1. Shoulder Impingement Syndrome
Shoulder Impact Syndrome describes the inflammation that develops in the subchromatic space and is due to the irritation of the tendons of the rotator cuff by their "impact" on the acromion. This results in pain, weakness and reduced shoulder range of motion.
Shoulder Impact Syndrome includes a range of conditions such as:
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Chronic tendon disease of the rotator cuff
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Hypochromic bursitis
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Lime tendonitis
These conditions lead to friction between the coracochromic arch and the supraspinatus tendon or the subchromic serous sac.
Shoulder Impact Syndrome is more common in people with the following characteristics:
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With intense activity
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With a profession that requires manual labor
This shoulder syndrome is the most common condition of the shoulder, as it is the cause for about 60% of painful shoulders.
The most common symptom of shoulder impact syndrome is pain in the front and upper shoulder, which gradually increases. The pain worsens on abduction and decreases at rest, and may be accompanied by weakness and stiffness.
The most common clinical tests to diagnose shoulder impact syndrome are the following:
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Neer test - The arm is placed on the patient's side and brought to a full inward turn. It then bends passively. The test is positive if pain develops in the front of the shoulder.
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Hawkins test - The shoulder and elbow are bent 90 degrees. The examiner stabilizes the arm and brings it passively in an inward turn. The test is positive in case the patient develops pain in the front of the shoulder.
The diagnosis of the syndrome is clinical and is easily made by the orthopedist with experience in the clinical examination of the shoulder. However, it is often confirmed by imaging tests. Ultrasound imaging of the shoulder in the office or MRI is usually the main imaging test for shoulder impact syndrome.
Features that can be observed are the following:
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Formation of subchromatic osteophytes
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Hypochromic follicle
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Bone formation
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Narrowing of the subchromatic space
In most cases, the main treatment for shoulder impact is conservative and includes:
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Medication with non-steroidal anti-inflammatory drugs.
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Regular physiotherapy with exercises for posture, stability, mobility, stretching and muscle strengthening.
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Corticosteroid or PRP platelet injections into the subchromatic space.
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Educate patients for adequate warm-up and early recognition of early symptoms.
In cases where, despite conservative treatment, the shoulder impact syndrome persists for more than 6 months, then it is treated surgically.
Surgery is particularly effective in patients with limited range of motion. The most appropriate and effective method of surgery is shoulder arthroscopy .
The Modern surgical techniques include:
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Repair of ruptures (if found), with the most common being the supraspinatus and the long head of the biceps tendon. The result is improved shoulder range of motion.
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Removal (cleansing) of the subchromatic follicle, during which the space where the arm moves moves increases and the pain decreases.
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Removal of part of the acromion (acromioplasty) in order to increase the subchromatic space and reduce the pain.
2. Arthroscopic suturing of the rotator cuff.
Rupture of the rotator cuff tendon is one of the most common causes of shoulder pain. It is either traumatic or degenerative. It can occur after a fall, when the patient lifts weight abruptly or when he makes a violent movement with resistance. It has been found that ¼ of people aged 60 years and ½ 80-year-olds have partial or total thickness of the rotator cuff (mainly of degenerative etiology). The above fact does not mean that all patients with rotator cuff rupture are limited in their daily lives, due to the body's ability to compensate for the problem with other mechanisms.
The rotator cuff consists of 4 tendons, the submandibular, the supraspinatus, the submandibular and the minor round. The tendons that most often rupture are the supraspinatus and the submandibular. Rotational petal ruptures can be partial or total thickness. An important role in prognosis and treatment is the displacement of the tendon from the anatomical point that normally subsides before the rupture occurs as well as the muscle atrophy.
A ruptured tendon causes pain in the shoulder area, decreased muscle strength and loss of smooth shoulder movement, leaving the patient either in pain or unable to perform simple daily movements such as combing, dressing and washing. The patient usually feels pain in the arm or shoulder. Many times the shoulder movements are so painful that the patient can not raise his hand above the horizontal level. The patient often complains of nocturnal resting pain as well as a tingling in certain shoulder movements.
The diagnosis of rotator cuff rupture is made by the patient's history, symptoms and clinical examination. During the clinical examination, the range of motion of the shoulder, the muscular strength are checked. The orthopedist performs specific tests during the clinical examination in order to better determine the cause of the pain. Confirmation of the diagnosis is made by imaging tests, ie MRI or ultrasound of the shoulder girdle. Plain X-rays help rule out other shoulder conditions.
The rotation of the rotator cuff cannot be healed automatically due to the constant tendency of the muscle in the opposite direction. Of course, this does not mean that the symptoms of rupture (eg pain) can not go away. A rotator cuff rupture that has been treated conservatively may grow over time, which makes postoperative rehabilitation of a future operation more difficult. The treatment of the rupture depends on the size of the lesion, the symptoms and the activity of the patient. In cases where the damage is small and the individual's requirements are limited, conservative treatment gives the solution. In cases of larger ruptures, people who have more demands on daily or sports activities or in cases where conservative treatment does not have the desired effect, arthroscopic suturing provides a solution to the problem.
During conservative treatment , the goal is to relieve the patient of pain and improve shoulder movement. Includes:
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Rest and reduce activities above shoulder level
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Avoid activities that cause pain
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Painkillers and Non-Steroidal Anti-Inflammatory Drugs
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Physiotherapy with kinesiotherapy and strengthening exercises
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Topical injection of cortisone
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Platelet Rich Therapy in Platelets
During the surgery , the tendon is repositioned and fixed at the anatomical point from where it has been sutured with sutures and special anchors of minimum size. The operation is now performed arthroscopically , that is, through small holes in the skin in a short period of about 60 minutes. The patient can be discharged from the hospital on the same day. The type and duration of postoperative rehabilitation depends on the size of the lesion and the type of surgery.
3. Tendonitis of the long head of the biceps.
The biceps begins - through two tendons - in the shoulder area and ends - through a tendon - in the elbow joint. In the shoulder the first tendon is the short head that starts at a point near the joint (crow's feet) and rarely causes problems, while the second tendon is the long head, it starts through the shoulder joint and is unfortunately a cause of frequent problems.
The length of the long head tendon is about 9 cm, coming out of the joint it bends about 90 degrees and passes through a narrow bone formation to end up in the biceps muscle. This flexion in the path of the tendon has occurred during the human control process when the shoulder joint together with the scapula moved from the side of the body to the back, to the back. This allowed the person to make casts, but unfortunately it also creates problems due to the intense loading of the tendon.
The most common symptoms are:
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Severe - deep pain in the anterior surface of the shoulder with possible reflection peripherally to the anterior surface of the arm - biceps (severe pain both during movements and at rest)
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Inability to perform specific shoulder movements due to pain
The differential diagnosis is:
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Tendonitis
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Degeneration
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Rupture
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Tendon instability (when it deviates from its normal course as it passes through the narrow bone formation)
Chronic recurrent micro-injury - irritation is what causes either the spontaneous rupture of the tendon, which shows ecchymosis in the arm area, but a gradual reduction of pain, or the partial rupture of the tendon, which has particularly painful symptoms and afflicts the patient.
The diagnosis is usually clinical , with history and clinical examination, and is confirmed by ultrasound or magnetic resonance imaging.
Treatment varies depending on the condition. Specialized physiotherapy and kinesiotherapy program, anti-inflammatory and injections (corticosteroids, local anesthetics and PRP) are the first line of treatment.
In particular, tendonitis is mainly treated conservatively with non-steroidal anti-inflammatory drugs, physiotherapy, as well as local infusion of drugs or biological agents under ultrasound control in the most difficult cases. While in resistant cases or ruptures of the tendon, surgical treatment in the form has a place arthroscopic tenotomy in the elderly and intra- or extra-articular tendonitis in younger and more active patients.
