Lump between neck and shoulder UPDATE

Hi Gem8. Welcome to the forum.

We’re not doctors here, so we can’t diagnose your lump, but the take home message is that most lumps are harmless. There are numerous possible reasons for lumps, and cancer is way down near the end of the list.

Your doctor is doing the right thing in sending you for an MRI, and don’t be too surprised if you’re referred to a specialist and/or the lump is biopsied. Don’t be alarmed if you’re sent for an “urgent” referral for “suspected cancer”.  Many people are similarly referred each year, and nine out of ten turn out not to have cancer.  I myself have been “urgently” referred for suspected cancer on two occasions in the last 3 years, and each time nothing nasty has been found – although I did need to have endoscopies and an MRI! 

Right now, you have no reason to suspect that this is cancer. Right now it’s an unidentified lump which may well turn out to be a cyst or a lipoma or something else equally harmless. You might need surgery to remove it, or it might resolve on its own, but there is no undue reason to be alarmed. 

So please try to keep calm, and don’t panic.

PS. Don’t bother asking the MRI radiographer whether the images show anything nasty. They’re not allowed to tell you because they’re not qualified to interpret what they see. The images need to be examined and interpreted by an experienced radiologist (a qualified doctor) who will write a report and send it back to the doctor who ordered the scan. 

PPS. If you’ve never had an MRI before, my advice is to take a favourite CD which contains a lot of short familiar tracks which will help you pass the time(you probably won’t be able to take an iPod because the MRI’s magnetic fields could well damage it).  Ask the radiographer to turn the machine’s internal fan onto maximum because the scans may make you feel warm, and to count down the number of scans left to go after each one finishes. A single scan lasts about 4 minutes, and the machine makes so much noise that you’re given headphones. If you can’t hear your CD, ask for the volume to be increased slightly. You’ll probably want to keep your eyes closed as much as possible during the procedure. It’s not much fun, but it is necessary. 

What are Shoulder swellings and lumps?

I have a shoulder lump what could it be?

Shoulder lumps are not uncommon. They can occur on the upper arm over the shoulder joint, in the arm pit (axilla), over the outer end of the collarbone (acromio-clavicular joint, ACJ), and over the inner end of the collarbone where it joins the breastbone (sterno-clavicular joint, SCJ).  The most common lump around the shoulder region are lipomas. A lipoma is a benign, fatty tumour that can occur anywhere around the body. 

Other causes of lumps or swellings around the shoulder region can be ganglions (cystic swellings from degenerate joints such as the shoulder joint, ACJ or SCJ), nerve sheath tumours (benign tumours that grow from the lining of nerves), and rarely sarcomas tumours  (malignant tumours from soft tissue or bone). Lumps or swellings in the arm pit (axilla) could be due to cysts or enlarged lymph nodes.

What are the features of a lump that I should be worried about?

Any lump which is increasing in size, painful, and deep to the soft tissues would be of concern. Harder lumps may cause more concern than softer compressible lumps. The size of a lump matters, and any lump bigger than 5cm (Golf Ball size) should be investigated. If you have had a lump removed in the past and it has come back, this should also be reviewed. A change to the skin over a lump is also a worrying sign. If you have any of these features don’t delay in getting your lump checked. Your surgeon would take a thorough history and examine you and the lump to determine the next steps.

Can lumps be investigated and removed?

Most lumps can be investigated and assessed by a simple ultrasound. On occasion a further investigations such as x-rays, MRI or CT scans may take place to get a clearer picture of what the lump is. Some lumps require a biopsy to determine what they are while other small lumps can be excised whole during surgery and sent to the laboratory for analysis. Not all lumps or swelling require removal but your surgeon will be able to discuss the treatment options with you.

How would lumps on the ACJ and SCJ be managed?

Swellings around the ACJ or SCJ are usually due to joint degeneration. Occasionally they can be due to infection. The treatment of a swelling over the acromio-clavicular joint or the sterno-clavicular joint would be to treat the underlying cause and most of the time this would cause the swelling to go away. In the case of a degenerate ACJ that is resistant to treatment, excising the joint using key-hole surgery is one way to treat the joint and prevent further swelling.

Thanks to Shoulder Elbow London Consultant Surgeon Nick Ferran for his valuable insight into common shoulder lumps.

Manchester Lumps Clinic runs a rapid diagnostic clinic. Get in touch via our contact form if you have a lump of concern or email us.

What You Should Know If You Feel a Lump On Your Neck : Lawrence Otolaryngology Associates: Otolaryngology

It may be surprising and upsetting when you discover a lump on your neck that you haven’t previously noticed. The good news is that neck lumps are common and most often harmless. They can come in different sizes and textures, and they’re usually non-cancerous.

But there are a few types of lumps that could be a sign of a more serious condition, and you can’t detect these through simple home evaluations.

Visiting an ear, nose, and throat specialist such as those on our team at Lawrence Otolaryngology Associates is always a good idea if you notice a neck mass. Chances are good you have nothing to worry about, and as with many health issues, early detection and medical treatment leads to the best prognosis.

Today we discuss a few of the more common causes of neck masses, but if you have any questions or concerns, call to make an appointment with Lawrence Otolaryngology Associates at one of our three locations.

Enlarged lymph nodes

Whenever your body experiences an infection, your lymph nodes may become swollen because they are filter tissues that store white blood cells needed to fight infection. They also store dead cells and bacteria to be flushed from your body. As well as causing lumps on either side of your neck, lymph nodes are located in your armpits, under the jaw, in the groin, and above your collarbone.

Thyroid nodules

Either fluid-filled or solid, thyroid nodules are usually harmless, but they can indicate an autoimmune disorder or cancer. In addition to a lump on your neck, a thyroid nodule could cause a cough or difficulty swallowing. Your voice may be hoarse, and you may have pain in your neck and throat.

Infectious mononucleosis

A viral condition that most often affects people of high school and college age, mononucleosis can cause neck lumps due to swollen lymph nodes as well as symptoms similar to thyroid nodules. In addition, you may have headaches and overall fatigue. Body aches and night sweats are also frequent symptoms.

Mumps

The mumps virus is very contagious, spreading through mucus, saliva, and close contact with those infected. The salivary glands swell, causing pain through increased pressure, usually felt at the rear of the cheeks. You could feel fatigued and achy, with accompanying fever, headache, and loss of appetite.

Lipoma

The neck is a common spot for lipomas to develop. These are fatty tissue deposits that can occur at any age, but that generally don’t affect children. Lipomas usually aren’t painful and won’t cause other problems. But a type of cancer called liposarcoma can resemble a lipoma, so you may need a biopsy to confirm your lump is benign.

Cancers

Skin and other types of cancers can lead to bumps on your neck. Some types of skin cancer cause raised growths that are often a different color. Throat and thyroid cancers produce lumps that are under the surface of the skin, pushing out and causing difficulty with swallowing and breathing in some cases.

There are many more causes that could be behind the mass on your neck. For a diagnosis and treatment, call one of our three locations to schedule an appointment.

Is a Lump on My Neck a Sign of Cancer?

Published: February 19, 2020

Updated: August 18, 2020

Key Takeaways:

• Most lumps are not a sign of cancer. However, if you have a lump on your neck that isn’t going away it should be examined by a doctor.
• A cancerous lump can vary in size and location, and some people may even feel a cluster of lumps grouped together.

Lymph nodes are key components of the body’s immune system. These small, bean-shaped capsules are located throughout the body and are responsible for filtering lymph fluid and removing harmful substances. They also contain immune cells, which help fight infections by attacking germs and bacteria carried through this fluid.

Typically, lymph nodes are soft and undetectable. However,
when activated to fight infections, they will enlarge. In most instances, this
swelling is normal and will subside once the body clears the virus. In rare cases,
these lumps can be the first sign of cancer.

“Feeling a lump on your neck is not a reason to panic,” says Jochen Lorch, MD, MS, director of the Thyroid Cancer Center at Dana-Farber/Brigham and Women’s Cancer Center. “While most lumps are benign, it’s still important to report persistent lumps to your doctor.”

What does a cancerous lymph node feel like?

Cancerous lymph nodes can occur anywhere on the neck and are typically described as firm, painless, and sometimes may be immovable. A lump will form when a cancer cell infiltrates the capsule and multiplies. If left unchecked, the cancer can break out of the lymph node and spread to the surrounding tissue.

In terms of size, these lumps can range anywhere from less
than one centimeter (less than half an inch) to several inches in diameter.
While you may only notice a single lump, it is not uncommon to find them
clumped together, spread out along one side of the neck, or even along both
sides of the neck depending on the location of a possible tumor.

For example, if the original tumor developed near the midline, such as in the tongue base area, typically both sides of the neck may be affected. What makes this tricky, however, is that infections may also present with enlarged lymph nodes on both sides of the neck.

Cancerous lumps can also fluctuate in size; however, they generally do not disappear only to reappear weeks later. If you experience this, Lorch encourages you to see a doctor because while it is likely not cancer, it could be a warning sign for something else.

What cancer(s) can a neck lump be related to?

The reason it is important to monitor lumps, and inform your
doctor of any changes, is because generally a lump is the only symptom of head
and neck cancer that a patient may experience. It’s important to remember
that these symptoms may also be caused by other, less serious conditions.

Jochen Lorch, MD, MS.

Make sure to consult with either you doctor or dentist if
you experience any of the following symptoms:

• Difficulty swallowing
• A persistent sore throat
• Earaches or a loss of hearing on just one side
• Fluid behind the eardrum
• A change or hoarseness in your voice

While 80 to 90 percent of reported thyroid lumps are not cancerous, it’s important to inform your health care provider if you notice any changes.

Patients with thyroid cancer may also feel a lump in their neck. The thyroid gland sits at the base of the neck (below the Adam’s apple), and if it becomes cancerous, it may cause one nodule or area to enlarge.

About the Medical Reviewer

WHAT IS A LIPOMA? | London Shoulder & Elbow Surgeon

What is a lipoma?

Lipomas are the most common soft tissue tumours in adults. They are common in the upper limb and tend to occur more proximally around the shoulder region, but they can occur anywhere along the upper limb.

They are benign fatty tumours and are not cancerous. Fat cells within the lipoma become engorged and grow out of control. Lipomas aren’t related to obesity or diet. The most common age group for lipomas is 40-60 years.

Less than 1% of soft tissue lumps are malignant, and these can sometimes be mistaken for lipomas.

How can I tell if my lump is a lipoma?

Lipomas can be superficial/subcutaneous (under the skin) or deep. Superficial lipomas are often soft and rubbery well-defined lumps that are not painful and are mobile. Deep lipomas occurring within or between muscles can be more difficult to feel and may just appear as an asymmetric swelling compared to the other limb. Lipomas can range in size from less than 1cm to massive swellings.

Some lipomas may be atypical and still be benign while there are some fatty lumps that can be malignant, so it is important to tell the difference.

How are lipomas treated?

Lumps greater than 5cm should be investigated to ensure that they are benign lipomas and not something more sinister. For smaller lumps ultrasound can be good at diagnosing, but larger lumps, deep lumps, and atypical lumps may require MRI scans.

Small lipomas can often be left alone and just self-monitored by patients. Larger lipomas can sometimes press on local structures and cause symptoms or may be unsightly or catch on things and therefore may need surgical removal. A simple lipoma on the upper limb can be removed by an upper limb surgeon.

Atypical lumps, or any lumps that are suggestive of possible sarcoma or malignancy should be referred to a sarcoma service for further diagnosis and definitive treatment.

Can a lipoma become malignant?

A simple lipoma is a benign tumour that has no risk of becoming malignant.

Can a lipoma come back after it is removed?

There is a less than 5% chance of a simple lipoma recurring after removal.

When do I need to worry about a lump?

Any of the following signs should be a cause for concern and a lump with any of these features should be checked out promptly by a doctor:

Rapidly growing
Painful
Firm
Ill defined
Fixed to deep tissues
Red
Hot/warm
Changes to overlying skin

It is recommended that all lumps greater than 5cm (size of a golf ball) be checked to rule out a soft tissue sarcoma (a malignant condition).

If you have a lump on your shoulder or elbow that you are concerned about do get in touch to book an appointment.

Neck Lumps and Bumps. What Neck Lumps are and what to do

Lumps in the neck are common and the cause is usually benign. In general practice, inflammatory lymph nodes are the most common cause^[1]. However, the lump may be the presentation of more serious disease (eg, malignancy or chronic infection) and so thorough assessment and diagnosis are essential. If there is any doubt as to the cause then the patient should be reviewed and/or referred for specialist assessment. Inflammatory, congenital and traumatic causes are more common in younger patients but cancers should still be borne in mind. Patients over the age of 40 are more likely to have a neoplastic cause.

Assessment

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Clinical assessment will be guided to some extent by the location and nature of the lump(s) and the likely diagnosis. Points in the history and examination which should be considered are listed below.

History

• How long has the lump been present?
• Is it painful?
• Has it changed? If so, over what time frame?
• Are there symptoms of recent infection of nearby structures (cough, cold, sore throat, earache, toothache, skin problems, head lice, bites)?
• Has there been a fever?
• Does eating affect the lump?
• Is there pain on swallowing?
• Is there any effect on voice?
• Does the person smoke?
• Is there a history of travel?
• Is there a past history of cancer?
• Are there red flag symptoms of systemic illness? For example:
• Night sweats.
• Weight loss.
• Unexplained bruising or bleeding.
• Persistent fatigue.
• Breathlessness.

Examination

Establish:

• Location of the lump. Examine the:
• Anterior triangle (bordered by the midline, the body of the mandible and the anterior border of sternocleidomastoid).
• Posterior triangle (bordered by the posterior border of sternocleidomastoid, the clavicle and the trapezius).
• Midline.
• Whether it is tender, hot, red, inflamed.
• Consistency.
• Size.
• Mobility.
• How deep the lump is: whether it is intradermal (suggesting sebaceous cyst with a central punctum, or a lipoma), subcutaneous or within deeper tissue.
• Whether it is pulsatile.
• Whether it is a solitary lump or if there is more than one.
• Whether it moves on swallowing (thyroid gland, thyroglossal cysts).
• Whether it moves when the person sticks out their tongue (thyroglossal cysts).

Further examination to help establish the cause may include:

• Examination of the skin of the head and neck for rashes, lesions or infection.
• Examination of the ears, nose and throat.
• Examination of the mouth – for malignancy, dental issues. If parotid disease is suspected, identify the orifice of parotid duct and palpate with the patient’s head tilted backwards.
• Examination of the chest.
• Examination for lymphadenopathy or organomegaly elsewhere.
• Checking for compression of the airway or vasculature.
• Taking note of general clues of systemic illness, such as jaundice, pallor, petechiae, bruising, excoriation.

Differential diagnosis

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There are numerous possible causes of lumps in the neck.

The most common cause is reactive lymph nodes:

• Bacterial causes, such as beta-haemolytic streptococci, Staphylococcus aureus, tuberculosis and secondary syphilis.
• Viral causes, such as common viruses causing upper respiratory tract infections, Epstein-Barr virus (EBV), cytomegalovirus, HIV, herpes simplex virus.
• Parasitic causes, such as head lice, fungal infections, toxoplasmosis.
• Non-infective causes, such as sarcoidosis and connective tissue disease.
• In children consider cat scratch disease, Kawasaki disease (more than one lymph node must be >1.5 cm and non-fluctuant – look for associated conjunctivitis, fever and desquamation).

Other causes include:

• Malignant lymph nodes: leukaemia, lymphoma, metastases.
• Infections of the skin: abscess, infected sebaceous cyst.
• Lipomas and other benign tumours: such as fibromas, chondromas, neuromas and vascular tumours.
• Thyroid swellings: diffuse enlargement, nodules and cancers^[4].
• Salivary gland problems: tumours, blocked ducts, infection and inflammation.
• Congenital swellings: thyroglossal cyst, dermoid cyst, cystic hygroma, lymphangioma.
• Developmental abnormalities: branchial cyst, laryngocele, pharyngeal pouch, cervical rib^[5].
• Carotid body aneurysm or tumour.
• Malignant tumours: sarcoma, chondrosarcoma, skin malignancy.

Making the diagnosis

Working toward the diagnosis will involve clues from:

Age
Neck lumps are more likely to be inflammatory than malignant in children and young people. Congenital and developmental lumps are also more likely in children and young people. Large cystic hygromas present at birth and may be huge and disfiguring. In older children, smaller lesions can present as a painless lump just below the angle of the mandible, soft, fluctuant and transilluminable. Branchial cysts are rare but usually present in late teens with a solitary painless swelling on the side of the neck, which varies in size and may be painful and red in some patients.

Onset
Inflammatory lumps usually arise suddenly and resolve within 2-6 weeks. Progressive enlargement over a short time is more likely to be malignant. A transient nature to the swelling and an association with eating suggest salivary gland blockage. Associated symptoms often give the clue to the cause of reactive lymph nodes or indeed malignant nodes. 

Consistency and mobility
A hard mass is more likely to be malignant. Congenital masses are usually smooth and mobile. Reactive lymph nodes are mobile. Thyroid gland swellings and thyroglossal cysts move on swallowing, and a thyroglossal cyst moves when the tongue is moved outwards^[4]. A fluctuant mass suggests a cystic nature. Tenderness suggests infection. A laryngocele enlarges with blowing or the Valsalva manoeuvre.

Location
Midline lumps are likely to be thyroid in origin or thyroglossal/dermoid cysts. Posterior triangle lumps are most commonly lymph nodes, although lymph nodes are a common cause of swellings in all areas of the neck. Bilateral swellings (tender) crossing the mandibular angle are likely to be parotid infection (mumps). Submandibular swellings may be related to the submandibular gland. A lump in the left supraclavicular fossa (a Virchow’s node) may indicate an infraclavicular metastatic malignancy such as lung or upper gastrointestinal tumours.

Associated symptoms
Red flags suggestive of haematological malignancy include night sweats, weight loss, pruritus, fever, bruising, breathlessness, fatigue, etc.

Investigations

Investigations will be guided by clinical assessment but may include:

• FBC and ESR (within 48 hours if generalised lymphadenopathy to exclude leukaemia).
• TFTs.
• Viral serology – eg, EBV, cytomegalovirus, toxoplasmosis.
• Throat swab.
• CXR (within two weeks for supraclavicular lymph node swelling or persistent cervical node in a person over 40 years old)^[6].
• Ultrasound scan – for thyroid swellings and as a first-line imaging option where diagnosis is unclear, with or without a view to ultrasound-guided fine-needle aspiration biopsy.
• Radionucleotide scanning (if masses of parathyroid or thyroid glands).
• CT or MRI scan.

Referral

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Referral is usually to an ear, nose and throat (ENT) specialist but findings may dictate referral to a dermatologist, an oral surgeon, or a chest physician. Any new neck mass persisting beyond six weeks should be referred^[7]. Referral more immediately may be appropriate in some cases.

Make an urgent two-week wait referral through the suspected cancer pathway if:

• The person has lost weight.
• There is associated hoarseness, difficulty swallowing (dysphagia), or breathlessness (dyspnoea) for three weeks or more.
• There has been haemoptysis.
• There are associated symptoms suggestive of lymphoma (weight loss, night sweats, fever, breathlessness, pruritus or bleeding) – two-week wait referral for adults but 48-hour referral for children and young people up to the age of 24 years.
• An unexplained enlarged lymph node is persistent.
• There are suspicious clinical features.
• Diagnosis is unclear.

Management

This will depend on the cause. Benign reactive lymph nodes usually settle on their own within six weeks, needing no treatment. One-stop assessment clinics (with access to ultrasound and fine-needle biopsy) can be useful^{[8, 9]}.

Lump – Symptoms, Causes, Treatments

A lump is a protuberance or localized area of swelling that can occur anywhere on the body. Other terms used to describe the various types of lumps include bump, nodule, contusion, tumor and cyst. Lumps can be caused by any number of conditions, including infections, inflammation, tumors or trauma. Depending on the cause, lumps may be single or multiple, soft or firm, painful or painless. They may grow rapidly or may not change in size.

Lumps due to local infectious causes may appear as boils or abscesses. Many types of infections cause the lymph nodes to enlarge and feel like lumps, most commonly in the neck, near the jawbone, in the armpits, or in the groin. Traumatic causes of lumps range from bug bites to severe injuries that can produce a localized collection of blood in the tissues (hematoma).

Both benign and malignant tumors of the skin, soft tissues, or organs can sometimes feel like lumps. In these cases, either a biopsy or surgical removal of the lump can determine whether cancer is present. Cysts, which are fluid-filled, sac-like structures that can form in various parts of the body, often feel like lumps. Some cysts may be present at birth, while others develop as a result of inflammation, tumors, or wear-and-tear over time.

Conditions that produce inflammation throughout the body, such as rheumatoid arthritis, may be associated with lumps. Lumps located in the thyroid gland may cause symptoms related to hormonal imbalance, including rapid heart rate, sweating, restlessness, and weight loss.

Lumps caused by infection, inflammation or trauma are usually temporary and subside as the underlying condition resolves. Lumps that persist or continue to grow over time may signal more serious conditions such as tumors. A lump on the head that is associated with an injury may signal bleeding in the brain or another emergency and may have life-threatening complications.
Seek immediate medical care (call 911) if you have a lump on the head as a result of an injury.

If you have any lump that is persistent or causes you concern,
seek prompt medical care.

90,000 Benign tumors of the neck (cyst, lipoma) ”Department of Endocrine Surgery

Neck tumors is a small but very diverse group of lesions in terms of clinical manifestations. Among them, tumors of the neck organs and extraorgan tumors that arise from the soft tissues of the neck can be distinguished. One of the main lymphatic collectors is located in the neck area, the defeat of the nodes of which often occurs when the lymphoreticular tissue is affected.

A neck tumor can be benign or malignant. Surgical treatment followed by radiation therapy. From other diseases, various forms of goiter are often found.

Classification of a neck tumor

Distinguish between organ tumors, extraorgan tumors, tumor lesions of the lymph nodes of the neck – primary and secondary (metastatic).

• Organ tumors retain structural elements of a normal organ (for example, a tumor of the thyroid gland, carotid glomus).Malignant tumors originate mainly from organs located in the neck.
• Extra-organ tumors are derivatives of the mesenchyme, muscle and nervous tissue. They can be benign (fibroma, lipoma, neuroma) or malignant (lymph node metastases).
• A separate group is represented by neck cysts: lateral neck cyst and median neck cyst, which are benign tumors, but rapidly growing with deformation and compression of the neck organs. Suppuration of neck cysts can lead to a serious complication – phlegmon of the neck.
• Tumor lesions of the cervical lymph nodes (primary in hemoblastosis, secondary in metastases).

Symptoms of a neck tumor

Any lump under the skin on the neck is always alarming and alarming. Each person, once faced with this, can confirm that with the onset of such changes, they begin to listen to them and even interpret the emerging symptoms in their own way or try to predict the next stage of their sensations.

To save yourself from unnecessary anxiety, it is important to know if a tumor is developing on the neck and what it might be.In other words, we are talking about self-diagnosis, since based on the analysis of all changes, it is possible to determine the degree of their danger. If you notice or palpate a swelling in the neck that grows or does not shrink within 2 weeks, it is necessary to consult a doctor. An absolute indication for consulting a specialist is the presence of pain in the area of ​​the tumor.

Diagnostics: how a tumor of the neck is diagnosed

Malignant tumors of the head and neck account for 5% of cases of malignant neoplasms detected annually.If a patient over 40 years of age has a mass for more than 4 weeks, it should be considered malignant until proven otherwise.

As in any other case, start with detailed questioning and physical examination. It is not worth rushing with a biopsy (incisional or total), since in most malignant tumors it increases the risk of local recurrence. Search for the primary tumor. If a malignant tumor of the head and neck is suspected, the patient is referred to an otorhinolaryngologist or endocrine surgeon.

When a primary neck tumor is found, it is biopsy (TAPB). To determine the prevalence and detect metastases, CT or MRI is performed – from the base of the skull to the upper aperture of the chest. Chest x-rays are taken to rule out lung metastases.

To confirm the diagnosis, the formation can be punctured. Unlike an incisional biopsy, a puncture does not increase the risk of local recurrence. However, in lymphoma, the diagnostic value of a puncture is low, and the suspicion of lymphoma is one of the few indications for a total lymph node biopsy.With an increase in the supraclavicular lymph node, mammography (in women) and examination of the digestive tract and genitourinary system are shown.

If the primary tumor cannot be found, direct laryngoscopy, bronchoscopy, esophagoscopy and posterior rhinoscopy with biopsy of suspicious mucosal areas are performed.

Treatment: how a neck tumor is treated

Treatment depends on the location of the tumor and the stage of the disease. With a growing neck tumor, surgical treatment is necessary, the operation should be performed in a specialized center, radically with an express histological examination, by a highly specialized head and neck surgeon or an endocrine surgeon, if necessary, with radiation therapy or combined chemotherapy and radiation therapy.Unlike adults, in children, only 10% of the volumetric tumors of the neck are of a malignant nature, therefore, first of all, inflammatory diseases and congenital anomalies are excluded.

A tumor of the neck is of various origins and often its malignant or benign nature can be judged only during the operation, after histological examination. Before removing it, it is necessary to find out the nature of the process (malignant or benign).

Cervicobrachialgia (neck pain radiating to the arm) – treatment, symptoms, causes, diagnosis

The neck and shoulder are formed by muscles, bones, nerves, veins and arteries, as well as ligaments and other supporting structures.Various conditions can cause pain in the neck and shoulder (arm). Some conditions can be life-threatening (such as myocardial infarction or injury) or be harmless enough (such as sprains or contusion).

Reasons

The most common cause of shoulder and neck pain is damage to soft tissues, including muscles, ligaments, and tendons. Such damage can be due to whiplash or other injuries. With degenerative arthritis in the cervical spine, compression of the roots and the appearance of pain in the neck radiating to the shoulder and arm can occur.With degenerative changes in the intervertebral discs, there may be local pain or radiating pain with a herniated disc, when the root is compressed by a herniated disc. Neck and shoulder pain can also be caused by various pathologies of the spinal cord of the lungs of the heart, and sometimes even with diseases of the abdominal organs.

For example, under conditions such as:

• Clavicle fracture. Typically, a collarbone fracture occurs when a fall on an outstretched arm (for example, this is common in cyclists).
• Bursitis. When the bursa is injured, inflammation occurs, and pain and stiffness appear.
• A heart attack (angina pectoris or heart attack) may present with neck and / or shoulder pain and the pain is mirrored.
• Fracture of the scapula. As a rule, fractures of the scapula occur with a forced impact on the scapula.
• Damage to the rotator cuff. The rotator cuff is a group of tendons that provide support for the shoulder.These tendons can be damaged when lifting heavy weights in sports where there are hand throws or repetitive movements. Long-term repetitive exercise leads to pain during shoulder movement and the development of impingement syndrome and, over time, to a significant decrease in the range of motion in the shoulder (frozen shoulder).
• Shoulder separation. The clavicle and scapula are connected by ligaments and when injury occurs, the ligaments can stretch or break.
• Whiplash injury.This is a damage to the ligamentous – muscular structures of the neck and shoulder, which occurs with a sharp overextension, for example, in a car accident.
• Tendinitis. Tendons attach muscles to bones. When the tendons are stretched, the tendons become inflamed, which can cause pain.
• Cholecystitis. Inflammation of the gallbladder can cause pain in the right shoulder.
• Inflammation of the diaphragm due to various causes can also be a source of reflected pain.

Symptoms

The pain is most often acute, but it can also be dull or with a burning sensation, tingling or electric current. The pain can lead to stiffness in the neck or shoulder and reduced range of motion. In addition, there may also be a headache. The peculiarity of the symptoms is important for the doctor, as it allows you to find out the cause of the pain syndrome.

Weakness can be associated with severe pain in muscles or bones when moving. In addition, nerves can also be damaged and it is therefore necessary to differentiate true weakness (muscle or nerve) from reduced weakness associated with pain or inflammation.

Numbness. If there is compression (injury, injury) of the nerves, sensitivity may be impaired. In addition to numbness, there may be tingling or lulling sensations.

Cold snap. A cold hand or hand may indicate possible damage to the veins or arteries. This symptom, as a rule, indicates insufficient blood circulation in the limb.

Color change. A blue or pale hand or shoulder can also be a sign of damage to your veins or arteries.Redness can be a sign of infection or inflammation.

Puffiness. Edema can be either generalized to the entire arm or localized in the area of ​​problematic structures (for example, a fracture zone or an inflamed bursa). Muscle spasm or induration can simulate swelling. Dislocation or deformation can also cause swelling.

Deformation can be with a fracture or dislocation. Tendon ruptures can lead to abnormal positioning of bone structures.

If you have symptoms such as increasing pain, weakness, cold extremity, deformity, fever, or symptoms such as dizziness, trouble breathing, or sudden numbness or weakness, seek immediate medical attention.

Diagnostics

In most cases, diagnosis can be made based on medical history and physical examination. Nevertheless, instrumental examination methods are prescribed in cases of need to verify the diagnosis, depending on the nature of the injury, localization of pain and other symptoms.

Radiography is prescribed if there is pain on palpation of the bones of the spine or shoulder, a history of trauma, the presence of deformity, or if there is a suspicion of problems in the lungs or heart.

ECG – electrocardiography can be prescribed for chest pain, respiratory failure and the presence of risk factors for coronary heart disease (high blood pressure, diabetes, high cholesterol, smoking).

Blood tests are prescribed in the presence of chest pain, shortness of breath and in cases where the doctor suspects the presence of inflammatory diseases.

CT. Computed tomography is prescribed when more detailing of changes in the tissues is needed or if there is a suspicion of diseases of the chest organs.

MRI. As a rule, MRI is prescribed only when it is necessary to differentiate between different conditions.

Treatment

Treatment of neck pain radiating to the shoulder and arm depends on the cause of the pain. For minor injuries, treatment can be at home. If the source of the pain is not known, or the symptoms may be a sign of a serious illness, then seek medical attention.

Rest. It is necessary to reduce the load on the damaged area for 2-3 days, and then you can gradually begin therapeutic exercises.

Cold 90 100. Apply cold compresses to the damaged area for 15-20 minutes several times a day.

Elevation arm. Elevating the injured limb can help reduce swelling. For this can be used.

Immobilization is carried out using a plaster orthosis or splint. It is necessary to follow all the doctor’s recommendations, especially when there is a need for prolonged immobilization.

Drug treatment . Analgesics and NSAIDs may be prescribed for neck and shoulder pain for several days.

Physiotherapy – the appointment of physiotherapy depends on the cause of the disease, and is widely used in the treatment of pain in the neck and shoulder.

Exercise therapy – gymnastics and exercises on simulators allow you to improve the muscle corset and muscle elasticity, both in the shoulder joint and in the spine.

Surgical methods are indicated only in the presence of clear clinical indications.

Prevention and prognosis

In order to prevent damage, it is necessary to clearly assess the possible risks when performing certain types of work or sports. Correct exercise technique can also help prevent injury. When performing new movements (exercises), it is necessary to assess the risk of possible damage.

As a rule, minor injuries, such as sprains, tend to heal rather quickly.In other cases, when the causes of neck and shoulder pain are more serious conditions, the duration of treatment may vary and recovery may take different periods of time.

90,000 ultrasound of soft tissues of the neck

Ultrasound examination of the soft tissues of the neck is an informative diagnostic technique that allows you to identify a lot of pathological processes in a short period of time. Any abnormal abnormalities can be identified even at the initial stage, while the patient does not experience any discomfort at all.Surgeons or neuropathologists can prescribe this study if they suspect a particular disease.

For whom ultrasound of soft tissues of the neck is indicated

Ultrasound examination has an excellent ability to clearly visualize the structures of soft tissues, muscles, adipose tissue and blood vessels. This type of diagnosis allows you to examine the neck in various projections and identify possible deviations. The study is assigned in such cases:

• On palpation or visually, lumps in the neck are determined;
• Enlarged lymph nodes;
• Suspected abscess;
• Pain when feeling the neck;
• Neck Injury;
• Frequent headaches and dizziness;
• Tinnitus bothers you;
• There is a high temperature in combination with one of the listed symptoms.

Also, this type of diagnostic study can be used to control the collection of biological material (biopsy), puncture of lymph nodes, endoscopy. Additionally, a Doppler attachment can be used if there is a suspicion of vascular pathology in the neck area.

Pros and Cons

Most of the experts assure that this research technology can reveal dozens of pathological processes, which indicates a high information content.Another significant advantage is the absence of pain during the study. The patient can relax mentally, which will significantly increase the reliability of the data obtained.
In some cases, when it is necessary to examine the organ in more detail, other diagnostic procedures may be prescribed. For example, computed tomography and MRI are considered to be more informative. However, these methods are significantly more expensive and have contraindications, therefore, it is worth resorting to them only if the doctor considers it necessary.The research result can be obtained immediately after the diagnosis.

Contraindications to ultrasound of soft tissues

Soft tissue ultrasound is a non-invasive procedure that does not require the use of medications and does not affect the functioning of the body in any way. For this reason, diagnostic manipulation is available to almost everyone, regardless of age or the presence of diseases.

Ultrasound diagnostics may be postponed for some time or other research methods may be prescribed if the patient’s skin is significantly injured in the investigated place.For example, this can happen with burns or an acute course of skin diseases, mainly psoriasis. If you have an individual intolerance to the gel used during the ultrasound scan, you need to inform your doctor about this.

How to prepare correctly

Examination of the soft tissues of the neck does not require preparation. If diagnostics is supposed to assess the state of blood vessels and blood flow velocity, it is recommended to follow simple rules: 48 hours before the ultrasound, give up alcohol, 24 hours before coffee and strong tea, 5 hours before smoking.

Before going to a medical facility, remove jewelry from your neck in advance. Before entering the office, it is advisable to collect long hair so that it does not get dirty and does not interfere with the study. If you have previously performed an examination of the soft tissues of the neck, take with you the protocols of the previous diagnosis.

Algorithm for ultrasound of the soft tissues of the neck

Ultrasound examination of the soft tissues of the neck is carried out by an ultrasound diagnostics doctor. The patient needs to free the neck for examination.A small amount of contact gel is applied to the skin of the examined area. If necessary, the specialist asks you to turn or tilt your head, strain your neck or fulfill other requests. At the end of the standard examination, the specialist can additionally use a Doppler to assess the state of blood flow and vessels. Usually, the procedure is carried out in 15-20 minutes. Further, the person is given the results of an ultrasound scan with a decryption in his hands, and he goes to his doctor to receive explanations and prescribe therapy if necessary.

Interpretation of results

Interpretation of the results is the responsibility of the attending physician who sent the patient for an ultrasound examination. Most often, the study is carried out in cases where there is a suspicion of cancer. In this case, the doctor pays attention to the details of the location of the tumor-like neoplasm, assesses the structure, localization and exact dimensions. Also, using this technology, it is possible to assess in detail the condition of the lymph nodes.It is worth remembering that ultrasound is only part of the diagnosis – if the doctor suspects a disease, he can prescribe other diagnostic procedures in order to confirm or deny the diagnosis.

Please note that the body of each person is purely individual, it is not informative to give accurate indicators for comparison. Do not try to decode the results yourself, trust the doctor and follow his recommendations.

What diseases can be detected

Let’s consider several pathological processes that can be detected during diagnostics by means of ultrasound:

• Deviations from the vascular system;
• Presence of blood clots or atherosclerotic plaques;
• Extensive bruising in soft tissues;
• Aneurysm;
• Cancer diseases;

If the doctor suspects one of the above diagnoses, this is not a big deal, in most cases such pathologies can be successfully treated.In serious cases, surgery may be required to eliminate the ailment.

Ito Clinic

What symptoms give rise to suspicion of thyroid disease and cause people to go to the hospital? Symptoms can vary depending on the type of disease, but usually people go to the doctor when they observe the following abnormalities:

1. Swelling in the front of the neck

The most common symptom is a swelling in the neck, that is, goiter.Some go to the hospital, finding the swelling on their own in the mirror, etc., others point out to others

2. Symptoms caused by thyroid dysfunction

The various symptoms below can result from malfunctioning of the thyroid gland. Many people seek medical attention for these symptoms.

• Rapid heartbeat even at rest
• Minor trembling fingers
• Increased sensitivity to heat, increased water intake and excessive sweating
• Weight loss with good appetite
• Irritability and anxiety
• Chills and hypersensitivity to cold
• Dry and rough skin
• Feeling sluggish and lethargic
• Weight gain with poor appetite
• Swelling of the face and hands in the morning
• Frequent constipation
• Daytime sleepiness and falling asleep
• Slow and weak pulse
• Irregular menstrual cycle
• Swelling on the neck

3.Exophthalmus

Ophthalmic symptoms are a feature of Basedow’s disease, and some patients go to the doctor precisely because of the appearance of these symptoms.

4.Doctor’s instructions during prophylactic medical examination, etc.

Clinical examination or screenings can detect abnormalities such as swelling of the thyroid gland, abnormalities in the blood test or ultrasound, even in patients without subjective symptoms.

90,000 Appearance of palpable painful seals: description of the disease, causes, symptoms, cost of treatment in Moscow

Painful lumps that appear behind the ear or in the nose area not only cause discomfort, but in some cases can be serious.It is categorically not recommended to leave the phenomenon without attention and treatment, since these disorders may turn out to be a malignant neoplasm or a serious abscess.

A lump behind the ear, in the earlobe, or in the nose can appear at any age. Gender, as well as age, does not affect the likelihood of developing pathology. In the event that the seal does not go away within 5 days, and also if it grows rapidly and there are symptoms of general intoxication, such as fever and general weakness, an urgent visit to a doctor is necessary.

For help, you can initially contact an ENT doctor or therapist. After examination, if necessary, the patient will be referred for an appointment with a surgeon or oncologist. In most cases, treatment is carried out by an otolaryngologist.

Reasons for the appearance of

Lumps in the ear or nose can appear for many reasons. It is very important to establish them before starting treatment, as this is a guarantee that further therapy will be as effective as possible.Seals can form for the following reasons:

1. development of a malignant process in mucosal tissues, soft tissues or lymph node;
2. inflammation of the lymph node – painful lump behind the ear in which intoxication of the body appears;
3. chronic inflammatory ear diseases;
4. chronic inflammatory diseases of the nasopharynx – nasal lumps appear with prolonged absence of treatment;
5. blockage of the sebaceous gland, due to which its contents cease to be released outward and a seal develops;
6. fibroma – usually appears as a small ball in the earlobe;
7. Serious hormonal changes in the body – often cause seals;
8. overgrowth of the lymphatic tissue of the adenoids – leads to the appearance of indurations and bumps in the nasal cavity;
9. a sharp decrease in the activity of the immune system;
10. traumatic injury, after which internal inflammation develops.There is a seal in the earlobe, a ball, a large inflammation behind the ear or in the nose;
11. Infection when piercing the ear due to insufficient sterility of the instrument – can occur when the earlobe or its upper part is pierced to insert earrings. In this case, the seal in the earlobe hurts and festers. The skin turns red;
12. the beginning of the formation of a boil;
13. foreign body in tissues;
14. benign neoplasms;
15. malignant tumors.

It is only the doctor who can determine exactly what caused the problem and how to treat it after examining the patient and, in some cases, additional examination using modern devices and conducting the necessary tests.

Types of seals

Lumps that appear in the tissues behind the ear, in the earlobe or in the nose are divided into several types. Depending on which of them the diagnosed seal belongs to, the necessary therapy is also prescribed.An error at this stage of the diagnosis will be the reason for the ineffectiveness of the treatment or even the deterioration of the patient’s condition.

1. Atheroma is a seal that occurs due to blockage of the sebaceous gland and is accompanied by mild pain. Such a seal can appear in any part of the body, but most often it affects the earlobe, the area behind the ear and the skin near the wings of the nose. To the touch, the formation is perceived as a small ball filled with liquid, which overflows if pressed on it.The transformation of this seal into a malignant one is impossible.
2. Lipoma (wen). Soreness with this induration appears due to pressure on the tissue. The formation is benign, large in size. In rare cases, a lipoma can degenerate into a malignant tumor, which is why it must be removed without fail.
3. Polyp – a lump in the nose of a child and an adult appears quite often and is benign.
4. Fibroma. It is a hard lump that causes pain only due to the compression of the surrounding tissue.Against this background, any touch causes painful sensations. The phenomenon is hereditary. This is a benign type of neoplasm.
5. Lymphadenitis. With a problem, inflammation of the lymph node occurs. In this case, the seal behind the ear is quite painful and is accompanied by reddening of the skin, itching and burning. There may also be general signs of intoxication. When the lump behind the ear hurts badly in children, they can comb it, exacerbating the disease.
6. Mastoiditis.The problem arises as a consequence of otitis media that has not been properly treated. As a result, the infectious fluid fills the pores of the bone and leads to the appearance of a hard, very painful lump behind the ear, which quickly grows in size. With such a violation, severe weakness appears, the temperature rises, and the patient’s general well-being is seriously disturbed. If there is a problem, a seal appears under the ear.
7. Malignant neoplasms. Depending on the species, they can have different manifestations, but for the most part they are all prone to rapid growth and are accompanied not only by soreness, but also by a slight increase in temperature.In this case, the seal in the earlobe hurts, the tumor ball has an unpleasant color and immediately attracts attention. Treatment is urgent. The prognosis is relatively favorable if the seal is detected in a timely manner.
8. Boil. Purulent-necrotic inflammation of the hair follicle, which is caused by pathogenic bacteria against the background of a decrease in the activity of the immune system. At the stage of infiltration, it manifests itself only as a very painful compaction, which gradually turns into a characteristic abscess.This often results in a lump in the nose.
9. Consequences of bruises. After damage, seals in the tissues, which are accompanied by pain, can persist for up to 10 days. Bruising is also common.
10. Consequences of tick infestation. If the tick was removed poorly, due to which its head remained in the tissues, then after their overgrowth, internal suppuration may develop, as a result of which a soft painful compaction appears. It can grow in size.

Whatever type of seal belongs to, it must be shown to the doctor. Painful sensations can be eliminated only after the necessary therapy is carried out. The seals themselves are extremely rare and should not be counted on.

Diagnostics

At the initial treatment of the patient, the doctor conducts his survey regarding the time of detection of the seal and the possible presence of provoking factors, as well as examines and probes the problem area.After that, if possible, a primary diagnosis is made or diagnostic tests and examinations are prescribed. If there is a suspicion of a malignant process in the tissues, the patient is referred for a consultation with an oncologist. For an accurate diagnosis, the following diagnostic methods and analyzes are used:

1. rhinoscopy – if there are seals inside the nose;
2. Computed tomography or magnetic resonance imaging of the skull;
3. Ultrasound of the lymph nodes – it is mandatory to carry out when there is compaction in their area;
4. Ultrasound of the seal – it is necessary to determine its exact size, content and connectivity with surrounding tissues.

If a cancer is suspected, a biopsy is indicated. Also, the patient may be assigned blood tests and a general examination of the body to exclude the presence of metastases. A lump on the nose and ear is not often cancerous.

Treatment of bursitis of the shoulder joint (inflammation of the bursae of the shoulder)

1. What is inflammation of the bursa of the shoulder joint?
2. Symptoms of bursitis of the shoulder joint
3. Causes of inflammation of the mucous membrane in the shoulder
4. Diagnosis and medical examination of bursitis
5. Conservative treatment
6. Surgical treatment of bursitis of the shoulder joint

In addition to inflammation of the mucous membrane, there are other causes of shoulder pain.Tendon inflammations, traumatic injuries or, for example, arthrosis have similar symptoms. To establish the causes of pain and choose the appropriate treatment, a specialized medical examination will flash. © yodiyim / fotolia

Bursitis (lat. Bursa “bag”) is a painful inflammation of the periarticular bag of the shoulder. The bursae are located close to the joints to balance the high mechanical stress between bones and other tissues. The largest bursa of the human body (Bursa subakromialis or bursa subacromial) is located in the shoulder.The cause of its inflammation can be the pathology of various structures of the complex structure of the shoulder joint. The shoulder may become inflamed due to the appearance of bony spurs of the acromial process of the clavicle (acromion) or structural changes in the supraspinatus tendon (eg calcium deposits and ruptures). As a rule, the cause of these injuries is traumatic injury or excessive stress. Pain often appears gradually, for example, when raising an arm. If a person does not attach importance to this and continues to load the shoulder, the pain intensifies and symptoms such as swelling and overheating appear.In most cases, doctors provide conservative treatment for shoulder bursitis. Experienced shoulder therapists recommend rest, anti-inflammatory medication, and biological treatments based on cellular technology. Quite rarely, clinics carry out surgical treatment with the removal of an inflamed bursa.

What is inflammation of the bursa of the shoulder joint?

During painful bursitis, there is swelling in the shoulder joint and an increase in the joint capsule, provoking pressure on nearby tissues.The bursa itself is an elastic slit-like cavity filled with synovial fluid that can change its shape between the muscles, tendons and bone structures. In addition, the bursa provides painless movement of various tendons, bones and muscles within a highly mobile joint without friction. Bursitis in the shoulder is basically an inflammation of the bursa located between the head of the humerus and the acromion. In addition, bursitis is the most common cause of stabbing pain in the arm.The subacromial bursa is the largest bursa in the human body, which most often undergoes various inflammations. Physicians use the term “subacromial” or “subacromial” bursitis when the area under the acromion of the clavicle (acromion) becomes inflamed.

Anatomy of the shoulder joint: Position of the periarticular sac under the acromion

Changes in the underlying supraspinatus tendon (eg tears and calcium deposits) can deform the bursa.Inflammation of the mucous membrane of the bag of the shoulder can cause structural changes in the acromion, such as bone spurs. Therefore, in search of the causes of persistent bursitis, it is necessary to undergo a complete examination of all structures of the shoulder. © bilderzwerg / fotolia

Inflammation of the periarticular bursa of the shoulder joint is characterized by swelling in the region of the subacromial bursa located under the acromion. Muscles, ligaments, tendons and bursa, that is, the soft tissues of the shoulder, are close to each other. Thus, the largest bursa ensures the health of the supraspinatus tendon – the tendon between
scapula and head of the shoulder.With exceeded loads on the subacromial region, due to raising the arm above the head, pressure is also exerted on the tendon of the supraspinatus muscle, which often causes inflammation and pain in the shoulder.

Symptoms: Shoulder pain when raising the arm up

Symptoms: 90 420

• Pain when raising the arm up
• Soreness when pressing on the shoulder and increased sensitivity
• Stitching pain when the arm is finally extended
• Night pain in the supine position
• Weakened muscle strength
• Swelling, redness, hyperthermia
• Pain radiating from the shoulder to the arm

Pain caused by bursitis of the shoulder joint begins gradually and increases depending on the nature of the movements.As a rule, at the beginning of bursitis, patients complain of discomfort when raising their arms to the top.

If the patient does not attach much importance to his complaints and continues to lead the usual way of life, the pain gradually becomes stronger. If the shoulder joint begins to hurt suddenly, then the cause is most likely not bursitis. Specialists who carry out the treatment of the shoulder joint strongly recommend not to load the shoulder. Otherwise, the pain will become more and more powerful and will bring you inconvenience even during rest.The shoulder’s increased susceptibility to pressure can lead to severe pain at night. If the patient sleeps on an unhealthy shoulder, the shooting pain can wake him up.

Soreness in the shoulder joint due to bursitis is often accompanied by increased sensitivity on the outer side of the shoulder.

When the range of motion of the shoulder joint is completely depleted, patients feel unpleasant tingling sensations in the shoulder. Such sensations are observed when a person raises his hand above his head in order, for example, to dry his head, comb his hair or put on a jacket.People who constantly sleep on their side also feel the negative effects of bursitis, since during sleep, pressure is exerted on the inflamed mucous bag on the sore shoulder. That is why bursitis of the shoulder joint is an unpleasant disease.

Repetitive, repetitive shoulder movements only increase the pain. Due to bursitis, pain can radiate towards the outer side of the shoulder to the elbow.

Unlike bursitis of the knee or elbow joint, inflammation of the bursa in the shoulder rarely causes external edema or changes in the shape of the shoulder itself.

However, with extremely severe inflammation of the mucous membrane, the patient may experience reddening of the shoulder joint.
These not immediately noticeable signs are primarily associated with bacterial bursitis. Sometimes a person’s body temperature rises during bursitis. Bacterial bursitis is also called septic bursitis in medicine.

Causes of bursitis of the shoulder joint

Causes

• Impact, push, injuries
• Overexertion, especially when raising the arm
• Monotonous movements
• Mature age
• Poor posture
• Calcium syndrome
• Diabetes of the forehead

• Several factors contribute to the development of bursitis of the shoulder joint.

  One of the most common causes is damage to the structure of the shoulder (injury). A fall or bump in the shoulder can cause bursa hemorrhage and mucosal inflammation. Despite the fact that over time the body reduces the blood content in the bursa, the inflammation of the mucous membrane on the outside of the mucous membrane remains for a long time. So, from a common trauma, chronic bursitis of the periarticular shoulder bag is formed. This form of inflammation is called traumatic bursitis by doctors.

  Another cause of bursitis is repeated pressure or excessive stress on the shoulder. In this case, the mucous bag becomes inflamed due to repeated minor injuries, which entail the same results as a blow with the shoulder on a hard surface. Painters, fitters or people whose profession is associated with raising their hands over their heads suffer from this pathology more often than others. Athletes performing powerful overhead movements, such as tennis or badminton players, report similar symptoms.

  With age, the likelihood of developing bursitis due to traumatic injuries or excessive exertion increases.

  Incorrect posture is another reason for inflammation of the bursal sac of the shoulder. With a strong bending of the body forward, the scapula extends to the top, which narrows the space under the acromion. If the patient comes to the doctor with such complaints, then he is diagnosed with impingement syndrome of the shoulder joint and referred for treatment. If the subacromial region is narrowed for a long time, mechanical pressure increases on the subacromial periarticular bursa and the tendon apparatus responsible for the mobility of the shoulder (rotator cuff).The interaction of these factors contributes to the development of the inflammatory process inside the synovial bag.

  Long-term cured bursitis can also contribute to inflammation of the bursal sac.

  Metabolic disorders of the shoulder joint can also cause bursitis: Calcification of the forearm (calcification of the supraspinatus tendon) often occurs simultaneously with bursitis. Calcium deposits in the supraspinatus tendon can lead to rupture of the overlying subacromial bursa and consequent inflammation of the bursa.

  Friction of the rotator cuff tendons against the acromion, which is the so-called roof of the shoulder joint, is characteristic of impingement syndrome. In addition, during periarthritis of the brachiocapulus, bone spurs (osteophytes) are formed on the acromial process of the clavicle, provoking ruptures and inflammation of the mucous membrane of the shoulder bag.

  Diagnosis and clinical examination of bursitis

  Before starting treatment, an orthopedic specialist conducts a series of examinations to exclude certain causes of the disease.Tendon inflammation, impingement syndrome or arthrosis of the shoulder joint have similar symptoms. In some cases, these pathologies are also accompanied by additional inflammation of the periarticular bag of the shoulder. Thus, medicine presents several causes of shoulder pain. The high-quality, state-of-the-art diagnostics at the Gelenk Klinik in Freiburg, Germany, identifies the underlying cause of shoulder pain.

  Medical history: diagnostic consultation with a doctor

  During anamnesis, drawing up a medical history, the doctor asks the patient several questions about his health:

  • Past and current diseases
  • General condition
  • Diseases caused by metabolic disorders (ex.diabetes, rheumatism, or gout)
  • Accidents or other incidents involving shoulder injuries
  • Overloads and impacts
  • Sports loads and features of professional activity

  Thus, the doctor gets a complete picture of the possible effects, deficiencies and prepositions of the shoulder joint.

  Physical examination and clinical examination

  During the examination, the shoulder specialist pays special attention to the following aspects:

  • Soreness to pressure (hypersensitivity)
  • Swelling
  • Hyperthermia and skin discoloration
  • Posture features

  Special tests to determine the strength and mobility of the arm during movement in different directions indicate possible ruptures and injuries of the tendons.

  Imaging examination of the shoulder joint: ultrasound, X-ray, MRI

  Modern medicine offers several imaging diagnostic methods, each of which shows different aspects of the disease.

  An ultrasound scan helps the doctor test the mobility of the muscles, tendons and soft tissues of the shoulder. Also, ultrasound examination shows swelling and accumulation of excess fluid in the bursa. The ultrasound also shows structural damage to the shoulder, for example. tendon ruptures and screams.© Gelenk-Klinik

  Ultrasound examination (US)

  An ultrasound imaging examination reveals the accumulation of excess fluid in the bursa of the shoulder joint, as well as ligament and tendon injuries during movement. In addition, the ultrasound shows tendon ruptures and calcium deposits.

  X-ray

  The X-ray does not show the condition of the soft tissues: the image shows only the position and condition of the bones of the shoulder joint. This image shows sufficient space between the head of the humerus and the acromion.It follows from this that impingement syndrome is not the cause of inflammation of the bursal sac of the shoulder.
  An ultrasound allows the doctor to examine muscles, tendons, and soft tissue while moving. In addition, ultrasound examination provides information about the presence of edema due to the accumulation of excess fluid in the bursa. Tendon injuries and inflammation in the shoulder also become visible after ultrasound.

  This image shows sufficient space between the head of the humerus and the acromion.It follows from this that impingement syndrome is not the cause of inflammation of the bursal sac of the shoulder. © Gelenk-Klinik

  MRI (Magnetic Resonance Imaging)

  MRI (Medical Tomographic Images) provide information about soft tissue injuries, inflammation, and structural changes in the shoulder joint. For the treatment of bursitis, MRI is not the main diagnostic method. If a patient is suspected of having inflammation of the mucous membrane, specialists in orthopedic clinics first perform an ultrasound scan.

  Before diagnosing shoulder bursitis and starting treatment, an imaging examination should be performed to exclude tendon ruptures and bone injuries. MRI is performed only in the case of a complicated form of bursitis and helps to make the final decision regarding the most appropriate form of treatment for the disease. Magnetic resonance imaging helps to choose the right method of surgical treatment and prepare for the operation.

  In difficult cases that do not respond to conventional treatment, it is very important to exclude injuries such as tendon ruptures and bone deformities using imaging diagnostics.Magnetic resonance imaging (MRI) is one of the most important methods for diagnosing shoulder bursitis.

  Laboratory analysis of blood and joint fluid

  Laboratory diagnostics

  • Diabetes
  • Gout
  • Rheumatism
  • Bacterial inflammation (septic bursitis)
  • Arthritis

  Movement disorders are not always the cause of shoulder pain. The patient may also feel discomfort in the hand due to metabolic disorders that limit mobility and cause pain.Such pathologies include, for example, rheumatoid arthritis, an inflammatory autoimmune disease. A blood test shows the presence of rheumatic factor, which can confirm rheumatoid arthritis. In addition, a CBC helps to rule out bacterial infections: With an increased number of leukocytes in the blood, the likelihood of illness increases.

  Conservative treatment of bursitis of the shoulder joint

  As a rule, inflammation of the periarticular shoulder bursa can be treated conservatively, that is, without surgery.

  Home remedies and treatment at home

  In most cases, the patients can carry out the treatment of inflammation of the mucous membrane of the shoulder bag on their own. However, if the pain persists and becomes more severe, you should immediately see a doctor. Regardless, note that there are risks associated with home treatment: If you use home remedies, you may miss some important shoulder injuries or abnormalities.

  • Cooling compresses for acute shoulder pain.
  • Anti-inflammatory medicines (e.g. paracetamol or ibuprofen)
  • Sports ointments (e.g. diclofenac)
  • Anti-inflammatory and cooling curd compressesn
  • Applying aluminum acetic salt on the shoulder

  Most cases of shoulder bursitis are treated with non-steroidal pain relievers (NSAIDs). In addition, orthopedic specialists recommend resting and cooling compresses to help restore the shoulder.In the most difficult cases, injections of the anti-inflammatory hormone cortisone, as well as pain relievers, can immediately stop inflammation of the periarticular sac and associated shoulder pain.

  Physiotherapy and biological treatment based on cellular technologies

  If drug treatment does not bring the desired result and the patient continues to feel pain, the doctor refers him to physiotherapy or physiotherapy exercises. One of the main specializations of the German medical center Gelenk Klinik in g.Freiburg is a cell-based regulatory therapy. The use of vibrotherapy in medical practice stimulates metabolism in the inflamed bursa of the shoulder joint, which helps to overcome inflammation in the shortest possible time.

  Matrix therapy consists of several modules that interact in the area of ​​arresting the development of the inflammatory process and tissue health with each other. This image shows biomechanical stimulation (BMS) of the muscles of the shoulder joint using a vibrating device.This technique helps to heal injuries, inflammations and disorders of the tendon structure of the shoulder. Inflammation of the bursa mucosa is one of the main indications for this treatment. © gelenkreha.de

  Minimally invasive shoulder surgery for inflammation of the periarticular bursa

  Only in cases where medical treatment of bursitis of the shoulder joint, as well as physiotherapy have been unsuccessful and the person continues to feel tingling in the shoulder, does it become necessary to conduct surgical treatment of subacromial bursitis.We draw your attention to the fact that the treatment of bursitis of the shoulder joint is carried out using artoscopic minimally invasive techniques. This operation, during which the surgeon completely removes the inflamed joint capsule, is performed through the so-called “keyhole”.

  Shoulder arthroscopy is a minimally invasive surgery for shoulder pain, for which the surgeon uses microscopic instruments with a diameter of 0.5 to 1 cm. The arthroscopic camera helps the doctor obtain a limited but accurate image of the surgical site.This intervention consists in aspiration (suction) from the articular capsule of the contents. In addition, in parallel, the surgeon can treat diseases that cause bursitis, such as impingement syndrome or forearm calcification. © bilderzwerg / fotolia

  Additional surgeries when removing the bursa (bursectomy)

  Additional surgeries

  In addition to the surgery, a specialist examines and, if necessary, begins treatment of all structures of the shoulder joint. Thus, if bursitis is suspected, arthroscopy can remove calcium deposits from the tendon of the supraspinatus muscle of the shoulder, as well as bone spurs under the acromion.

  Shoulder Arthroscopy: Postoperative Treatment and Prognosis

  After surgical removal of the periarticular bursa of the shoulder (bursectomy), a new bursa is formed in the same place within a short time, which performs the functions of the removed tissue in full.

  The motor functions of the shoulder are restored a few days after the operation.
  The pain syndrome disappears immediately.

  Almost immediately, the patient can move the shoulder as before and return to the previous activity.The stitches are removed after about 10 days.

  Shoulder myalgia

  Myalgia (from the Greek myo – muscle; algos – pain) is a pain syndrome localized in muscle tissue, which is accompanied by acute, dull or aching pain in both tense and relaxed muscle states. Most often, these painful sensations arise as a result of hypertonicity (spasm) of muscle fibers. Pain is one of the most common reasons for visiting a doctor, and among them, myalgia is one of the leading positions.

  It is extremely important to consult a specialist on time and start competent therapy, otherwise myalgia can go from an acute form to a chronic one, which will require a longer and more complex treatment.

  Causes of shoulder myalgia

  Myalgia can be both an independent disease, for example, with physical overwork of muscles, and a manifestation of any disease, for example, with a pathology of the shoulder joint. It is often difficult to establish what is causing the pain: pain of articular origin or pain associated with the pathology of ligaments and tendons or the muscle itself.

  In the practice of a doctor, combined conditions are quite common when one or another pathology of the shoulder joint is observed, for example, arthrosis, against the background of which there is a reflex contraction of the muscles surrounding this joint. In this case, the pathology of the joint can be of a traumatic nature or be the result of a systemic inflammatory disease (rheumatological diseases). But, in the first, that in the second cases, changes in the joint will be accompanied by local inflammatory reactions, in which the release of pro-inflammatory biologically active substances (serotonin, bradykinin, prostaglandin E2, etc.)), which in itself contributes to the formation of spasm and pain in the muscles surrounding the inflamed joint. An indirect sign by which it can be assumed that pain comes from a muscle, and not from a joint, is an increase or the appearance of pain when the muscle is loaded, but this test has an extremely low specificity in order to unequivocally assert that the cause is in the muscle.

  Also, pain in the shoulder area can be with inflammation at the site of attachment of the ligament or tendon of the muscle to the bone, this condition is called enthesopathy.It is often observed with prolonged shortening of the muscle, prolonged power load on this muscle, while the ligament or tendon of the muscle at the site of attachment begins to exfoliate the periosteum from the bone, causing an inflammatory reaction. In addition, blunt trauma to the muscle, underlying bone and periosteum can cause reflex local spasm.

  All of the above situations, in most cases, will proceed with the formation of myofascial syndrome, which is characterized by the appearance of dense cords in the thickness of the muscle, pain syndrome, and in some cases sensory disturbances are possible: numbness, creeping sensation.The pain can be local, or it can be reflected.

  Shoulder myalgia symptoms

  Pain in shoulder myalgia, in particular in the presence of myofascial pain syndrome, is often described by patients as aching, dull, constricting, boring pain, which can increase with load on this muscle, and in some patients it can manifest itself in a dream when a certain posture occurs impact on the trigger point in the muscle. A trigger point is a thickening of muscle fibers, which, on palpation, is felt as a dense muscle cord or as a dense rounded formation and is accompanied by sharp soreness.The pain can manifest itself at a specific point (you can point the localization with your finger), or it can be reflected, in this case, trigger points located in different muscles have certain zones where pain can spread.

  Often, myalgia in the shoulder area is accompanied by a functional limitation of active movements in the limb, for example, it hurts the patient to move his arm to the side over a certain degree.

  Muscles most often manifested by local or reflected pain in the shoulder region.

  Scala muscle. The scalene anterior muscle, although it belongs to the muscles of the neck, but the pain from the trigger point located in it spreads to the upper limb. At the same time, characteristic pathways of propagation are noted: along the anterior and posterior surfaces of the shoulder girdle, the upper medial edge of the scapula, the outer surface of the shoulder and forearm, on the thumb and index fingers.

  In the figure, the zones of the most intense pain are marked in red. Spasm of these muscles can lead to a feeling of stiffness and limited movement in the cervical spine.The reason for the tension of the flattering muscles can be, for example, carrying heavy bags in the hands, prolonged cough, lung pathology that requires the inclusion of auxiliary respiratory muscles (chronic obstructive pulmonary disease, bronchial asthma).

  Between the anterior and middle scalene muscles passes the neurovascular bundle, and the spasm of these muscles contributes to the pinching of the bundle, which will manifest itself in the form of numbness, a tingling sensation, which is most pronounced in the hand, especially after physical work with this hand.This pathology is called scalene syndrome or scalenus syndrome.

  The pectoralis major and minor muscles. The localization of the trigger point in the clavicular part of the pectoralis major muscle and the pectoralis minor is manifested by similar symptoms, namely: the reflected pain is localized along the anterior surface of the shoulder joint (in the figure, the zone of greatest pain intensity is indicated in red). Active movements that cause tension or stretching of these muscles, especially when lifting weights forward on an outstretched arm, can aggravate pain, and trigger points can also be affected during sleep in a position on the stomach, which leads to the onset or intensification of pain and frequent awakenings.There may be a restriction of movement of the hand to the side.

  When trigger points are localized in the left pectoralis major muscle, pain can mimic attacks of angina pectoris, a feeling of compression in the chest.

  With pronounced hypertonicity of this muscle, infringement of the lateral trunk of the brachial plexus and axillary artery often occurs, which is manifested by impaired sensitivity along the inner surface of the shoulder, forearm, in the ring finger and little finger.

  One of the main causes of myofascial syndrome in these muscles is improper posture: a stooped back, in which the shoulders go forward, which leads to shortening of the pectoral muscles.

  The infraspinatus muscle. With myofascial syndrome of the infraspinatus muscle, pain is localized in the anterior, lateral and posterior surfaces of the shoulder joint, and may descend along the anterior surface of the shoulder. The pain is often characterized as deep, according to the sensations, inside the joint (in the figure, the places with the most intense pain are indicated in red). Patients note difficulties in servicing the back hemisphere of the body: it is difficult to wash the back, fasten the bra lock; attempts to comb your hair or brush your teeth cause severe pain in the shoulder.

  Coracohumeral muscle. Reflected pain in the presence of trigger points in this muscle is localized along the anterior surface of the shoulder joint and slugs down along the outer surface of the shoulder, dorsum of the forearm and hand. The pain, as in the case of the infraspinatus muscle, will increase when the arm is pulled behind the back. Trigger points in this muscle, as a rule, arise secondarily, i.e. in the presence of active pain points in adjacent muscles, inflammation of the tendon of the biceps head, pathology of the shoulder joint, etc.

  Diagnostics

  This article does not present the entire spectrum of muscles and diseases of the structures of this region, which can manifest as myalgia. Diagnostics requires a careful individual approach to each patient with this problem. In most cases, it is possible to find the cause of the pain based on the collected complaints, medical history and manual muscle testing. In some cases, instrumental diagnostic methods are required, such as: X-ray and MRI of the shoulder joint, to exclude its involvement in the pathological process.In addition, the very painful process in the muscles surrounding the shoulder joint is capable of causing inflammatory changes in the joint.

  An early appeal to a competent specialist will allow you to quickly identify the cause of the pain and begin adequate treatment.

  Do not self-diagnose, sometimes it is difficult even for a specialist to determine the exact cause.

  Shoulder myalgia treatment

  Today there are many methods of treatment of this pathology, among them there are both non-drug and medication.Non-drug methods of treatment have shown high efficiency in this matter: techniques of soft manual therapy, acupuncture, physiotherapy, deep tissue massage, etc.