Painful shoulder; It is the third most common problem after waist and neck pain. Shoulder pain is one of the top reasons for consulting a doctor, especially for people who work using their arms. It is a common problem in young adults and middle age groups. It is the cause of pain and dysfunction that affects daily life. One of the most important reasons why shoulder pain is common is that the shoulder joint is the most mobile and complex joint of the human body. The shoulder joint is formed by the collarbone, shoulder blade and humerus. These bone structures do not contribute much to the solid structure of the joint; The soft tissues around the joint provide this. The soft tissues around the shoulder joint consist of capsule, ligament, tendon, bursa and muscles. It is a process that can extend from bursitis to tendon damage and partial or full thickness tendon rupture, or even frozen shoulder. Although overuse, metabolic diseases such as diabetes and thyroid dysfunction increase susceptibility and exacerbate damage, the proposed causes are still controversial.
In the articles published about painful shoulder, the most common problem with 70% is 'impingement syndrome', and both internal and external factors are mentioned in its development. Tendon-related factors refer to internal factors, and the tight and thick ligament and tendon-compressing factors of the bone refer to external factors. Any factor or formation that narrows the area through which the tendon passes can cause pain. The internal factor occurs when the arm is stretched in the air and rotated outwards, that is, following minor trauma in the 'throwing position'. Especially after sports such as swimming and basketball and repetitive traumas, the cartilage covering the tendon and joint surface is also affected.
What are the symptoms of impingement syndrome?
Complaints often occur as a result of using the shoulder and arm. Over time, the pain begins to become constant. It turns into a pain that keeps the patient awake, especially at night. It reaches a level that affects the patient's daily life activities such as dressing and undressing.
Impression syndrome is a clinical syndrome and can often be diagnosed during physical examination. Ultrasound and Magnetic Resonance Imaging, which are imaging methods, not only help diagnosis, but also help determine where the damage is. It plays an important role in detection and injection treatment. The ball-socket shaped shoulder is a complex structure with dense bony protrusions and has a dynamic balance provided by muscles and ligaments. Tendons, which are the extensions of the muscles and the extensions that attach to the bone, are subject to many compressions during arm movement. Between the tendon and bone protrusions, there are cushions called bursa, which inflate in trauma and try to protect the tendon like an airbag. Three phases of impingement syndrome have been defined; These are 1) edema and bleeding phase (<25 years), 2) repair and tendon thickening phase (25-40 years), 3) tendon tears and bone growth phase (>40 years). In the advanced stage, after the pain becomes chronic, the shoulder muscles lose function, creating a vicious circle, and the distance becomes narrower. It permanently restricts shoulder movement as a hardening and structural deterioration that increases with age in the area where the tendon blood supply is poor.
Treatment; Although it varies depending on the current stage, it may require a conservative approach or surgery. Conservative treatment approaches applied by us FTR physicians include physical therapy, ice packs, special strengthening exercises, oral painkillers and injection treatments.
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