Shoulder Impingement Disease

The shoulder joint is made up of many joints, which together with the combination of muscles and tendons create a wide range of movement. Although the shoulder forms many different structures, it is vulnerable to many different problems. Rotator cuff/sheath problems are the most common cause of shoulder pain.

Shoulder Anatomy
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The arm is attached to the shoulder joint in a socket by the rotator cuff. The muscles and tendons of the rotator cuff surround the shoulder joint between the shoulder blade and upper arm bones.
Between the upper acromion bone of the shoulder and the rotator cuff there is a lubricating sac called the bursa. The bursa allows the rotator cuff to slide easily under the acromion when we move our arm. The shoulder consists of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle).

Rotator cuff (Cuff) is a common cause of shoulder pain. The pain may be due to the following causes;
– Tendonitis: The tendons (tendons) of the rotator cuff may be damaged or irritated.
– Bursitis: Pain can be caused by inflammation or swelling with excess fluid or edema.
– Impingement: When we lift our shoulder and arm up, the space between the acromion and rotator cuff is narrowed. In this case, the acromion irritates the rotator cuff and causes pain. This is called shoulder impingement syndrome, which can cause serious problems if not treated early.

Causes of Shoulder Impingement
Rotator cuff pain is common in young athletes and middle-aged people.
It is common in young athletes who are interested in sports such as swimming, tennis and baseball. People who work with their arms raised upwards, such as paper hangers, wall painters and construction workers, are also predisposed. Pain can also be caused by a simple injury. Sometimes there may be no apparent cause.

Complaints and Findings in Shoulder Impingement
Rotator cuff pain usually manifests itself with marked swelling and tenderness in front of the shoulder.
It may cause pain and stiffness when raising your arm. There may be a decrease in pain when lowering your arm from a high position.
Initial symptoms may be mild and patients do not accept treatment at an early stage. These symptoms include;
• Pain starts at the front of the shoulder and radiates down the side of the arm
– Sudden pain with raising the arm
• Pain caused by lifting the arm up in tennis or throwing sports
Increased and persistent symptoms as the problem progresses;
• Night pain
• Loss of strength and movement

• Difficulty with activities such as placing the arm behind the back, for example, forcing buttons to be buttoned or zippers to be pulled up…
If the pain comes on suddenly and the existing discomfort progresses, the shoulder can become severe, with the result that all movements are painful and restricted.

Physician Examination in Shoulder Impingement

It is checked for deformity, muscle weakness, tenderness in any area. To measure the mobility of your shoulder, your arm strength is tested by making arm movements in many different directions.

Imaging Tests in Shoulder Impingement

X-ray
This examination does not visualize the soft tissues related to the rotator cuff. Generally, bone structures, joint relationship and excess bone in the acromion that may cause discomfort in the rotator cuff are evaluated.

A normal radiograph on the left side shows excess bone on the right side, which is the cause of impingement.

MRI and Ultrasound:
MRI and ultrasound are more useful in identifying and evaluating soft tissues such as the rotator cuff. It better shows edema, inflammation, inflammation or damage in the rotator cuff and bursa. In some cases, it will allow visualization of partial tears.

Treatment of Shoulder Impingement
The main goal of treatment is to reduce pain and restore shoulder function. The treatment plan is decided according to your age, activity level and general health.

Non-Surgical Treatments for Shoulder Impingement

Rest: You should avoid movements that will increase your pain and rest your arm.

Physiotherapy: The physiotherapist will initially rest your shoulder in a normal position. Then stretching exercises and a rotator cuff strengthening program will be applied. Especially stretching exercises are very useful to increase the range of motion. After the painful condition has passed, you will be given exercises to strengthen the rotator cuff muscles.

Steroid / Cortisone Injection
If rest, medications and physical therapy do not relieve your pain, a cortisone injection with local anesthetic may be helpful. Cortisone is a very effective anti-inflammatory drug. It can be injected into the bursa under the acromion to relieve pain.