Sodium Hyaluronate Injections Compared to Local Modalities for the Treatment of Shoulder Impingement Syndrome/Omuz Sikisma Sendromu Tedavisinde Sodyum Hiyaluronat Enjeksiyonu Ile Lokal Modalitelerin Karsilastirilmasi (Original Article / Orijinal Makale) (Report‪)‬

Introduction Shoulder impingement syndrome (SIS) is a common cause of chronic shoulder pain and disability (1). It refers to compression of the rotator cuff tendons and subacromial bursa between the humeral head inferiorly and the coracoacromial arch, the anterior third of the acromion, the coracoacromial ligament and the acromioclavicular joint superiorly (2). Accurate diagnosis of SIS depends mainly on the history and physical examination of the patient (3). Among the many tests that have been developed for physical examination of the shoulder, Neer and Hawkins tests are considered to be highly efficient in diagnosing SIS (4). A reference standard test, however, is the subacromial injection test (SIT) which is considered positive if marked relief of pain and almost total improvement in passive and/or active shoulder range of motion (ROM) are achieved after an injection of 10 cc of 1.0% xylocain or lidocain into the subacromial space (5). Routine X rays, especially supraspinatus outlet radiographs may also be helpful, and if a tear of the rotator cuff is suspected, additional radiologic studies such as ultrasound, magnetic resonance imaging and finally arthroscopy may be performed (3).