Impingement syndrome of various joints

Impingement, or impeachment syndrome, is a specific pathology, which is characterized by contact of bone elements that form a joint. Such contact leads to limitation of motor function and occurs due to a disrupted anatomical relationship of the articular surfaces.

When talking about impeachment syndrome, most people mean a pathology of the shoulder joint. However, no less often, such a problem also affects the hip or ankle joints, which is explained by their structural features.

Normal motor function in a joint is possible with adequate articular surfaces. When a bone growth forms on one of them, a motor disorder occurs, which most often manifests itself during high-amplitude movements.

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Epidemiology

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

Impeachment syndrome of the shoulder often develops in people whose activities are associated with regular and prolonged lifting of the limbs. For example, the pathology is often determined in fitters, builders, rock climbers, weightlifters, etc.

There is also a small percentage of cases where the syndrome was diagnosed as a result of minor traumatic injury to the joint, or even without an obvious cause.

Men are more likely to get sick than women. This is most likely due to professional characteristics and greater physical activity of the male population.

Causes impeachment syndrome

Like any disease, impeachment syndrome has its underlying causes:

• neurodystrophic processes in the tendons, as a result of osteochondrosis, spondylosis, or changes in the position of the vertebrae;
• muscle damage due to regular or one-time overloads;
• injuries accompanied by damage to the integrity of tendons and blood vessels;
• general diseases (heart failure, heart attack, diabetes, traumatic brain injury, Parkinson's disease, tuberculosis);
• surgical interventions.

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Risk factors

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

• hypothermia of the joint;
• congenital form of arthropathies;
• atherosclerotic changes, osteochondrosis, endocrine pathologies;
• prolonged and intense physical exertion;
• excess weight.

Pathogenesis

Let's consider the pathogenetic features of the disease using the example of impeachment syndrome of the shoulder joint. Normally, there is a gap between the rotator cuff and the acromion - so that there are no problems for the passage of tendons. However, with each lift of the limb, the tendon and joint capsule are pressed - in such a situation, they talk about impeachment syndrome.

The syndrome can manifest itself to varying degrees in almost any adult. But pronounced pathology is observed mainly in those who often perform any actions with their arms extended upward.

Often, the syndrome develops when the cuff tendons are damaged. The problem can develop as a result of any conditions that cause a shortening of the acromial tendon space. For example, a common cause of such a shortening is the appearance of a clavicular bone spur.

In some patients, the gap is reduced due to deformation or enlargement of the scapular process.

Subacromial impeachment syndrome is a structural change in the shoulder joint near 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 moment of the extreme vertical position of the limb.

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Symptoms impeachment syndrome

Impeachment syndrome first manifests itself as pain in the affected joint. At the initial stage, the pain is not very pronounced: many patients describe it as a certain temporary discomfort. Gradually, as the pathological process develops, the pain begins to bother - first with wide-amplitude movements, and then - with any motor activity of the affected limb. Signs of intra-articular inflammatory process gradually appear.

The first signs of impeachment syndrome may be:

• acute pain when moving the joint;
• clicking in the joint, especially when relaxing the limb;
• increased pain when palpating the affected joint;
• periodic increase in pain at night;
• increasing pain when performing large-amplitude movements;
• increasing stiffness in the joint;
• atrophic processes in the muscles related to the affected joint.

Already when one of the listed symptoms appears, it is necessary to contact a doctor. If impeachment syndrome is recognized in a timely manner, then the disease can be stopped and many troubles can be avoided.

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Stages

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

Stage II is called irreversible: fibrosis and tendinitis develop. This stage is typical for patients aged 25-40. Acromioplasty is appropriate as a treatment.

Stage III is also considered irreversible and is characterized by the formation of growths and ruptures of the cuff. The stage is typical for patients aged 40 and older. Surgical intervention has to be used to alleviate the condition.

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Forms

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

1. Primary syndrome – develops as a result of mechanical damage:

• against the background of post-traumatic deformation;
• in case of tendon injury;
• for osteophytes;
• in case of congenital malformation of the joint structures.

1. Secondary syndrome – occurs as a result of narrowing of the subacromial space, which, in turn, can be provoked by:

• violation of the integrity of the tendon or rotator cuff;
• damage to the ligamentous apparatus;
• congenital ligamentous insufficiency;
• compaction of the bursa or rotator cuff;
• muscle spasm or weakness;
• displacement of bone structures.

Impeachment syndrome of the shoulder joint

Impeachment syndrome of the shoulder is the most common. The appearance of such pathology of contact of articular surfaces can be accompanied by the following symptoms:

• diffuse aching pain in the shoulder area;
• increased pain when lifting the limb vertically, when moving the arm behind the back towards the buttock.

Over time, joint movement deteriorates. Muscle weakness may occur when attempting to raise the arm: this usually indicates damage to the rotator cuff tendon.

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

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

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Impeachment syndrome of the hip joint

In impeachment syndrome, the border of the acetabulum and the neck or head of the femur are in contact with each other in the hip joint. The condition is characterized by pain in the groin area radiating to the outer surface of the thigh and to the knee area. Symptoms are clearly evident with a wide range of motion, upon reaching the extreme positions of the femur.

Movement disorders may vary depending on the location of the bone growths: usually flexion, extension, rotational movements, as well as abduction of the leg to the side, are affected.

Impeachment syndrome of the ankle joint

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

In anterior contact syndrome, pain is observed at the moment of extreme extension of the foot. For posterior syndrome, pain is characteristic at extreme flexion. In both cases, motor problems worsen if the disease is not detected in a timely manner.

Impeachment of the knee joint

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

Most often, knee impingement 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 such a problem as impeachment syndrome. We must not forget that advanced pathology is more difficult to treat and can lead to the development of negative consequences:

• paralysis;
• motor activity disorders;
• limitation of range of motion.

A late visit to a doctor negatively affects the prognosis of impeachment syndrome and can lead to disability.

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Diagnostics impeachment syndrome

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

Currently, arthroscopy is actively used for impeachment syndrome of the knee, ankle, shoulder and other large joints. The procedure is performed in a hospital setting, using general or local anesthesia with sedation. Three small punctures (about 5 mm) are made in the affected area, through one of which a special device is inserted into the joint - an arthroscope. Other holes are needed to insert instruments. After the procedure is completed, fluid is pumped out or medicinal solutions are introduced through the same punctures, after which stitches are applied and bandaged.

When impeachment syndrome is confirmed, tests are performed only to assess the general condition of the body. As a rule, the patient is recommended to take a general blood and urine test, as well as a biochemical blood test.

• The blood test results include the amount of C-reactive protein, the definitive amine reaction, an increase in the number of leukocytes, and the ESR rate. The level of uric acid and the level of lysosomal enzymes may also increase.
• The results of a urine test are used to assess whether there are any problems with the kidneys, for example, whether there is protein in the urine.

Instrumental diagnostics helps to assess the condition of the joint in more detail.

• Ultrasound of the joint is used for differential diagnosis of injuries, rheumatological diseases, inflammatory processes, and impeachment syndrome.
• MRI is a very informative but relatively expensive procedure that provides a clear image of the joint structure. Magnetic resonance imaging allows identifying post-traumatic conditions, degenerative processes, etc.
• X-rays are taken for any joint pain, stiffness, swelling in the joint area. The procedure lasts no more than a couple of minutes. Taking the pictures may take another quarter of an hour. X-rays help to see the presence of joint deformation and other pathological changes.
• Computer tomography allows you to take pictures on a "section" in any plane. CT is able to demonstrate any tissue changes, the presence of osteophytes and cartilage growth.

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Differential diagnosis

Differential diagnostics are carried out with the following pathologies:

• diseases and unstable conditions of the spinal column;
• calcifications in tendons;
• neuropathology (with impeachment syndrome of the shoulder - neuropathy of the subscapular nerve);
• arthrosis;
• osteochondrosis of the spinal column;
• other inflammatory diseases that may be accompanied by irradiation of pain to the joints (upper lobe pneumonia, cholecystopancreatitis, etc.);
• adhesive capsulitis.

Treatment impeachment syndrome

In most cases, conservative methods are used to treat impeachment syndrome. Such medications as non-steroidal anti-inflammatory drugs, such as Ibuprofen or Diclofenac, may be prescribed. At first, a cool compress and maximum immobilization of the limb are recommended to relieve pain.

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

Additionally, physiotherapy and exercise therapy are prescribed without fail, with maximum immobilization of the joint.

Medicines for impeachment syndrome

	Method of administration and dosage	Side effects	Special instructions
Ibuprofen	Adults take 1-2 tablets every 5 hours, but no more than six tablets per day. The course of treatment should not exceed 3-5 days in a row.	Nausea, sleep disorders, gastritis, pancreatitis, anemia, allergic reactions.	Long-term use of the drug may cause increased thrombus formation and disruption of digestive processes.
Diclofenac	Administer 1 ampoule of the drug per day, intramuscularly, for 2-3 days.	Thrombosis, hypersensitivity reactions, depression, headaches, fatigue, palpitations, abdominal pain.	The course of treatment should be as minimal as possible, as should the dosage of the drug.
Meloxicam	Administer intramuscularly 15 mg once a day for 2-3 days.	Headache, dizziness, dyspepsia, nausea, vomiting, diarrhea, pain at the injection site.	The drug is administered slowly to avoid hardening at the injection site.
Nimesulide	Nimesulide gel is applied to the area of the affected joint and rubbed in little by little, 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 on the same area of skin.
Diprospan	The standard dose is 0.5-2 ml of the drug administered intra-articularly.	Muscle weakness, cramps, endocrine disorders, depression.	Intra-articular administration of the drug should only be performed by a medical specialist. Avoid injecting the drug into an unstable joint or directly into tendons.

Physiotherapy treatment

The use of physiotherapy in combination with conservative treatment often leads to the emergence of stable and long-term relief of impeachment syndrome. Of course, any method has its own indications and contraindications, so the doctor always evaluates the general condition of the patient and the presence of other background diseases before prescribing such treatment.

For impeachment syndrome, the following physiotherapy procedures are most often recommended:

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

Exercise therapy for impeachment syndrome

A special gymnastic complex plays a huge role in improving the patient's condition. It is worth noting right away that exercises for shoulder impingement syndrome begin to be performed only after the acute period of the disease has subsided.

The patient does the first exercises under the doctor's supervision. If there are no questions about the motor technique, then you can start doing exercise therapy at home.

For shoulder impingement syndrome, it is recommended to perform the following exercises:

• "pendulum" movement of the limb to the left and right;
• raising and bending your arms to the sides while holding a stretched scarf or towel;
• attempts to reach with your hands as high as possible;
• Dumbbell exercises targeting the rotator cuff muscles.

For impeachment syndrome of the hip joint, perform the following exercises:

• Lie on your back with your knees bent. Without lifting your feet off the floor, move your hips away and bring them in, gradually widening the range of motion.
• They lie on their backs, stretch their legs straight out. They try to lift one leg, simultaneously swinging it left and right, with different amplitudes.
• They sit on a chair, lean forward, touching their feet with the tips of their fingers.
• Standing straight, hold on to the back of a chair. Swing your legs forward and backward, gradually increasing the amplitude.

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

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Folk remedies

• To eliminate acute pain, procedures are used to increase blood circulation in the affected joint. Among such procedures, the most common are alcohol compresses, honey massage, ointments based on mustard or red pepper.
• To warm up the painful area, they usually use means that can retain heat for a long time - for example, coarse salt, ozokerite, dry buckwheat or rice, boiled potatoes, paraffin. Warming up with cereals or salt is carried out as follows: heat the ingredient in a dry frying pan, pour it into a cloth bag or knot, tie it well. Apply the bag to the affected joint (through a towel or scarf, so as not to burn yourself), leave for 1-2 hours.
• Alcohol-based compresses are used. This allows achieving an analgesic, resorption and anti-inflammatory effect. To warm up the joint and reduce pain, the affected area is covered with a 4-layer gauze napkin soaked in an alcohol solution. Wax paper or cellophane is placed on top of the napkin. Next, you should tie a warm scarf or shawl. As a rule, compresses are applied at night and removed only in the morning. For treatment, you can use regular vodka or an alcohol solution, as well as alcohol tinctures of horse chestnut, calendula, and sea buckthorn.

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Herbal treatment

Traditional treatment for impeachment syndrome involves not only external use of various remedies, but also taking medications internally. Thus, experts advise drinking infusions of plants that have anti-inflammatory, analgesic, anti-edematous and chondroprotective effects. Such plants include:

• lingonberry leaves;
• cranberries and lingonberries;
• chestnut pods;
• bay leaf (a dozen leaves are poured with 200 ml of boiling water and infused for half an hour, drink a third of a glass 2-3 times a day).

In case of severe pain, additionally apply compresses with cool infusions of chamomile, birch leaves, calendula. You can apply grated raw potatoes, freshly picked burdock or cabbage leaves.

Taken orally daily:

• 2 teaspoons of juniper tincture (1 tablespoon of fruit per 200 ml of vodka);
• diuretic collection;
• fresh pumpkin or cucumber juice;
• succession infusion (¼ glass three times a day);
• fresh celery juice (1 tbsp before meals);
• honey with black radish juice.

Homeopathy

Homeopathic remedies are successfully used for impeachment syndrome simultaneously with traditional methods of treatment. Such drugs allow you to set up correct metabolic processes, reduce body weight, and restore muscle tone.

Homeopathy offers a whole range of drugs – both combined and “mono”. They are prescribed only by a doctor who has the appropriate qualifications.

• Aurum - prescribed for joint pain, osteoarthrosis, arthrosis, atherosclerosis. There are no side effects when using the drug. The dosage is determined by the doctor depending on the stage of the syndrome and the patient's constitution.
• Repisan is a complex drug that is actively used for arthrosis, osteochondrosis, bursitis, arthritis. Patients are recommended to take the drug for two months, three times a day, 10 drops, between meals.
• Ziel-T is a complex remedy that has anti-inflammatory, chondroprotective and analgesic effects. The drug is taken sublingually, three times a day, one tablet, for 6 weeks.
• Traumeel S is an effective complex homeopathic preparation that helps in the treatment of various inflammatory and degenerative diseases of the joints. The standard dose is one tablet half an hour before meals, three times a day. The course of treatment is six weeks.

You should not self-medicate, even if it is harmless homeopathic remedies. You should definitely get advice from a doctor first.

Surgical treatment

If conventional treatments do not improve the condition of impeachment syndrome, the doctor may recommend surgery to the patient. It helps to increase the gap that causes painful contact.

The surgeon surgically removes bone protrusions that interfere with the normal functioning of the joint.

Since impeachment syndrome in many patients is combined with osteoarthritis, the operation is often performed simultaneously with resection arthroplasty. The essence of the intervention is to eliminate pain that occurs due to friction of the acromial ends with the clavicle. Subsequently, there is an overgrowth of connective tissue and filling of the space between the clavicle and the process, the so-called "false joint" is formed.

Arthroscopy is used to treat some patients. A special device is inserted into the joint cavity through a puncture. The image can be viewed on the monitor. This method allows you to accurately indicate the area with a reduced gap. After detecting a pathologically changed area, the doctor inserts the instrument through another puncture and removes the interfering part of the bone.

After the operation, the patient leads a gentle lifestyle. In most cases, the limb is immobilized for a period of 1 to 2 months. Such a long rehabilitation period is explained by the fact that the damaged tissues must fully recover.

Prevention

The diagnosis of impeachment syndrome is often established in patients who are actively involved in sports or heavy physical labor. In order to prevent the development of pathology, it is important to try to prevent the problem in advance.

Physical activity for joints is necessary. However, it is better if it is dosed and gradual, without excessive overloads and wide-amplitude abrupt movements. For people who lead a predominantly sedentary lifestyle, it is necessary to do light gymnastics several times during the day.

The syndrome can also be prevented by proper nutrition and giving up bad habits. The diet should include foods rich in calcium, vitamins, zinc and collagen. Collagen is present in large quantities in jelly, aspic, marmalade.

If possible, it is necessary to avoid bruises and other joint injuries. If an injury does occur, it is important to follow all the doctor's recommendations until the damaged area is completely healed.

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

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Forecast

If impeachment syndrome is detected in a timely manner, and treatment is prescribed fully and competently, then one can hope for a relatively favorable prognosis of the disease. That is, the disease cannot be cured completely conservatively. However, doctors can quite well stop the further pathological process and significantly improve the patient's condition.

If the visit to the doctor is late, the patient may develop irreversible changes in the joint, which most often leads to a permanent loss of ability to work. Therefore, we can draw the appropriate conclusion: early treatment increases the chances of high-quality recovery from such a pathology as impeachment syndrome.

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