Subacromial Impingement Syndrome; It is the compression of the muscles around the shoulder and the structure called bursa in the shoulder joint in the space between the shoulder joints. At the same time, the muscle called supraspinatus, which comes from the upper part of the shoulder blade towards the shoulder, is also compressed under the bone called acromion.
The movement of lifting the arm forward and turning it inward while the pole is bent, the avascular (non-vascular) region of the muscles around the shoulder, the shoulder blade. and it is observed that it passes through the gap where the collarbone articulates. The change in the protruding part of the scapula and the notch formed cause compression of this area. Lesions occur in this area due to repeated trauma. Repeated lesion with lifting the arm forward and rotation of the shoulder blade causes injury.
When the functions of the shoulder muscles in sports and exercise are analyzed, it has been found that the serratus anterior muscle, known as the boxer muscle, is activated in overhead sports. It has also been observed that muscle fatigue due to repeated use of the serratus anterior muscle may affect the function of the muscles in the muscular system around the scapula and cause compression in the subacromial (collarbone and shoulder joint) region.
Neer et al. describe subacromial compression in 3 stages. They defined:
Stage 1, edema and inflammation (injury) are observed. It is a treatable process and can be seen at any age. There is pain in the range of 60-120 degrees when opening the arm to the side. Joint range of motion may be affected.
In Stage 2, there are findings of physhrosis (hardening of the muscle) and tendinitis (inflammation in the tendon). It is common between the ages of 25-40. There are pathologies in soft tissue. The shoulder joint space is narrowed. Joint range of motion is restricted.
Stage 3, Bone deformity and tendon tear are observed. It is common in individuals aged 40 and over. Joint range of motion is limited. Atrophy (shrinkage) is observed in the infraspinatus (rotator muscle) muscle. Weakness in opening and turning the arm to the side and tenderness in the area where the shoulder blade and collarbone joint are observed.
The symptoms of subacromial impingement syndrome are observed. There are conservative and surgical treatments.
Conservative treatment consists of rest, anti-inflammatory drugs and functional exercise programs of the muscles around the shoulder. In the conservative treatment of subacromial impingement syndrome, successful results are achieved by correcting the scapulothoracic (the area where the shoulder blade is located) rhythm. A special strengthening program should be created to regulate the rhythm. Correction of scapulothoracic rhythm reduces the risk of impingement by ensuring synchronization of shoulder joint movement. Fibrous tissues occurring in the rotator cuff muscles (around the shoulder) and surrounding soft tissues are intervened with manual applications. Stabilization around the shoulder is achieved by strengthening the rotator cuff muscles (around the shoulder).
In case of impingement problems leading to surgery, the arm is suspended and fixed after surgery. The surgical area on the arm is suspended for 4 weeks and is expected to heal. The physical therapy process begins when the arm is removed from the sling. The first goal is to relieve the limitation in the joint. Manual therapy can be applied for tightness and shortness in the soft tissue. The muscles in the area where joint opening is provided have weakened. The patient is followed up with a personalized exercise program.
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