There are two bony prominences called the corocoid and acrominon on the upper part of the shoulder head, and there is a strong bridge-shaped connection between them. Muscles that lift the head of the shoulder with a lever-like movement and move it inward and outward are damaged by rubbing against the upper ligament during the movement. This situation occurs as pain and limitation of movement in situations that require you to bring your hand over your head.
Symptoms : The most characteristic symptom of this syndrome is pain when raising the arm to the side, especially between 70 and 110 degrees, when the shoulder muscles rub under the belt. When the arm is raised more than 110 degrees, the pain is relieved as the friction disappears. This is seen in the early stages of the disease. However, if a large tear and bleeding has occurred in the muscles due to prolonged exposure to this friction, the pain may continue even at rest and may wake you from sleep.
Stages of Discomfort:
Stage 1 (Edema and Bleeding Stage): Excessive friction occurs due to excessive use in sports such as tennis, swimming, and weight lifting. As a result, edema and bleeding develop. In order to distinguish the disease from other shoulder disorders at this stage, special movement examinations and a local anesthetic injection test into the shoulder are performed by the Orthopedist. If the pain disappears with the injection, the problem is in that area. This stage of impingement syndrome is generally seen between the ages of 20-25.
At this stage, non-invasive treatment is successful. Rest is given. If there is no mania with chest diseases, cold can be applied. Anti-inflammatory drugs are prescribed. The arm is partially at rest. Movements on the horizontal plan are avoided. In order not to cause a frozen shoulder by completely immobilizing the shoulder, the movement is maintained by stretching and strengthening movements. The person, and especially the athlete, is taught which movements can cause friction. Simple measures such as using the monitor at eye level, sitting upright and reducing the curvature on the shoulder are very beneficial. For example, in tennis, turning the body sideways towards the court while serving, reduces friction.
Stage 2 (Scabbing and Tendon Hardening) Long-term recurrent bleeding and edema due to friction harden over time, forming a hard tissue like a scab at the injury site. At this time, this newly formed hard and thick scar tissue causes compression in the friction area. Thus, a vicious circle is entered by causing friction to the wound and friction to the newly formed scab. This stage of compression usually occurs between the ages of 25-40.
The problem is now chronic and does not improve with non-invasive treatment. With the arthroscopic method, that is, operations performed with a camera by entering through two or three holes of 1 cm, the thickened tissues and the ceiling causing friction are cleaned. Afterwards, strengthening exercises are given to the stretching unit.
Stage 3 (Bone Protrusions and tendon ruptures) At this stage, calcification-like bone protrusions develop on the worn surfaces. The muscle called supraspinatus, which raises the head of the shoulder upwards, is eroded by friction and ruptures. This stage is seen over the age of 40.
Treatment is surgery. Arthroscopic tendon repair and thinning of the bone tissue in the ceiling are performed. The ends of the ruptured tendon are sutured with special techniques to the threads of the screw that is driven into the shoulder bone using the closed method. By thinning the bone roof thickness, re-wearing of the tendon repaired by friction is prevented. In elderly patients, even if the ruptured tendon is sutured, it may be damaged enough to rupture again. In such cases, only cleaning surgery or even shoulder prosthesis surgeries can be applied in advanced stages.