Friday, June 20, 2008

Common impingements

From the anatomical and clinical viewpoints, impingements are classified as
1. Bone impingement,
2. Soft tissue impingement and
3. Entrapment neuropathy, depending on what impinges on the others.

Examples: The most important impingement syndromes of the upper and the lower limbs from the clinical viewpoint are as follows.
In the upper limb:
1. Supraspinatus impingement is a frequent cause of shoulder pain in both athletes and the normal population; the painful subacromial arch is a typical sign of the rotator cuff impingement syndrome and of outlet and non-outlet impingement as well.
2. As for the elbow, both medial and lateral impingement.
3. The carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb; it is caused by compression of the median nerve at the wrist.
In the lower limb:
1. Iliotibial band friction syndrome, which is the most common overuse syndrome of the knee and the ankle impingement syndrome.
2. The latter includes anterolateral impingement (with chronic anterolateral and lateral pain and ankle instability), sinus tarsi impingement, anterior impingement (with pain during foot dorsiflection and posterior impingement.
3. The tarsal tunnel syndrome is the most important ankle entrapment neuropathy causing burn pain and paresthesias in the toes and sole of the foot.

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