Impingement syndrome occurs more frequently in a smaller shoulder joint, namely the acromio-clavicular joint, as a result of inflammation of the tendons of the rotator cuff muscles, tendons located in the subacromial space (under the acromion bone). The rotator cuff is a tendinous blade that covers the anterior, upper and posterior face of the shoulder joint capsule. It is composed of the tendons of 4 muscles: supraspinatus, infraspinatus, small round muscle, subscapularis muscle. The action of these muscles maintains the humeral head in the shoulder joint and ensures the movement of the arm in different directions.

Of the tendons of the muscles of the rotator cuff, most commonly affected is the tendon of the supraspinatus muscle. The supraspinatus is a muscle that stabilizes the shoulder joint and also helps raise the arm to the side. When the arm rises to the side, the tendon of the supraspinatus muscle slides under the acromion. At the time of inflammation, the tendon can be trapped or pushed under the acromion: impingement.

There is also the bursa, a fluid bag with a lubricating role, which is located between the acromion bone and the tendon of the supraspinatus muscle, allows the tendons to move freely avoiding rubbing the tendon against the bone. When the bursa becomes inflamed, a condition known as subacromial bursitis, it takes up even more subacromial space, thus pushing the inflamed tendon even more.

The shoulder impingement syndrome tends to occur frequently after the age of 50, although there are situations when it occurs in younger patients.

It can cause hypertrophy (thickening) of the joint leading to a decrease in the space under the joint and to the pushing of the tendon of the supraspinatus muscle. As time passes, there is a risk of developing bone spurs on the lower part of the acromio-clavicular joint, which will further narrow the subacromial space.

There is a close correlation between the subacromial impingement and the form of the acromion bone, classified as follows:

➢ type I: flat/smooth acromion → low incidence

➢ type II: curved acromion → higher incidence

➢ type III: acromion with the appearance of a beak → increased incidence; it can be an anatomical variant or it has a degenerative cause (type II that degenerates)

The inflammation of the bursa under the acromio-clavicular articulation that further narrows the subarticular space causes the grip/pushing of the tendons of the rotator cuff.

Shoulders pushed outwards and raised shoulder blades can also cause impingement syndrome.

Certain repeated movements in the shoulder joint, such as movements in golf, tennis, basketball, but also in other sports, can cause inflammation of the tendons of the rotator cuff and then pushing.

First of all, it should be known that the recovery is long-lasting and can take between 6-12 months

Anti-inflammatory drugs are indicated to reduce pain and inflammation, but only for a maximum period of 7-14 days.

Cortisone (stronger anti-inflammatory) injections may be indicated to reduce inflammation and pain in the situation in which they are intense and greatly affect the quality of life.

Ice applied topically, in sessions of 5-10 minutes, 3-5 times/day for several weeks, also helps reduce inflammation. Always put a thin towel between the ice and the area on which it is applied.

Through stretching exercises and exercises to tone the stabilizing muscles of the shoulder, adapted to individual needs, physical therapy has an important role in

➢ relieving pain

➢ regaining the complete movement of the shoulder,

➢ restoring the muscles of the rotator cuff

➢ returning to sports, with the possibility of performing speed and force movements

➢ resuming daily activities

➢ Pay attention to the correct dosing of the shoulder joint load both in the case of athletes but also of people who, in their professional activity, often raise their arms above the head.

➢ Avoid sleeping on the affected side or with the arm raised above the head

➢ Perform daily stretching exercises to maintain the flexibility of the shoulder joint

➢ Hold a correct posture of the shoulders.