Impingement syndrome
Updates to Article Attributes
Body
was changed:
An impingementImpingement syndrome is a painful encroachment of joint motion caused by protruding bony or soft tissue structures.
Epidemiology
Impingement syndromes are common and can occur at any age.
Risk factors
·
- developmental osseous anomalies
· - overuse activity
· - trauma
Associations
·
- osteoarthritis
·tendon degeneration and -
tendinosis and tears
· - myotendinous injury
· - bursitis
· - chondral and labral injury
Clinical presentation
The usual presentation of an impingement syndrome is a painful reduction in the range of motion of the affected joint 1.
Pathology
The pathological correlate of impingement is a mechanical entrapment or encroachment of soft tissue structures between bony formations of a joint.
Aetiology
Bony structural abnormalities due to:
·
- developmental anomalies
· - trauma
· - repetitive microtrauma
· - malunion
· - osteoarthritis
Location
Typical locations are the following joints 1:
·
Classification
Internal impingement: refers to an intraarticular impingement, the affected structures are within the joint e.g. femoroacetabular impingement, anterior, anteromedial, anterolateral, posterior or posteromedial ankle impingement
External impingement: refers to an extraarticularextra-articular impingement, of which the affected structures lie outside the joint e.g. ischiofemoral impingement, extra-articular lateral hindfoot impingement
Radiographic features
Plain radiograph/CT
Depiction of predisposing osseous abnormalities e.g.:
·
-
os acromiale, acromion type III, decreased coracohumeral distance
· -
cam and/or pincer morphology, decreased ischiofemoral distance
· - ulnar variance
· - anterior/anteromedial
tibialtibiotalar osteophytes, flat foot,hindfoothindfoot valgus
Ultrasound
A dynamic ultrasound examination allows the demonstration of the abutment or narrowing effect on the impinged soft tissue structures 1.
MRI
In addition to osseous morphologies or abnormalities, MRI can depict a stress response of the affected bony and soft tissue structures asas e.g. bone marrow like signal of the affected bone or signs of tendinosis, muscle oedema or tears of the encroached tendinous and/or myotendinous structures 1. Further, it can show sequelae as ligamentous injuries, bursitis, capsulitis, chondral or labral injury and muscular changes as atrophy or fatty degeneration.
Treatment and prognosis
Treatment depends on the location and extent of symptoms. It typically includes exercise therapy, activity modification, taping, physical and manual therapy, temporary immobiliastionimmobilisation as well as nonsteroidal anti-inflammatory drugs, and guided injections of local anaesthesteticanaesthetic or corticosteroids. Surgery is usually done if conservative managementmanagement fails or if complications have already occurred.
See also
·
-<p> </p><p>An <strong>impingement syndrome</strong> is a painful encroachment of joint motion caused by protruding bony or soft tissue structures.</p><p><strong>Epidemiology</strong></p><p>Impingement syndromes are common and can occur at any age.</p><h5>Risk factors</h5><p><!--[if !supportLists]-->· <!--[endif]-->developmental osseous anomalies</p><p><!--[if !supportLists]-->· <!--[endif]-->overuse activity</p><p><!--[if !supportLists]-->· <!--[endif]-->trauma</p><h5>Associations</h5><p><!--[if !supportLists]-->· <!--[endif]-->osteoarthritis</p><p><!--[if !supportLists]-->· <!--[endif]-->tendon degeneration and tears</p><p><!--[if !supportLists]-->· <!--[endif]-->myotendinous injury</p><p><!--[if !supportLists]-->· <!--[endif]-->bursitis</p><p><!--[if !supportLists]-->· <!--[endif]-->chondral and labral injury</p><p><strong>Clinical presentation</strong></p><p>The usual presentation of an impingement syndrome is a painful reduction in range of motion of the affected joint <sup>1</sup>.</p><p><strong>Pathology</strong></p><p>The pathological correlate of impingement is a mechanical entrapment or encroachment of soft tissue structures between bony formations of a joint.</p><p><strong>Aetiology</strong></p><p>Bony structural abnormalities due to:</p><p><!--[if !supportLists]-->· <!--[endif]-->developmental anomalies</p><p><!--[if !supportLists]-->· <!--[endif]-->trauma</p><p><!--[if !supportLists]-->· <!--[endif]-->repetitive microtrauma</p><p><!--[if !supportLists]-->· <!--[endif]-->malunion</p><p><!--[if !supportLists]-->· <!--[endif]-->osteoarthritis</p><p><strong>Location</strong></p><p>Typical locations are the following joints<sup> 1</sup>:</p><p><!--[if !supportLists]-->· <!--[endif]-->shoulder</p><p><!--[if !supportLists]-->· <!--[endif]-->hip</p><p><!--[if !supportLists]-->· <!--[endif]-->ankle</p><p><!--[if !supportLists]-->· <!--[endif]-->wrist</p><p><strong>Classification</strong></p><p>Internal impingement: refers to an intraarticular impingement, the affected structures are within the joint e.g. femoroacetabular impingement</p><p>External impingement: refers to an extraarticular impingement, of which the affected structures lie outside the joint e.g. ischiofemoral impingement</p><p> </p><p><strong>Radiographic features</strong></p><p><strong>Plain radiograph/CT </strong></p><p>Depiction of predisposing osseous abnormalities e.g.:</p><p><!--[if !supportLists]-->· <!--[endif]-->os acromiale, acromion type III, decreased coracohumeral distance</p><p><!--[if !supportLists]-->· <!--[endif]-->cam and/or pincer morphology, decreased ischiofemoral distance</p><p><!--[if !supportLists]-->· <!--[endif]-->ulnar variance</p><p><!--[if !supportLists]-->· <!--[endif]-->anterior/anteromedial tibial osteophytes , flat foot, hindfoot valgus</p><p><strong>Ultrasound</strong></p><p>A dynamic ultrasound examination allows the demonstration of the abutment or narrowing effect on the impinged soft tissue structures <sup>1</sup>.</p><p><strong>MRI</strong></p><p>In addition to osseous morphologies or abnormalities, MRI can depict a stress response of the affected bony and soft tissue structures as e.g. bone marrow like signal of the affected bone or signs of tendinosis , muscle oedema or tears of the encroached tendinous and/or myotendinous structures <sup>1</sup>. Further, it can show sequelae as ligamentous injuries, bursitis, capsulitis, chondral or labral injury and muscular changes as atrophy or fatty degeneration. </p><p><strong>Treatment and prognosis</strong></p><p>Treatment depends on location and extent of symptoms. It typically includes exercise therapy, activity modification, taping, physical and manual therapy, temporary immobiliastion as well as <a href="/articles/non-steroidal-anti-inflammatory-drugs">nonsteroidal anti-inflammatory drugs</a>, and guided injections of local anaesthestetic or corticosteroids. Surgery is usually done if conservative management fails or if complications have already occurred.</p><p><strong>See also</strong></p><p><!--[if !supportLists]-->· <!--[endif]-->shoulder impingement</p><p><!--[if !supportLists]-->· <!--[endif]-->hip impingement</p><p><!--[if !supportLists]-->· <!--[endif]-->ankle impingement</p><p><!--[if !supportLists]-->· <!--[endif]-->ulnar impingement</p>- +<p><strong>Impingement syndrome</strong> is a painful encroachment of joint motion caused by protruding bony or soft tissue structures.</p><h4>Epidemiology</h4><p>Impingement syndromes are common and can occur at any age.</p><h5>Risk factors</h5><ul>
- +<li>developmental osseous anomalies</li>
- +<li>overuse activity</li>
- +<li>trauma</li>
- +</ul><h5>Associations</h5><ul>
- +<li><a href="/articles/osteoarthritis">osteoarthritis</a></li>
- +<li>
- +<a href="/articles/tendinosis">tendinosis</a> and tears</li>
- +<li>myotendinous injury</li>
- +<li><a href="/articles/bursitis">bursitis</a></li>
- +<li>chondral and labral injury</li>
- +</ul><h4>Clinical presentation</h4><p>The usual presentation of impingement syndrome is a painful reduction in the range of motion of the affected joint <sup>1</sup>.</p><h4>Pathology</h4><p>The pathological correlate of impingement is a mechanical entrapment or encroachment of soft tissue structures between bony formations of a joint.</p><h5>Aetiology</h5><p>Bony structural abnormalities due to:</p><ul>
- +<li>developmental anomalies</li>
- +<li>trauma</li>
- +<li>repetitive microtrauma</li>
- +<li>malunion</li>
- +<li><a href="/articles/osteoarthritis">osteoarthritis</a></li>
- +</ul><h5>Location</h5><p>Typical locations are the following joints<sup> 1</sup>:</p><ul>
- +<li><a href="/articles/shoulder">shoulder</a></li>
- +<li><a href="/articles/hip-joint-1">hip</a></li>
- +<li>ankle</li>
- +<li><a href="/articles/radiocarpal-joint">wrist</a></li>
- +</ul><h5><strong>Classification</strong></h5><p><strong>Internal impingement:</strong> refers to an intraarticular impingement, the affected structures are within the joint e.g. <a href="/articles/femoroacetabular-impingement-1">femoroacetabular impingement</a>, <a title="Anterior ankle impingement syndrome" href="/articles/anterior-ankle-impingement-syndrome">anterior</a>, <a title="Anteromedial impingement of the ankle" href="/articles/anteromedial-impingement-of-the-ankle">anteromedial</a>, <a title="Anterolateral impingement of the ankle" href="/articles/anterolateral-impingement-of-the-ankle">anterolateral</a>, <a title="Posterior ankle impingement syndrome" href="/articles/posterior-ankle-impingement-syndrome">posterior</a> or <a title="Posteromedial ankle impingement" href="/articles/posteromedial-impingement-of-the-ankle">posteromedial ankle impingement</a></p><p><strong>External impingement: </strong>refers to an extra-articular impingement, of which the affected structures lie outside the joint e.g. <a href="/articles/ischiofemoral-impingement">ischiofemoral impingement</a>, <a href="/articles/extra-articular-lateral-hindfoot-impingement-syndrome-1">extra-articular lateral hindfoot impingement</a></p><h4>Radiographic features</h4><h5>Plain radiograph/CT</h5><p>Depiction of predisposing osseous abnormalities e.g.:</p><ul>
- +<li>
- +<a href="/articles/os-acromiale">os acromiale</a>, <a href="/articles/acromial-types">acromion type III</a>, decreased coracohumeral distance</li>
- +<li>
- +<a href="/articles/cam-morphology-fai">cam</a> and/or <a href="/articles/pincer-morphology-fai">pincer morphology</a>, decreased ischiofemoral distance</li>
- +<li><a href="/articles/ulnar-variance">ulnar variance</a></li>
- +<li>anterior/anteromedial <a href="/articles/tibiotalar-spurs">tibiotalar osteophytes</a>, <a href="/articles/pes-planus">flat foot</a>, <a href="/articles/hindfoot-valgus">hindfoot valgus</a>
- +</li>
- +</ul><h5>Ultrasound</h5><p>A dynamic ultrasound examination allows the demonstration of the abutment or narrowing effect on the impinged soft tissue structures <sup>1</sup>.</p><h5>MRI</h5><p>In addition to osseous morphologies or abnormalities, MRI can depict a stress response of the affected bony and soft tissue structures as e.g. bone marrow like signal of the affected bone or signs of tendinosis, muscle oedema or tears of the encroached tendinous and/or myotendinous structures <sup>1</sup>. Further, it can show sequelae as ligamentous injuries, <a href="/articles/bursitis">bursitis</a>, capsulitis, chondral or labral injury and muscular changes as atrophy or fatty degeneration. </p><h4>Treatment and prognosis</h4><p>Treatment depends on the location and extent of symptoms. It typically includes exercise therapy, activity modification, taping, physical and manual therapy, temporary immobilisation as well as <a href="/articles/non-steroidal-anti-inflammatory-drugs">nonsteroidal anti-inflammatory drugs</a>, and guided injections of local anaesthetic or corticosteroids. Surgery is usually done if conservative management fails or if complications have already occurred.</p><h4>See also</h4><ul>
- +<li><a href="/articles/shoulder-impingement">shoulder impingement</a></li>
- +<li>hip impingement</li>
- +<li><a href="/articles/ankle-impingement-syndromes">ankle impingement syndromes</a></li>
- +<li><a href="/articles/ulnar-sided-wrist-impaction-and-impingement-syndromes">ulnar-sided wrist impaction and impingement syndromes</a></li>
- +</ul>
References changed:
- 1. Palmer W, Bancroft L, Bonar F et al. Glossary of Terms for Musculoskeletal Radiology. Skeletal Radiol. 2020;49(S1):1-33. <a href="https://doi.org/10.1007/s00256-020-03465-1">doi:10.1007/s00256-020-03465-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32488336">Pubmed</a>
- 2. Garving C, Jakob S, Bauer I, Nadjar R, Brunner U. Impingement Syndrome of the Shoulder. Deutsches Ärzteblatt International. 2017;114(45):765-76. <a href="https://doi.org/10.3238/arztebl.2017.0765">doi:10.3238/arztebl.2017.0765</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29202926">Pubmed</a>
- 3. Berman Z, Tafur M, Ahmed S, Huang B, Chang E. Ankle Impingement Syndromes: An Imaging Review. BJR. 2017;90(1070):20160735. <a href="https://doi.org/10.1259/bjr.20160735">doi:10.1259/bjr.20160735</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27885856">Pubmed</a>
- 4. Aydingoz U, Maras Ozdemir Z, Gunes A, Ergen F. MRI of Lower Extremity Impingement and Friction Syndromes in Children. Diagn Interv Radiol. 2016;22(6):566-73. <a href="https://doi.org/10.5152/dir.2016.16143">doi:10.5152/dir.2016.16143</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27538047">Pubmed</a>
Sections changed:
- Syndromes
Systems changed:
- Musculoskeletal
Unable to process the form. Check for errors and try again.