What is Shoulder Impingement Syndrome?
Although the shoulder is made up of many different structures, it is vulnerable to many different problems. Rotator cuff problems are the most common source of shoulder pain.
The rotator cuff is a common cause of shoulder pain. Conditions that can cause shoulder pain can be summarized as; tendonitis (rotator cuff tendons (tendons) can be damaged or irritated), bursitis, impingement (when we lift our shoulder and arm up, the space between the acromion and rotator cuff narrows, in this case the acromion irritates the rotator cuff and causes pain. This condition is called shoulder impingement syndrome, which can cause serious problems if not treated early), rotator cuff tears.
Rotator cuff pain is common in young athletes and middle-aged people, and in young athletes who do sports that lift their arms up, such as swimming, tennis, and baseball. People who work with their arms up, such as hanging papers, painting walls, and construction workers, are also more prone to it. Pain can also occur with a simple injury. Sometimes, there may be no obvious cause.
It usually occurs with significant swelling and tenderness in the front of the shoulder. Initial symptoms may be mild and patients may not seek treatment in the early stages. Symptoms include:
- Mild shoulder pain that does not go away with daily activities or rest
- Pain starting from the front of the shoulder and radiating down the side of the arm
- Sudden pain when lifting the arm
- Pain triggered by lifting the arm in tennis or throwing sports
As the problem progresses, symptoms increase and become persistent:
- Night pain
- Loss of strength and movement
- Difficulty with activities such as placing your arm behind your waist, such as buttoning or zippering
If the pain increases suddenly and the current condition worsens, the discomfort in the shoulder can become serious. As a result, all movements become painful and limited.
After evaluating the symptoms, complaints, and medical history, the doctor examines the shoulder. The examination checks for any deformities, muscle weakness, tenderness, etc. To measure shoulder mobility, arm movements are made in various directions and arm strength is tested.
The doctor also examines other possible problems with the shoulder joint. The diagnosis is made by excluding diseases such as cervical disc herniation, nerve compression, joint calcification or rheumatoid arthritis to clarify the source of the pain.
Imaging Methods
X-ray: Usually, bone structures, joint relationships and excess bone in the acromion that may cause discomfort in the rotator cuff are evaluated.
Magnetic Resonance (MRI)
MRI is a highly sensitive and specific method in the identification and evaluation of soft tissues such as the Rotator Cuff, soft tissue problems, bone marrow edema and tears.
Shoulder Impingement Syndrome Treatment
The main goal of treatment is to reduce pain and regain shoulder function. The individual's age, activity level and general health status are taken into account in treatment planning.
Shoulder Impingement Syndrome Non-Surgical Treatments
Rest: Your doctor will recommend that you avoid movements that will increase your pain and rest your arm.
Physiotherapy: Depending on the intensity of the pain, treatment will be planned in the normal position of your shoulder. Then, a stretching exercise and rotator cuff strengthening program is applied. Stretching exercises are especially useful for increasing range of motion. After the painful condition is over, rotator cuff muscle strengthening exercises will be given.
Steroid Injection: If rest, medications, and physical therapy do not relieve your pain, a cortisone injection with local anesthesia may be helpful. Cortisone is a very effective anti-inflammatory drug. Pain can be relieved by injecting it into the bursa under the acromion.
Shoulder Impingement Syndrome Surgical Treatment
If your pain does not go away with nonsurgical treatments, surgery may be recommended. The aim of surgical treatment is to create more space for the rotator cuff and eliminate the compression. To do this, the inflamed bursa will be removed. If there is excess acromion bone, the front of the bone will be shaved with a procedure called acromioplasty. This is also called sobacromial decompression. These procedures are performed with open or closed, or arthroscopic, techniques.
Arthroscopy is a closed modern system performed with a camera and mini tools through two or three mini holes around the shoulder. It removes the bursa and the front part of the acromion with small hand tools. During arthroscopic surgery, you also have the opportunity to evaluate other normal and pathological tissues in your shoulder.
In the open surgery technique, a small incision is made in the front of your shoulder to visualize the acromion and rotator cuff.
Shoulder Impingement Syndrome Rehabilitation
After surgery, your arm will be placed in a sling for a short time. This will allow for early recovery. The sling will be removed once you begin exercising and using your arm. The physical therapist will provide a rehabilitation program based on the surgical findings and the patient's needs. These exercises will restore shoulder range of motion and strength. It usually takes 1 to 4 months to achieve complete relief from pain, but it can take up to 1 year.
What is Shoulder Impingement Syndrome?
Shoulder Impingement Syndrome is a condition that occurs when the rotator cuff tendons and bursae in the shoulder joint become compressed under the acromion bone. This compression causes pain and limited movement.
What are the symptoms of Shoulder Impingement Syndrome?
- Pain and tenderness in the front of the shoulder.
- Pain when lifting the arm up or extending it back.
- Pain at night, especially when lying on the affected shoulder.
- Limited shoulder movements and weakness.
What are the causes of Shoulder Impingement Syndrome?
- Activities that require repetitive shoulder movements (e.g., swimming, tennis, painting).
- Direct blows or injuries to the shoulder area.
- Loss of elasticity of tendons due to aging.
- Structural differences in shoulder anatomy.
Who is more likely to experience Shoulder Impingement Syndrome?
- Athletes who frequently raise their arms (such as swimming, tennis, baseball).
- Occupational groups that work with their arms raised (painters, construction workers).
- In older individuals, due to decreased elasticity of tendons.
How is Shoulder Impingement Syndrome diagnosed?
- Physical examination: The doctor evaluates the shoulder range of motion and pain points.
- Display methods: Shoulder structures are examined with X-ray, magnetic resonance imaging (MRI), or ultrasound.
How is Shoulder Impingement Syndrome treated?
- Rest: Avoiding activities that increase pain.
- Physiotherapy: Exercises to increase shoulder range of motion and strengthen muscles.
- Drug therapy: Painkillers and anti-inflammatory medications.
- Steroid injections: Corticosteroid injections in cases of severe pain.
- Surgical intervention: Relieving compression with arthroscopic surgery in cases that do not respond to other treatments.
What happens if Shoulder Impingement Syndrome is left untreated?
If left untreated, pain and limited range of motion can increase, making daily activities difficult, and can lead to more serious problems, such as rotator cuff tears.
How can I protect myself from Shoulder Impingement Syndrome?
- Doing regular exercises that strengthen the shoulder muscles.
- Avoiding repetitive shoulder movements or performing these movements with correct technique.
- Do not neglect warm-up and stretching exercises.
What exercises are recommended for Shoulder Impingement Syndrome?
- Pendulum exercise: Leaning the body forward, releasing the arm and making circular movements.
- Wall walk: Raising the arm by walking up the wall with the toes.
- Internal and external rotation exercises: Rotating the arm inward and outward using a rubber band.
What is the recovery process after Shoulder Impingement Syndrome surgery?
Recovery time after surgery varies from person to person, but usually takes between 4 and 6 weeks. Physical therapy and rehabilitation are important to regaining full function.
