various inflammatory and degenerative joint diseases. Standard take one tablet for half an hour before meals, three times a day. The course of treatment is six weeks.

Do not engage in self-medication, even if it comes to harmless homeopathic remedies. You must first get advice from a doctor.

Surgery

If the usual methods of treatment do not lead to an improvement in the impeachment syndrome, the doctor can recommend surgery to the patient. Thanks to it it is possible to increase the gap, which contributes to the appearance of painful contact.

The surgeon in an operative way removes bone protrusions that interfere with the normal operation of the joint.

Since impeachment syndrome in many patients is combined with the phenomena of osteoarthritis, the operation is often carried out simultaneously with resection arthroplasty. The essence of the intervention is to eliminate the pain that occurs due to friction of the acromial ends with the clavicle. Further, the connective tissue proliferation and the filling of the gap between the clavicle and the appendage, the so-called "false joint" is formed.

For the treatment of some patients, arthroscopy is used. A special device is injected into the joint cavity through a puncture made. The image can be viewed on the monitor. This method makes it possible to specify with accuracy the region with a reduced gap. After discovering the pathologically altered area through another puncture, the doctor enters the instrumentation and removes the interfering part of the bone.

After the operation, the patient leads a sparing lifestyle. In most cases, the limb is immobilized for a period of 1 to 2 months. Such a long period of rehabilitation is due to the fact that damaged tissues should be completely restored.

Prevention

Diagnosis impeachment syndrome is often set to patients who are actively engaged in sports or heavy physical labor. To prevent the development of pathology, it is important to try to prevent the appearance of the problem in advance.

Physical stress is required for the joints. However, it is better if it is dosed and gradual, without excessive overload and wide-amplitude sharp movements. For people who lead a largely sedentary lifestyle, you need to do light gymnastics several times during the day.

You can also prevent the syndrome with proper nutrition and avoiding bad habits. The food ration should include foods rich in calcium, vitamins, zinc and collagen. Collagen in large quantities is present in jellies, holodtsah, marmalade.

If possible, bruises and other joint injuries should be avoided. If the trauma does occur, it is important to follow all the doctor's recommendations until the damaged area is completely healed.

It is equally important to timely diagnose and treat any inflammation in the body - both acute and chronic.

[42], [43], [44], [45]

Forecast

If the impeachment syndrome is detected in a timely manner, and the treatment is prescribed full and competent, then one can hope for a relatively favorable prognosis of the disease. That is, the disease can not be cured conservatively completely. However, doctors will be able to stop the further pathological process and significantly improve the patient's condition.

If treatment to the doctor is belated, the patient can develop irreversible changes in the joint, which often leads to a permanent loss of ability to work. Therefore, we can draw an appropriate conclusion: an early appeal for medical care increases the chances of a qualitative disposal from such a pathology as impeachment syndrome.

[46], [47], [48]