Shoulder Impingement Syndrome

What is Shoulder Impingement Syndrome?

Shoulder impingement syndrome, also known as impingement syndrome, occurs when one or more problems coexist. These problems include:

• Swelling of the lubricating sac called the bursa, known as bursitis. It gets compressed when the shoulder is rapidly extended under high load. This is most commonly seen in sports that involve throwing. It can also occur during activities such as painting or window cleaning. It can develop spontaneously in older individuals as well.
• Swelling, edema, and inflammation of the rotator cuff tendons, known as tendinitis. It often begins with sudden and intense physical activities. The reason here is that the muscles are not yet prepared for such activity.
• Calcium deposits after wear and tear and tears in the tendons, known as calcific tendinitis.
• The joint between the clavicle and the scapula narrows due to osteoarthritis, which causes the tendons to pass through a narrowed space. This leads to friction and the development of tendinitis in the tendons.
• Excessive curvature of the front part of the roof (acromion) above the shoulder also causes the tendons to get trapped during lifting the arm upward, resulting in tendinitis and, in advanced cases, tears.

What are the symptoms of shoulder impingement?

Patients with shoulder impingement often initially overlook the symptoms. Typically, there is initially mild pain and slight muscle weakness. Limited shoulder mobility and increased pain during overhead movements occur later. The pain is particularly worse at night and often wakes patients up from sleep.

How is shoulder impingement syndrome diagnosed?

History and physical examination are crucial in diagnosing shoulder impingement syndrome. X-rays and MRI scans can be used for additional problems or differential diagnosis. Sometimes, if there is still uncertainty, an impingement test can be performed using local anesthetic drugs.

What are the treatment options for shoulder impingement?

Initial Treatment for Shoulder Impingement:

First, rest (avoiding repetitive overhead movements that may cause the condition), ice application, anti-inflammatory medications, corticosteroid injections, and ultrasound therapy can provide effective treatment. Temporary use of a sling may be necessary. Once the pain subsides, shoulder strengthening exercises should be initiated. Local steroid injections should be used cautiously, avoiding them in young athletes and when there is a tear in the rotator cuff tendons. In older patients, corticosteroid injections can be used to alleviate pain even if there is a tear. A maximum of three injections should be administered. If initial treatment for shoulder impingement is ineffective:

Shoulder surgery is performed.

Shoulder surgery can be performed as open surgery or arthroscopically. The main decisive factors for the surgical treatment of shoulder impingement disease are the presence of a rotator cuff tendon tear and the structure of the acromion bone that forms the roof of the shoulder. Normally, the acromion bone forms a flat surface (Type I acromion). However, it can sometimes be slightly concave (Type II acromion) or have a hooked shape (Type III acromion). In cases where the acromion is concave, especially in those with a hooked shape, it compresses the rotator cuff tendons during arm elevation and can cause tears in advanced stages. In open surgery, a skin incision of approximately 4-5 cm is made, while in arthroscopic surgery, all procedures are performed through three small incisions of approximately 0.5 cm each. In arthroscopic shoulder surgery, all joints are examined, and previously unidentified problems can be treated. In the treatment of shoulder impingement disease, the acromion is reshaped, the

joint between the clavicle and the scapula is cleared if it is affected by osteoarthritis, and the bursa sac is removed.