Usually, when we lift our arm, there is enough space between the acromion and the rotator cuff tendons to allow the tendons to slide and move. However, every time we raise our arm, there is some friction of the tendon and bursa tissue against the acromion. This phenomenon is called impingement. Normally, there is some amount of impingement in the shoulder joint. Every time we raise our arm above shoulder level during the day, it causes some impingement. Jobs that require the arm to be raised above the shoulder constantly, repetitive throwing motion can cause this impingement to become a problem.

Jamming;

It becomes a problem when it causes irritation or damage to the rotator cuff tendons. The lifting motion of the arm forces the arm bone (humerus) towards the corner of the acromion. With overuse, this causes irritation and swelling of the bursa tissue. Anything that narrows the space between the acromion and the rotator cuff worsens the impingement. Bony prominences can narrow the space between the acromion and rotator cuff.

Wear at the acromioclavicular joint can result in bone spurs. In some patients, this space is narrow due to the anatomical structure of the acromion. Some types of acromion are sloped very low and create compression on the rotator cuff. In the early stages there is constant pain in the shoulder. It also causes pain when raising the arm to the side or forward and upward. Most patients report difficulty lying on the affected shoulder because of the pain. Sharp pain when reaching into the back pocket

is one of the symptoms of impingement syndrome. As the condition progresses, the discomfort in the shoulder increases. Weakness and inability to lift the arm suggest a tear in the rotator cuff. Diagnosis Impingement syndrome is diagnosed by detailed history and physical examination. X-rays are requested to see abnormally curved acromion or bony prominences. If a rotator cuff tear is suspected, MRI (magnetic resonance imaging) is ordered. MRI is an imaging method that gives us detailed information about both bone structure and tendons. In some cases, a local anesthetic is injected into the bursa tissue in the shoulder joint to differentiate whether the pain is caused by the shoulder or an event in the neck. If the pain disappears after the injection, it confirms that it originates from the shoulder.

Treatment
Non-Surgical Treatment
First, anti-inflammatory and painkiller treatment is started. It is useful to rest the joint and apply ice. If the pain does not decrease, cortisone injection can be done. The effect of cortisone is temporary. Physical therapy can be used to reduce pain and inflammation. Exercises to increase the range of motion of the shoulder are useful.

Surgical Treatment
Surgical treatment is considered if the symptoms do not improve with non-surgical treatment methods. Subacromial Decompression The aim of surgical treatment is to enlarge the area between the rotator cuff tendons and the acromion. The process of reducing the compression of the acromion is called subacromial decompression. First, the bony protrusions under the acromion that compress the rotator cuff and bursa tissue are removed. Usually, some bone tissue is also removed under the acromion to widen the space. Acromioplasty is the surgical cutting and shaping of the acromion.

Resection Arthroplasty
Impingement may not be the only problem in an overused shoulder. Degenerative changes in the acromioclavicular joint are common. If calcification is believed to be present in the acromioclavicular joint, the tip of the collarbone can be amputated. This procedure is called resection arthroplasty. A 2 cm section is removed from the tip of the collarbone. The aim here is to eliminate the pain caused by rubbing against the bone. Arthroscopic Intervention Impingement surgery can be performed with arthroscopy. The arthroscope is a small camera that is inserted into the joint through a small incision and allows the joint to be visualized. Thanks to this camera, the area being worked on is seen on a television screen. Through several small incisions, surgical instruments are inserted and the bone tissue is rasped. You can be discharged the next day after arthroscopy. Open Intervention In some cases, open surgery is performed through a 5-6 cm incision to remove the bone spurs. Bony protrusions under the acromion are removed. The rough surfaces of the bone are shaved. If necessary, part of the bone can be cut. The patient is hospitalized for 1-2 days.

Rehabilitation
Non-Surgical Treatment Rehabilitation
In cases that do not require surgical treatment, a strengthening and stretching exercise program is given to the shoulder and rotator cuff group muscles. Strengthening these muscles increases stability in the shoulder joint. It is also useful in reducing the symptoms of impingement syndrome. You will also be given information about the things you should pay attention to in your daily activities to prevent the problems in your shoulder from progressing.

Rehabilitation after Surgical Treatment
Rehabilitation after shoulder surgery is a slow process. The rehabilitation period lasts a few weeks. Full recovery may take 2-3 months. It is important to provide and increase movement in the shoulder in the early period, but it is necessary to apply a balanced rehabilitation program to protect the healing tissues. An arm-body sling is worn for a few days after surgery to protect the shoulder. Rehabilitation after arthroscopic procedures progresses rapidly. It starts with exercises that provide range of motion and continues with stretching and strengthening exercises. You need to be careful not to do too many exercises in too short a time. Rehabilitation after surgeries in which the muscles in the front of the shoulder are cut is slow. It starts with passive exercises. During passive exercises, your shoulder is moved but the muscles are not actively contracted. Your therapist gently moves your shoulder and stretches your arm. You will be told how to do these passive exercises at home. The active therapy period starts in week 3-4. It starts in week 3-4.