What is shoulder impingement syndrome?

In order to define this disease, it is necessary to know the anatomy of the shoulder first. The shoulder girdle consists of the articulation of the upper arm bone, collarbone and shoulder blades. In this articulation area, there are 4 muscles called “rotator cuff muscles” that provide some movements of the arm. In addition, there is a separate protective sheath called “bursa” that protects the muscles in this area.

Repetitive and frequent overhead movements, throwing sports, doing tasks that constantly force and tire the arm such as painting or tea-making, exposure to trauma or having an inconsistent anatomical structure that narrows this area from birth can cause this disease. These compressions, which occur over time in the bursa and rotator cuff muscles in this area, cause inflammation, edema and tiny tears, and these problems are called impingement syndrome.

To diagnose this condition, a detailed shoulder examination by an orthopedic doctor is required. There are many shoulder pathologies that can be confused with this disease and it can be differentiated with special examination methods. After the preliminary diagnosis is made, the radiographs to be taken and the diagnosis are finalized after MRI.

Depending on the stage of the disease and the patient’s complaints, there are many treatment modalities and combinations can be applied. Success can be achieved in almost all patients with shoulder rehabilitation, medication and ice therapy, injections, and surgical treatment with the closed method, also called arthroscopic, in resistant cases. In this method, anatomical structures that cause trauma are shaved and muscle tears can be sutured by entering through three separate 1 cm holes. Thus, patients return to their daily life earlier and their pain disappears.

The knee joint is a closed space formed by the union of certain parts of the 3 bones (femur, tibia, patella). In this space, there are structures that both ensure stable movement of the knee joint and distribute the load on the joint equally. menisci, These structures are composed of anterior and posterior cruciate ligaments, articular cartilages, and glands called synovium that form the fluid in the knee. Menisci are medium-hard cartilage structures in both the inner and outer cavities of the knee and provide suspension of the load on the joint. Anterior and posterior cruciate ligaments They prevent the knee from slipping forward or backward by providing a connection between the shin and the thigh bone. located at the ends of the bones forming the knee cartilagesOn the other hand, they both provide painless joint movement and contribute to suspension. Synoviacloth called synovial fluidThanks to this, it provides nutrition to the structures that make up the knee joint, and provides the continuation of joint movement in a slippery way with the fluid it produces.

Sudden traumas in the knee joint or microtraumas due to misuse of the knee can cause damage to the intra-knee structures. As a result of these traumas inner meniscus/outer meniscus tears, anterior cruciate/posterior cruciate ligament tears, due to injury or lack of blood supply in certain parts of the cartilages cartilage death (osteochondritis dissecans) observable. In addition, many patients have some of these injuries together. Apart from this, increase in synovial structure secondary to some synovial diseases or rheumatic diseases ( synovial hypertrophy, polyvillonodular synovitis) and an increase in synovial fluid may be observed.

Meniscus tears can often cause complaints such as tenderness in the joint line, locking in the knee, increasing pain after activity and swelling in the knee, depending on the location. While meniscal tears that occur at young ages are often manifested as a single tear area, meniscus tears that occur on the ground of calcification in older ages are formed by the crushing mechanism that increases over time and are multi-part tears. Tears are divided into 4 stages according to their size and surgical treatment is preferred especially in stage 3-4 tears. Cysts in the posterior space of the knee after the increased joint fluid escapes behind the knee in patients with meniscal tears ( Baker’s cyst) may occur.

In anterior and/or posterior cruciate ligament injuries, a feeling of rotation in the knee and a feeling of discharge and falling in the knee joint are observed during walking or sudden knee movements. Sports activities to be performed in the presence of ligament tears in patients may cause bone edema (bone bruise “Bone bruise”) around the cartilage of the bones forming the knee joint due to unstable knee. These patients often have a concomitant meniscus tear, and the findings of meniscal tear also create additional complaints in the patient.

There is a cartilage structure of approximately 4-5 mm on the sides of the bones that make up the knee joint. Trauma, death of certain parts of the cartilage (Osteochondritis dissecans – OCD), cartilage damage occurring behind the anterior knee bone, which was also called “chondromalacia patella” in the past, and cartilages can be injured in “osteoarthritis” disease, which is also called calcification in advanced ages. In these patients, depending on the area of ​​cartilage damage, pain, swelling around the joint and a feeling of being stuck if there is a ruptured piece can also be observed.

In patients who apply to the outpatient clinic with various complaints in the knee joint, first of all, the patient’s past history is questioned. The location and duration of the complaint, the timing of the pain and its relationship with activity, and whether there is trauma are questioned. Afterwards, an evaluation is made in terms of the source of the pathology by using examination techniques specific to the intra-knee structures. In order to reach a definitive diagnosis, compression knee radiographs and knee joint MRI are usually requested. The type of treatment is decided by evaluating the patient’s history, clinical and radiological results together.

The aim of the treatment in all knee pathologies is to bring the patient to social life in the early period without pain and complaints, with surgical or non-surgical methods. Treatment modalities may vary according to the diseases;

In meniscal tears, the age of the patient, the mechanism of trauma and the size of the tear in MRI are important. Stage 3-4 tears that occur as a result of trauma at young ages, especially locking, are treated with arthroscopic surgery called the closed method. Surgery may not always give positive results in degenerative tears that occur as a result of crushing in advanced ages. In this case, you should discuss the pros and cons of surgery in detail with your doctor. Non-surgical methods are often preferred in early stage tears.

The most commonly used treatment method in anterior cruciate ligament or posterior cruciate ligament tears is surgically creating a new ligament. The most commonly used technique when creating a ligament is the creation of a new ligament with the tendons taken from you. This newly formed ligament is placed in its anatomical place with the arthroscopic, that is, closed method, and the knee is regained its former stability. These patients are often accompanied by a meniscus tear, and meniscus surgery is also performed.

Cartilage injuries are usually seen in a specific region of the knee, but may vary. In the early stages, non-surgical methods (such as rehabilitation, weight cutting, device use, ice, medical treatment, PRP) can be used depending on the amount of the complaint. In advanced stage and life-affirming patients, arthroscopic surgery, blood supply of the cartilage (Microfracture), cartilage transplantation from the non-load-bearing area of ​​the knee to the diseased area (Mosaicplasty), or stem cell transplantation are surgical techniques that can be applied.

In synovial diseases, on the other hand, although the excess synovium is cleaned arthroscopically, the possibility of recurrence is frequent.

Evaluation of the joint with arthroscopic, that is, closed method, is a surgical method that has been used for many years and has very high success rates. In this method, the knee is entered through 1 cm holes opened on both sides of the knee. First of all, the knee is inflated with serum and an environment is created in which the instruments to be inserted into the knee can work comfortably. Treatment of intra-articular pathologies is provided by inserting a camera through one hole and surgical instruments through the other. With this method, cleaning the torn meniscus, suturing the meniscus, anterior/posterior cruciate ligament surgeries, shaving or blood supply for cartilage injuries (microfracture), synovial cleaning in case of increased synovium, and sometimes the extra filamentous formations (Plica) in the knee that damage the cartilage can be provided. . The most important advantages of this surgery are cosmetic benefits, early recovery and social life. As with any surgery, complications can be seen in this surgery. In this respect, it is very important that you accept the surgery by talking to your doctor in detail before the surgery.

Which complaints are the harbingers of shoulder impingement?

Mild pain at first

Severe pain when arms are raised

Pain around the neck joint

In the later period, locking and severe pain in the shoulder joint.

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