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Muscle tissue damage symptoms: Symptoms, Tests, and Treatment of Muscle Strain


Muscle Injuries and Disorders | Tears & Inflammation

Muscle is a tissue of the body specialized for movement. There are 3 types of muscle in the body:

  • Cardiac muscle is only found in the heart.
  • Smooth muscle is found in the internal organs.
  • Skeletal muscle hangs from our skeletons and allows us to move.

In general, skeletal muscle is under voluntary control whereas the other 2 types of muscles are controlled automatically from our brains.

People with problems of skeletal muscle usually present with complaints of pain, stiffness or weakness. 

Muscle pain and pain caused by other structures in the body can be difficult to identify because muscle overlies many different types of structures including the bursa , joints, and bone.

Additionally, muscle weakness may not necessarily indicate a problem with the muscle since an issue with the nerve can also demonstrate similar symptoms. Your doctor will use a combination of history, physical exam, lab tests, and imaging to help distinguish between the different possibilities.

Muscle pain/weakness in autoimmune disease

People with autoimmune conditions such as scleroderma, vasculitis and myositis, can experience muscle pain many times because of the symptoms linked with the condition. These can include:

  • flare of underlying autoimmune condition
  • toxicity of a medication or drug
  • infection
  • hormonal and genetic illnesses
  • fibromyalgia

Muscle pain/weakness and myositis

Inflammation of muscle, or myositis, can be seen in patients with scleroderma, vasculitis, and inflammatory myopathy. Common symptoms include:

  • muscle weakness
  • evidence of inflammation on muscle biopsy
  • elevated muscle enzymes in the blood

Inflammatory myopathy includes the illnesses polymyositis, dermatomyositis, inclusion body myositis, overlap myositis, and necrotizing autoimmune myopathy. In these conditions, the muscles are the major target of inflammation.

In scleroderma, 13% of people may have myositis and up to 90% will have some type of muscle involvement such as pain or stiffness.

Muscle involvement is not common in the ANCA associated vasculitides such as Churg-Strauss or Wegener’s granulomatosis, but there are case reports of this happening. 

In polyarteritis nodosa, muscle involvement is seen in 51% of the cases with muscle pain being the most common symptom of the disease. 

Mixed connective tissue disease is a condition associated with a particular autoantibody called anti-ribonucleo protein (anti-RNP). This condition is characterized by an overlap of scleroderma, myositis, and lupus. Between 50 and 70% of these patients will have also myositis.

Other causes of muscle weakness/pain

Several drugs can cause toxicity to muscle including statin drugs, hydroxychloroquine (Plaquenil), colchicine, and steroids.

Infections such as influenza, coxsackievirus, and Lyme disease can also cause muscle aches and weakness.

Hypothyroidism, hyperthyroidism, hyperparathyroidism and hypoparathyroidism can also cause problems with muscle.

Fibromyalgia is a condition where patients have diffuse muscle pain but there is no associated inflammation.

There are very effective ways to treat true muscle inflammation, but it is important to be sure that such inflammation is the cause of the problem. Your physician should be able to understand the reason for muscle complaints through a combination of careful questions, physical exam, blood tests, and sometimes more involved testing (such as EMG/Nerve conduction studies, MRI of muscle, or even muscle biopsy). 

Talking to your doctor early will allow them to prescribe a directed therapy plan to limit the problem’s effect on your life. 

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Muscle Strain – Harvard Health

What Is It?

A muscle strain is the stretching or tearing of muscle fibers. Most muscle strains happen for one of two reasons: either the muscle has been stretched beyond its limits or it has been forced to contract too strongly. In mild cases, only a few muscle fibers are stretched or torn, and the muscle remains intact and strong. In severe cases, however, the strained muscle may be torn and unable to function properly. To help simplify diagnosis and treatment, doctors often classify muscle strains into three grades, depending on the severity of muscle fiber damage: 

  • Grade I strain. In this mild strain, only a few muscle fibers are stretched or torn. Although the injured muscle is tender and painful, it has normal strength. 
  • Grade II strain. This is a moderate strain, with a greater number of injured fibers and more severe muscle pain and tenderness. There is also mild swelling, noticeable loss of strength and sometimes a bruise.  
  • Grade III strain. This strain tears the muscle all the way through, sometimes causing a “pop” sensation as the muscle rips into two separate pieces or shears away from its tendon. Grade III strains are serious injuries that cause complete loss of muscle function, as well as considerable pain, swelling, tenderness and discoloration. Because Grade III strains usually cause a sharp break in the normal outline of the muscle, there may be an obvious “dent” or “gap” under the skin where the ripped pieces of muscle have come apart. 

Although the risk of muscle strain is especially high during sports activities, you also can strain a muscle by lifting a heavy carton or by simply stepping off a curb. 

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Soft tissue injuries – What are they & how can you best recover

What are the symptoms of soft tissue injuries?

When soft tissue is damaged, there is usually immediate pain along with immediate or delayed swelling (excessive swelling can slow the healing process – see treatment below). Stiffness is also very common as a result of the trauma and swelling. Bruising may also develop after 24-48 hours.

In the case of moderate to severe soft tissue injuries of muscles, tendons and ligaments around a joint, there may be instability experienced, especially to weight-bearing joints like the hip, knee and ankle.

How long will it take to recover from a soft tissue injury?

The recovery time from grade 1 soft tissue injuries in one to two weeks and three to four weeks for a grade 2. Grade three soft tissue injuries require immediate assessment and treatment, with much longer recovery times. Recovery times can also depend on your age, general health and occupation. If you are not sure of the nature or extent of your injury, contact an experienced Specialist Physiotherapist for advice.

Should I go to a hospital with a soft tissue injury?

With severe trauma, there may also be a fracture and as with all severe trauma, it is advisable to go directly to A&E for a detailed assessment and diagnosis. A good gauge for when a soft tissue injury requires a full examination is, for example, if:

  • You are unable to put any weight on the injured structure
  • There is an unusual deformity or shape
  • You heard a pop or crack at the time of injury
  • Any surrounding bony structures are painful
  • There is presence of neurological signs like numbness or pins and needles (either at the injury site or anywhere else)

Treatment for soft tissue injuries:

There are principally three stages of treatment and recovery from soft tissue injuries like ankle sprains

Stage one: During the first 24-72 hours, it is important to protect the injured area, gain an accurate diagnosis and follow the PRICE regime (see below). If possible, gentle pain free movement should be encouraged.

Stage two: Reduce swelling and stiffness and begin to regain normal movement.

Stage three: Regaining of normal function and return to normal activities.

PRICE Regime for Soft Tissue Injuries

Minimise using the affected area the area and initially avoid stretching which could further weaken the damaged tissue.

If trauma is severe, protect the injury from further damage. Stop any activity that will aggravate the injury. Use of crutches to take the weight off an injured knee, hip or ankle injury may be necessary. A sling may help to protect an arm or shoulder.

Rest and avoid activities that cause significant pain (for example walking, raising your arm). Allow sufficient rehab time for even small injuries. Choose alternative.

Wrap ice cubes in a damp tea towel, use frozen peas or a sports ice pack. Use the ice pack for 15–20 minutes every three to four hours when awake.

Very cold products can induce hypothermia or cold burns so wrapping the ice in a cloth is advisable.

Apply a firm bandage that does not restrict circulation or cause additional pain. The bandage should cover the whole joint.

Raise the limb above the level of your heart, if possible in order to help reduce the swelling. Support the limb with cushions or a sling to keep it raised when not walking or using the limb.

Pain relief may also be required. If you are not sure what medication to use, your Specialist Physiotherapist, Pharmacist or GP can advise you.

What to avoid when you have a soft tissue injury?

In the first 48-72 hours, it is important to avoid the following:

Increases blood flow and swelling.

Increases blood flow and swelling, and will slow up the healing process.

Promotes blood flow and can increase swelling and can, therefore, increase damage if begun too early.

Physiotherapy treatment for soft tissue injuries

An experienced Physiotherapist can assess your injury, and confirm both the diagnosis and extent of damage. They will provide you with advice, hands-on treatment and exercises which will promote a prompt and effective recovery, as well as reduce the risk of further injury in the future. (see also “how to avoid running injuries”) Your  Specialist Physiotherapist will also advise you on a progressive return to normal activities and alternative exercises to follow whilst you are injured.

How Soft Tissue Injuries Cause Neck Strain

Neck strains and sprains can range from mild discomfort to severe neck pain that hinders routine activities, like driving or getting dressed. Here’s how these soft tissue injuries can happen, and how to get relief.

Neck Strains and Sprains Video


A neck strain is not a serious injury; but the resulting pain can be severe.
Neck Strains and Sprains Video

Soft tissue injuries in the neck

There are numerous soft tissues that attach to the neck, including muscles, tendons, and ligaments. These soft tissues all work in tandem to support your neck and head. At the same time, they also enable movement in your neck. A neck strain or sprain occurs when one or more of these soft tissues is stretched beyond its normal range (or is injured in another way).


While the terms strain and sprain are commonly used interchangeably, they have different meanings:

  • Neck strain is an injury to a neck muscle or tendon (fibrous tissue that connects muscle to bone)
  • Neck sprain is an injury to a neck ligament (fibrous tissue that connects 2 bones)

Neck strains and sprains can vary in severity depending on the extent of the injury. For example, a minor neck strain may only have a few muscle fibers that are torn. A more severe neck strain involves more tears in the muscle fibers and takes longer to heal.1

Watch Cervical Muscle Anatomy Animation

Neck strain symptoms

Neck strains and sprains can have similar symptoms. Some of the more common symptoms include:

  • Pain localized to the neck region
  • Pain that ranges from achy or throbby to sharp or intense
  • Stiff neck
  • Neck muscle spasm
  • Pain that worsens with movement

Neck strain may also involve pain in nearby areas, such as the head, shoulder, or upper back.

Read more about Neck Strain Symptoms

Neck strain causes

Common ways for neck strains to occur include:

  • Poor posture or holding the neck at an awkward angle
  • Lifting something that is too heavy
  • Whiplash, such as during a car collision
  • Repetitive neck motion motions
  • Performing a new or unfamiliar activity

Two of the more common neck muscles to have pain include the upper trapezius and the levator scapulae. It can also be very difficult to determine when the pain is arising from these muscles, or if the pain is referred from an underlying spinal pathology.

Read more about Neck Strain: Causes and Remedies


Neck strain treatments

Common first-aid treatment options for neck strain include:

  • Rest and/or activity modification
  • Over-the-counter pain medication (such as acetaminophen, ibuprofen, or naproxen)
  • Cold therapy
  • Heat therapy

After the initial flare-up of pain, an exercise program of neck stretches and strengthening may help prevent future injuries. To reduce the risk of further injury, speak with your doctor before starting an exercise program.

Read more about Neck Strain Treatments and Prevention

When to see the doctor

Neck strains and sprains typically start to feel better within a few days without needing to visit the doctor. For neck pain that persists or recurs despite self-care, or is associated with other symptoms such as weakness or severe arm pain, seek medical attention to rule out other more serious pathologies.

Learn more:

Neck Strain Diagnosis

Stiff Neck Causes, Symptoms, and Treatment


  • 1.Grassi A, Quaglia A, Gian LC, Zaffagnini. An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. 2016; 4(1):39-46. doi: 10.11138/jts/2016.4.1.039.

Muscle strain: Symptoms, Causes and Treatment

Treatment of muscle strain

You can usually treat mild muscle strains at home. But sometimes you may need to see a physiotherapist or have an operation to repair your damaged muscle.

Your recovery time will depend on how badly you’ve injured yourself and which muscle is involved. It also depends on how active you need to be afterwards. It may take you a few weeks to be able to walk around as normal and it may take even longer for you to go back to sports. With a very bad strain, it may take months for you to recover completely.

It’s important to keep your muscle moving after an injury, but you may need to make some changes to the way you do things. You may be more prone to hurting that muscle again in the first four to six weeks, so you’ll need to take extra care. To prevent another injury, warm up properly before you exercise.

Physiotherapy for muscle strain

If your injury is very bad or it keeps coming back, physiotherapy may help to strengthen your damaged muscle.

Your GP may refer you to a physiotherapist or you can book an appointment with a physiotherapist yourself. You can also choose to see a physiotherapist privately.

The physiotherapist will create a programme of exercises to gradually strengthen and stretch your muscles. These exercises will depend on the type of injury you have and how bad it is.

Surgery for muscle strain

If your muscle strain is very bad, or you have a completely torn muscle, you may need an operation to repair it. Your GP will arrange for you to see an orthopaedic surgeon who will explain which type of procedure you need. You’re most likely to be referred if:

  • you’re not recovering as quickly as you should be
  • your symptoms are getting worse
  • you’re getting new symptoms
  • your symptoms are worse than they should be for your type of injury

The type of operation you need will depend on the location of the tear and muscle involved.

You’ll probably need to see a physiotherapist after your surgery to get back to normal.

Low Back Strain and Sprain – Symptoms, Diagnosis and Treatments

Low Back Strain and Sprain | American Association of Neurological Surgeons

When the lumbar (lower) spine is strained or sprained, the muscles and tissues become swollen. This inflammation causes pain and may cause muscle spasms.

Low Back Strain Image from Innovative Health Fitness


Lumbar (lower back) muscle strains and sprains are the most common causes of low back pain. Muscle strains and sprains are common in the lower back, because it supports the weight of the upper body and is involved in moving, twisting and bending. Lumbar muscle strain is caused when muscle fibers are abnormally stretched or torn. Lumbar sprain is caused when ligaments (the tough bands of tissue that hold bones together) are torn from their attachments. Both of these can result from a sudden injury or from gradual overuse. Lumbar strain or sprain can be debilitating.

Types of Muscles Supporting the Spine


  • Low back pain that may radiate into the buttocks, but does not affect the legs
  • Stiffness in the low back area, restricting range of motion
  • Inability to maintain normal posture due to stiffness and/or pain
  • Muscle spasms either with activity or at rest
  • Pain that persists for a maximum of 10-14 days

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When & How to Seek Medical Care

If low back pain lasts for longer than one to two weeks, seek medical care. First, make an appointment with your primary care physician.

Seek immediate medical attention if any of the following symptoms are present in addition to back pain:

  • Severe abdominal pain
  • Unexplained fever (higher than 100.4F or 38.0C)
  • Loss of control of your bowels or bladder

Testing & Diagnosis

Diagnostic testing is usually not necessary, unless pain has lasted for more than six weeks and has not improved as expected following physical therapy. It is important to rule out underlying causes, such as an undetected disc injury. If symptoms are persistent for longer than six weeks and physical therapy has not improved the condition, the following tests may be ordered by a doctor.

  • X-ray: An x-ray produces a picture of a part of the body, and can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are used to search for other potential causes of pain, i.e. infections, fractures, etc.
  • Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas as well as enlargement, degeneration and tumors.

Low Back Strain Image from Radiopaedia


Staying active and avoiding bed rest is recommended when experiencing back pain. Bed rest can lead to a loss of muscle strength and may increase muscle stiffness, adding to pain and discomfort. Sprain and strain is commonly treated with nonsteroidal anti-inflammatory medication, if the pain is mild to moderate.

A doctor may recommend physical therapy. The therapist will perform an in-depth evaluation, which, combined with the doctor’s diagnosis, dictates a treatment specifically designed for patients with low back pain. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises. A physical therapist will also recommend exercises to do regularly at home in the long-term. Alternative holistic options to relieve low back pain include acupuncture, chiropractic care, massage and yoga. Pain medications and muscle relaxants may also be helpful on a short-term basis in combination with the physical therapy.


The likelihood of a complete recovery from a lumbar strain or sprain injury is excellent. More than 90% of patients completely recover from an episode of lumbar muscle strain or sprain within one month. Heat and ice treatment are recommended on an as-needed basis at home to treat sudden flare-ups of low back pain, along with anti-inflammatory medications. However, low back strain may develop into a chronic condition unless efforts are made to change habits that contribute to the problem.

Low Back Strain Image from Ehealth Star

The following tips may be helpful in preventing low back pain associated with strain and sprain:

  • Do core strengthening exercises to provide more spine stability in the long-term. Swimming, stationary bicycling and brisk walking are good aerobic exercises that generally do not put extra stress on the back.
  • Use correct lifting and moving techniques, such as squatting to lift a heavy object. Do not bend and lift. Get help if an object is too heavy or awkward.
  • Maintain correct posture when sitting and standing.
  • Quit smoking. Smoking is a risk factor for arthrosclerosis (hardening of the arteries), which can cause lower back pain and degenerative disc disorders.
  • Avoid stressful situations, if possible, as this can cause muscle tension.
  • Maintain a healthy weight. Extra weight, especially around the midsection, can put strain on the lower back.

Resources for More Information

  1. 1. Cleveland Clinic. (2018). Back Strains and Sprains. Retrieved from https://my.clevelandclinic.org/health/diseases/10265-back-strains-and-sprains
  2. 2. NIH. (2019). Low Back Pain Fact Sheet. Retrieved from https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/low-back-pain-fact-sheet

Patient Pages are authored by neurosurgical professionals, with the goal of providing useful information to the public.

Julie G. Pilitsis MD, PhD, FAANS, is a professor of neurosurgery and of neuroscience at Albany Medical College and Chair for the Department of Neuroscience and Experimental Therapeutics. To date, Dr. Pilitsis has served as chair of the AANS/CNS Section on Pain as well as chair of the AANS/CNS Section for Women in Neurosurgery. Dr. Pilitsis maintains an NIH sponsored research program focused on device optimization for neuromodulation and has published over 120 journal articles, 4 books and numerous chapters. She serves as section editor of functional neurosurgery in Operative Neurosurgery and is on the editorial board of Neuromodulation.

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

6 Types of Soft Tissue Injuries

Soft tissue injuries, which involve damage to ligaments, tendons, or muscles throughout the body, can cause a major disruption to everyday life. These types of injuries can occur during sports, exercise, or even everyday activities. Being aware of soft tissue injury types is one of the best ways to avoid them, and at IMPACT Physical Therapy, we aim to educate. Below, we will dive into the causes and specifics of six types of soft tissue injuries, so read on to learn more.

6 Common Soft Tissue Injuries

1. Anterior Cruciate Ligament Knee Injuries (ACL)

Commonly referred to as the ACL, the Anterior Cruciate Ligament enables the rotational stability of the knee joint by resisting the motion of the anterior tibial translation and internal tibial rotation. This ligament is commonly injured through jumping, landing, pivoting, or changing direction while engaging in sports or similar activities. Symptoms of an ACL injury can include severe pain, swelling, loss of range of motion in the area, and a feeling of instability. While surgical treatment is often necessary for repairing the ACL, our team of clinical therapists at IMPACT Physical Therapy will work closely with your doctor to properly assess your injury and devise a treatment program for your needs. To provide optimal healing, focus should be placed on strength, stability, range of motion, agility, proprioception (your perception of the position and movement of your body), and pain reduction. Check out our blog, 4 Tips to Prevent an ACL Injury.

2. Bursitis

The soft tissue injury known as bursitis commonly impacts the bursae, small, fluid-filled sacs that cushion the bones, tendons, and muscles surrounding your joints. This painful condition may occur when the bursae become inflamed, typically affecting the bursae of the hips, elbows, and shoulders. Inflammation can arise due to repeated motions and overuse, and symptoms may include an achy or stiff feeling and swelling in the affected area. Physical therapy treatment for bursitis includes techniques to reduce pain and swelling, and therapeutic exercises to help stretch and strengthen the muscles in order to prevent future injury from occurring

3. Sprains

Sprains, the overuse or tearing of fibrous ligament tissues, are among the most common soft tissue injuries, affecting both athletes and non-athletes. While most individuals experiencing a sprain experience them within the ankle, sprains can affect several different areas of the body where this ligament tissue intersects between two bones. At IMPACT Physical Therapy, we offer our comprehensive Astym® therapy, assisting in the healing of hamstring, ankle, and elbow sprains. This comprehensive process involves the regeneration of healthy tissue and reduction of scar tissue. In addition to Astym® therapy, sprains are most effectively resolved through rest of the affected area, the use of ice, compression and elevation. Our clinical therapists will assess the extent of your sprain and provide you with the best guidance and support needed to heal this soft tissue injury.

4. Tendinitis

Tendinitis, which is similar to bursitis, involves the inflammation or irritation of a tendon, or the fibrous cords that attach a muscle to a bone. This inflammatory condition commonly affects areas such as your shoulders, wrists, knees, and elbows. Common symptoms of tendinitis include a dull ache in the area, tenderness, or mild swelling. It is possible for tendinitis to occur suddenly, but most cases of this uncomfortable condition occur in people who regularly perform the same repetitive action. Tendinitis treatment is aimed towards reducing pain and inflammation, and physical therapy techniques designed to stretch and strengthen the muscle have proven to be an effective method of treatment.

5. Contusions

While the term ‘contusion’ may refer to the common bruise, individuals may additionally suffer from a small lump on the injured area and pain which accompanies the discoloration of the skin. Contusions are a type of hematoma, which may indicate a more serious injury to a ligament, tendon, or bone. If the contusion is mild, a combination of rest, ice, compression, and elevation will promote healing, but more severe contusions that affect more than just the surface of the skin may require treatment by a physical therapist.

6. Concussions

As concussions notably impact brain tissue and often result in damage to brain function, they are considered soft tissue injuries. Though there are many causes of concussions, this soft tissue injury most commonly affects athletes or individuals involved in contact sports, such as football and boxing. Concussions require evaluation by a healthcare professional so the proper precautions and treatment steps can be taken. Those suffering from a concussion would most benefit from our comprehensive Concussion Rehab, wherein our trained therapists assess the cardiovascular, neurological, and orthopedic effects of your concussion.

Find Soft Tissue Injury Treatment Near You

Don’t let a soft tissue injury slow you down! At IMPACT Physical Therapy, we will work with you to address and treat your soft tissue injury so you can get back to feeling your best. Our dedicated clinicians can effectively treat a variety of soft tissue injuries, and we also provide many other physical therapy and performance services to our extensive clientele. Contact us at one of our seven Illinois locations to learn more about treating your soft tissue injury today!

90,000 Rupture (damage) of the rotator cuff of the shoulder joint

The shoulder joint is one of the most mobile joints in the human body. The structure of this joint makes it possible to carry out various movements of the upper limbs in a wide range: rotational, flexion, abduction, extension and adduction actions.

Description of the disease

Rotator cuff of the shoulder – the anterior outer part of the capsule of the shoulder joint.It combines the tendons of the supraspinatus, infraspinatus, and small round muscles. Despite the difference in their functions, such an anatomically close place of muscle fixation allowed traumatologists to identify them into a common group (rotator cuff).

Injury to the rotator cuff can be considered a rupture of one or a group of tendons that make up it. Most often it is caused by trauma, dislocation, or previous chronic inflammation.

What causes rotator cuff injury?

As discussed above, trauma is the most common cause of rotator cuff injury. Most often, ruptures occur in the elderly, but in young people, rupture can also occur due to serious injuries, such as a fracture of part of the humerus or dislocation.

  • A fairly common cause of damage to the rotator cuff is permanent tendon trauma , which is chronic.Basically, this applies to people whose professional activities are associated with hard physical labor. Stress and severe stress on the joints, accompanied by repeated movement operations, leads to chronic inflammation and pain.

  • Spontaneous rupture or damage to tendons, as a rule, is preceded by a period of degenerative-dystrophic changes . Lack of blood supply is the main cause of tissue degeneration or tendopathy.Many doctors attribute a genetic predisposition to another possible cause of the development of degeneration.

  • Another reason may be individual anatomy . Sometimes, insufficient space between the head of the humerus and the tip of the scapula leads to constant friction and injury to the rotator cuff tendons. In addition, the anatomically determined is the hook-shaped form of the acromial process and the presence of an accessory bone on the tip of the scapula that damages the tendons.

Symptoms of rotator cuff rupture

The rupture is always accompanied by a sharp attack of pain localized in and around the shoulder joint. The pain often radiates to the hand, neck and forearm. A characteristic symptom is increased pain when trying to make a certain movement of the hand, for example, to raise it or take it to the side. In some cases, patients are completely deprived of the ability to move their arm. The individuality of the symptoms and the degree of their severity depends on whether the rotator cuff rupture was complete or partial.Patients also very often complain about the inability to sleep on the side where the joint is damaged.

The place where the center of pain is located directly depends on the location of the damaged tendon. The most common in clinical practice is supraspinatus tendon rupture. Such a case can be diagnosed by asking the patient to take his hand to the side. If we are dealing with just such damage, the patient will not be able to complete this task. If, however, abduction of the arm is possible, but a pronounced pain is felt, it is most likely that the tendon is not completely torn, but only severely damaged.

Diagnosis of rotator cuff injuries of the key joint

In order to make the correct diagnosis, the doctor takes a set of measures to establish the clinical picture.

  • The first method is interviewing the patient : the doctor needs to establish the circumstances under which the pain appeared, establish how long the patient has experienced unpleasant sensations in this area and ask about the nature of professional activity.

  • A thorough inspection is then required using specific tests . Thus, the level, the severity of the pain syndrome, the degree of weakness of the motor function and the state of the adjacent muscles are determined. Usually, a complete rupture has a number of pronounced symptoms, so it can be easily diagnosed.

Below are some diagnostic tests to help your doctor understand the nature of your shoulder injury.

Painful Dowborn Arch

The arm is passively and actively retracted from the starting position along the body.

Score . Abduction pain between 70 ° and 120 ° is a symptom of an injury to the supraspinatus tendon that is compressed between the greater tubercle of the humerus and the acromial process during this phase of movement (“subacromial impingement”).

Test of abduction of hands from zero position

The patient stands with lowered and relaxed arms.The physician covers the distal third of each forearm of the patient with his own hands. The patient tries to spread his arms while the doctor resists.

Assessment. The abduction of the hand is carried out by the supraspinatus and deltoid muscles. Pain and especially weakness in the process of abduction and deviation of the arm convincingly confirms a rupture of the rotator cuff.

The eccentric position of the shoulder head in the form of its upper displacement when the rotator cuff ruptures occurs due to an imbalance in the muscles surrounding the shoulder joint.Partial tears, which can be functionally compensated, impair function to a lesser extent with the same severity of pain. Complete ruptures are invariably characterized by weakness and loss of function.

Jobe Supraspinatus Test

This test can be performed with the patient standing or sitting. With the forearm extended, the patient’s arm is positioned in the 90 ° abduction position, 30 ° horizontal flexion and in internal rotation. The doctor resists this movement by applying pressure to the proximal shoulder.

Assessment. If this test causes significant pain and the patient is unable to independently hold the arm abducted 90 ° against gravity, this is called a positive falling arm symptom. The upper portions of the rotator cuff (supraspinatus) are assessed mainly in the position of internal rotation (the first finger looks down), and the state of the anterior portion of the cuff – in the position of external rotation.

Falling hand test (falling flag symptom, chess clock)

The patient sits, the doctor passively moves the patient’s extended arm by approximately 120 °.The patient is asked to independently hold the hand in this position, and then gradually lower it.

Assessment. Failure to hold the arm in this position with or without pain, or a sudden drop in the arm confirms damage to the rotator cuff. The most common cause is a defect in the supraspinatus muscle. With pseudoparalysis, the patient cannot raise the injured arm on his own. This is the main symptom that confirms the abnormality of the rotator cuff.

External rotation abduction test for infraspinatus tendon rupture

The patient’s arm is positioned in 90 ° abduction and 30 ° flexion.In this position, the action of the deltoid muscle as an external rotator is excluded. Then the patient is offered to start external rotation, which is prevented by the doctor.

Assessment. A decrease in active external rotation in the abducted position of the arm is characteristic of clinically significant damage to the infraspinatus tendon.

Further, without fail, the patient receives a referral for an X-ray. With the help of an X-ray examination, the doctor receives a picture typical of a particular case.Unfortunately, the gap is not clearly defined; only a number of indirect signs can indicate it. The most informative diagnostic method today is magnetic resonance imaging. It can help visualize the tendons, muscles and ligaments of the shoulder joint. This method provides the clearest and most vivid picture of the patient’s soft tissue condition.

Methods for the treatment of rotator cuff rupture

The very first action of the doctor will be measures to relieve pain: usually, these are anti-inflammatory pain relievers and ointments.Complete rest of the injured arm and fixation with a bandage or abduction splint is recommended. The application of cold, such as an ice pack, will help to remove the swelling.

Surgical treatment

A complete rupture of the cuff will not be able to heal on its own, and therefore an immediate surgical intervention is required in order not to lose the motor function of the joint. In this case, it is important to perform the operation as early as possible, because a chronic injury leads to shortening of the muscle and the impossibility of stretching it to its original length.In such cases, it is very difficult to return the tendon to its place and will require a lot of effort from the surgeon. The optimal period for the execution of the operation is several months from the date of the break.

In the process of surgical intervention, the damaged tendon is pulled, attaching it to its original position, and also sutured, if necessary. All lifeless tissues that have undergone degeneration are removed so that the tendon is better adhered to the place of artificial attachment. Anchor clamps are mainly used to attach the tendon.The anchor is screwed into the part of the bone, where the soft tissues will subsequently be connected. The threads attached to the anchor are passed through the rotator cuff and pulled up to the bone using interrupted sutures. Thus, the seams hold the tissue until the rupture sites are completely healed. The operation to restore the functions of the rotator cuff can be called quite difficult, and it is performed by an incision.

Arthroscopic treatment

Arthroscopy is the most advanced surgical treatment for a rotator cuff rupture.It is performed without incision by creating a special puncture with a diameter of 1-2 centimeters. A camera, an arthroscope, is inserted through the puncture cavity into the joint, due to which the surgeon sees a clear picture of the inner space of the joint. The image obtained from the surface of the arthroscope is transmitted to the screen, looking at which the surgeon performs all the necessary manipulations and simultaneously controls them.

The operation performed in this way is the most preferable, since healing occurs much faster, and the tissues surrounding the joint are practically not damaged during the intervention.After surgery, the patient’s arm is immobilized for several weeks by applying a splint. This will protect against the possibility of repeated rupture and will allow the tissues to grow together after the operation.

Rehabilitation after trauma

Rehabilitation after this injury cannot be called quick: as a rule, it can take from 3 to 6 months. The load on the damaged joint must be accurately dosed so as not to disrupt the fusion process.

Special exercises and restorative gymnastics are shown as rehabilitation.The development of the joint should be started with passive movements. Active exercise can be allowed no earlier than 6 weeks after surgery. Physiotherapy is prescribed to relieve tissue swelling and pain after surgery.

Myopathy – Neurology with manual therapy – Departments

Myopathies – a group of diseases based on various disorders in the metabolism and structure of muscle tissue, leading to a decrease in the strength of the affected muscles and limitation of motor activity.typical features of myopathy are: progressive muscle weakness, development of muscle atrophy, decreased tendon reflexes and muscle tone. Most of the cases of the disease are genetic pathology.

Symptoms: muscle weakness, fatigue of walking and exercise, progressive muscle atrophy.

Primary myopathies are based on genetically determined disorders in the functioning of mitochondria and ion channels of myofibrils, in the synthesis of muscle proteins or enzymes that regulate the metabolism of muscle tissue.

Acquired myopathies can develop against the background of endocrine disorders (hyperparathyroidism, Itsenko-Cushing’s disease, hypothyroidism, hyperaldosteronism), chronic intoxications (substance abuse, alcoholism, drug addiction), malabsorption , avitaminosis, processes of chronic diseases, .

Features of individual forms of myopathies:

Erb’s juvenile form: is inherited in an autosomal recessive manner. Pathological processes begin to appear in 20-30 years.First of all, they cover the muscles of the pelvic girdle and thighs.

Duchenne pseudohypertrophic myopathy is inherited recessively linked to the sex, only boys are ill, Manifesto of the disease in the first 3 years of life. Typically, it begins with atrophic changes in the muscles of the pelvic girdle and proximal legs, accompanied by pseudohypertrophy of the calf muscles. Contractures and curvature of the spine occur early. The disease proceeds with damage to the respiratory muscles and heart (in 90% of patients with Duchenne myopathy, cardiomyopathy is noted, which is the cause of early death).

Shoulder-scapular-facial myopathy Landouzy-Dejerine – has an autosomal dominant inheritance, manifests from 10-20 years with a lesion of facial muscles.

Scapuloperoneal myopathy is an autosomal dominant disease. Its feature is the development of atrophy in the muscles of the distal legs and proximal arms, light sensory disorders of the limbs.

Oculopharyngeal form : characterized by a combination of lesions of the oculomotor muscles with weakness of the muscles of the tongue and pharynx.Usually manifests as bilateral ptosis, later swallowing disorders join. A feature of myopathy is its late onset 40-60 years.

Distal late myopathy is inherited in an autosomal dominant manner. Differs in the development of weakness and atrophy in the distal extremities.


Physical examination, electroneuromyography , blood biochemistry (increased levels of aldolase, CPK, AST, ALT, LDH), muscle biopsy.

Therapy currently pathogenetic treatment of myopathies is in the state of scientific experiments in the field of genetic engineering. Symptomatic consists mainly of improving the metabolism of muscle tissue:

90,000 Osteoarthritis, tendon rupture or inflammation?

  1. Pain in the shoulder after traumatic injuries:
    Contusion, sprain, trauma of the acromioclavicular joint, dislocation, fracture
  2. Painful inflammation in the shoulder:
    Calcification of the forearm, bursitis, frozen shoulder syndrome (periarteritis of the shoulder scapula), rheumatism
  3. Degenerative changes in the shoulder joint:
    Osteoarthritis, shoulder impingement syndrome, rupture of the biceps brachii (biceps), stenosis of the cervical spine,
  4. Nonspecific shoulder pain: Stress, improper posture, shoulder blade, cervical spine

Often hurts from sudden injury: A fall or impact can damage tendons and soft tissues.As a rule, not only one structure is injured. In most cases, patients are diagnosed with sprains or ruptures of the tendons, bursa, joint capsule, and muscles surrounding the shoulder joint. In addition, such shocks can lead to damage to bone structures: A fracture of the humerus head or rupture of the acromioclavicular joint can have long-term consequences and cause arthrosis of the shoulder joint. Conscientious, targeted treatment is essential to prevent post-injury contractures and pain.
The shoulder is a complex structure consisting of a ligamentous apparatus, tendons and an articular capsule. An injured shoulder can lead to overstretching and even rupture of these connective tissue structures. Each deformation of the shoulder joint can lead to serious consequences, the recovery period is delayed. Inflammation, subcutaneous hemorrhage, painful swelling are sources of stabbing pain in the shoulder and limitation of movement. © Sebastian Kaulitzki / fotolia

In addition to traumatic deformities, pain of the shoulder joint appears due to metabolic metabolic disorders: Calcification of the forearm and layering of calcium salts in the tendon of the supraspinatus muscle or inflammation of the joint capsule (“frozen shoulder” syndrome) can lead to severe pain and discomfort in the shoulder without external influence …Due to the frequent repetition of stressful situations, metabolic problems cannot always be distinguished from shoulder overload. Activities such as raising your arms over your head while working or playing sports can cause inflammation of the bursal sac (bursitis) of the shoulder or inflammation of the tendon sheath. As with other joints, wear and tear on the articular cartilage (arthrosis) can cause chronic pain and contracture of the shoulder joint. There is a conservative treatment for every source of shoulder pain.In difficult cases, surgical treatment is recommended. Experienced orthopedic specialists at the Gelenk Klinik in Germany will conduct a qualified examination, after which they will offer the patient treatment depending on the diagnosis.

Shoulder pain after injury: Injury to the shoulder joint

Most often, athletes complain about shoulder pain after injuries and power loads: Overstretching, deformations and falls cause traumatic pain in the shoulder.

Contusion of the shoulder joint (shoulder contusion)

  • Shooting pain
  • Hematomas and blue discoloration on the skin
  • Sparing shoulder position
  • Restricted mobility
  • Abrasions on the shoulder

Bruises in the shoulder area occur after falls, impacts and collisions, as a result of which the soft tissues, muscles and tendons of the shoulder joint are compressed.The causes of a bruised shoulder are usually obvious, since the person deliberately experienced the injury.

After a shoulder injury, the situation can be complicated by pre-existing tendon defects (eg rotator cuff and biceps tendon). A shock to the shoulder joint can lead to degenerative partial ruptures of previously damaged tendons.

A bruised shoulder joint causes severe pain almost immediately. This fact is the reason for repeated subcutaneous hemorrhage and the appearance of hematomas.An important aspect of the examination is the timely exclusion or confirmation of degenerative changes in the tendons and bones using such imaging techniques as X-ray, ultrasound and magnetic resonance imaging.

How is a bruised shoulder treated?

  • Immobilizing dressing, fixing the band
  • NSAIDs – non-steroidal anti-inflammatory drugs (e.g. Ibuprofen)
  • Physiotherapy and, above all, biological regulatory treatment based on cellular technologies

Symptoms of a bruised shoulder joint disappear without consequences within a few days or a maximum of two weeks …If complaints last longer than usual, additional testing should be done to check for structural mutations in the shoulder area. Treatment of this injury is carried out with the help of immobilization, special fixation bandages and stress relief.

Sprains of the ligaments of the shoulder joint – the cause of stabbing pain in the shoulder

  • Shooting pain in the shoulder
  • Hemorrhages and bruises)
  • Restricted mobility and sparing position

Ligament expansion in the shoulder is a phenomenon in which, for various reasons, the length of the ligaments becomes longer than normal.Very often, this pathology appears due to excessive loads or after strength sports training, and sometimes it occurs after falling on an outstretched arm. A sprained shoulder joint is a rather painful injury that limits the mobility of the shoulder, after which it is necessary to keep the hand in a sparing position and not overload. In the most difficult cases, patients are also diagnosed with inflammation of the soft tissues of the shoulder joint, accompanied by subcutaneous hemorrhage (hematoma).

As a rule, the causes of shoulder sprains are obvious, as patients experience the trauma while fully conscious and immediately experience typical pain. In order to exclude structural damage to muscles, tendons and bone structures, in addition to clinical examination, it is recommended to conduct an imaging study using ultrasound, X-ray and MRI ..

This disease is dangerous by the rapid transition from simple stretching to such serious shoulder pathologies, such as rupture of the rotator cuff and the biceps tendon, as well as SLAP – shoulder joint syndrome (damage to the upper part of the articular lip of the scapula)….

How is shoulder sprain treated?

  • Immobilization with fixing bandages
  • Physical rest

The healing process of this ailment is quite quick and simple: The pain in the shoulder goes away after 2-4 weeks. If the shoulder hurts for longer than the specified period, highly qualified orthopedists at the Gelenk Klinik in Freiburg will carry out additional diagnostics for possible structural deformities and prescribe the appropriate treatment.

Periosteal contusion (“Bone Bruise”)

  • Acute and dull pain for several months
  • Sometimes abrasions on the shoulder
  • Hemorrhage (hematoma)

Bone Bruise is compression or contusion of the periosteum of the shoulder joint with damage to the cartilaginous surface and the accumulation of excess fluid (edema) in the underlying bone structures …

Shoulder pain caused by this condition lasts a very long time and goes away rather slowly.Often, Bone Bruise of the humerus appears in conjunction with a sprained shoulder joint or a bruised shoulder.

Quite often, after traumatic situations, only superficial damage to soft tissues is assumed. The healing process of patients suffering from this disease can take several months. The typical Bone Bruise accumulation of excess fluid can only be detected with an imaging diagnostic MRI scan. …

How is bruised bones treated?

  • Sparing position, immobilization of the joint
  • NSAIDs – non-steroidal pain medications (Ibuprofen, Diclofenac)
  • In case of concomitant injuries: arthroscopy of the shoulder joint

Treatment of periosteal contusion “Bone Bruise” -to play sports and limit physical activity.Surgical treatment after a bone injury with shoulder arthroscopy is necessary only for concomitant tendon or cartilage damage. Nonsteroidal pain relievers can help relieve shoulder pain after bone injury.

Dislocation of the shoulder: Stitching pains and stiffness of the arm

X-ray of the shoulder joint after dislocation. In case of violation of congruence in the shoulder, the head of the humerus jumps out of the joint capsule, after which it changes its position and is far from the acromion.The current situation leads to damage to soft tissues: There is a rupture of the cartilaginous articular lip of the glenoid cavity of the shoulder. Numbness in the arm as well as shooting pains are consequences. The dislocation should be corrected by the doctor as soon as possible. Then it is necessary to conduct a detailed diagnosis of the articular structures in order to exclude degenerative changes in the tendons, ligaments and cartilage tissue. © Gelenk-Klinik

  • Impaired shoulder joint mobility: Dangling of the arm along the torso
  • Shooting pains
  • With nerve endings injuries: Sensory disorder on the lateral side of the shoulder
  • With concomitant injuries of the biceps muscle: Pain and weakening of the flexor of the arm

With shoulder dislocation, the head of the humerus slips out of the glenoid cavity.This is usually caused by external factors or accidents. This injury is often accompanied by damage to the labrum or capsular ligamentous apparatus.

After dislocation of the shoulder joint, the arm and shoulder lose their original functions. Until the patient seeks a specialist who can correct the dislocation, the arm will remain motionless and very painful.

Sharp intense pain, characteristic of a dislocated shoulder, as well as stiffness in the arm, contribute to a quick diagnosis.More difficult is the diagnosis of concomitant injuries in the shoulder: For example, rupture of the articular lip and capsular-ligamentous apparatus.

The most accurate dislocation can be detected with the help of X-ray examination. Ultrasound and CT help to identify accompanying traumatic disorders of the articular lip and other soft tissues.

How is shoulder dislocation treated?

  • Reduction of dislocation
  • Anesthetic treatment
  • Physiotherapy
  • Surgical reposition
  • Arthroscopy of the shoulder joint with tearing of the labrum and capsular ligamentous apparatus

Displacement of the humeral head is treated by simple reduction of the dislocation.Doctors recommend doing this procedure immediately after the injury, namely after a few minutes. The situation becomes more complicated with additional soft tissue injuries: Treatment of such complications is possible only with shoulder arthroscopy.

Ruptured acromioclavicular ligament of the shoulder: Stitching pain in the shoulder, nocturnal pain and numbness

When the acromioclavicular joint is torn, the ligaments, bones and articular surfaces are damaged. The degree of impairment is measured depending on the amount of deformities in the bone structures.An obsolete type of classification of the severity of AC joint injury according to the Tossi method is at the heart of this image. Injuries are currently classified according to the Rockwood five-step scheme. Mobility disorders, stitching pains of the shoulder joint, as well as restrictions in movement are a consequence of this disease. With this ailment, the patient cannot lie on his shoulder, as he feels severe pain. In medical terminology, several degrees of damage to the acromioclavicular joint are mentioned, for the treatment of which fixation braces are most often used.In rare cases, clinics perform operative ligament reconstruction. © Alila Medical Media / fotolia

  • Limited mobility of the shoulder joint
  • Shooting pains
  • Night pains during sleep
  • Key effect (protrusion of the acromial end of the clavicle)
  • Swelling and bruising

In medical terminology, the shoulder joint is also called the acromioclavicular joint, which connects acromion with the sternal end of the clavicle (Clavicula).Falls during skiing and cycling are common causes of rupture of the acromioclavicular ligament of the shoulder joint. Typically, the victim falls from a height directly onto the shoulder so that most of the impact falls on the shoulder. A characteristic phenomenon of such a bruise is severe pain in the shoulder joint, limited mobility in the shoulder, as well as hematomas. During the examination, an experienced specialist immediately notices the protrusion of the clavicle of the shoulder joint and prescribes the appropriate treatment for the patient.

After a clear visual diagnosis, doctors perform an X-ray of the shoulder joint, which finally confirms the diagnosis. Sometimes X-rays are taken under stress. To obtain information about changes in the functionality of the shoulder joint, weights are recorded on the injured arm.

How is acromioclavicular ligament rupture treated?

  • Immobilization of the joint with fixation bandages
  • Surgical treatment (re-fixation of the acromioclavicular joint)
  • Tendon transplantation

In case of rupture of the ligaments of the acromioclavicular joint, our medical center mainly offers conservative treatment with stabilizing bandages.Surgical treatment is carried out only in severe cases, for example, if the patient’s arms and shoulders are subjected to heavy stress on a daily basis. With the help of special retainers and screws, the surgeon reconnects the separated fragments. Also, tendon transplant methods help restore shoulder performance.

Immobility of joints in the shoulder and stitching pains as a result of a fracture of the head of the humerus

  • Deep, shooting or dull pain in the shoulder
  • Impaired shoulder joint mobility
  • Hematomas and edema

Fractures of the humeral head are quite common.Typically, this type of fracture occurs after falls, bumps or accidents. This injury occurs especially often if a person falls on an outstretched arm, for example, while riding, skiing, or after falling off a bicycle.

Due to the fracture of the humerus, patients constantly feel severe pain and can no longer move the shoulder as before. With the help of X-ray examination, the category of the fracture and the position of the separated fragments are established. Computed tomography (CT) scans provide a three-dimensional image of the shoulder joint and can recognize more severe fractures.

How is a humerus fracture treated?

  • Immobilization of the shoulder joint
  • Reconstruction and refixation in case of fractures with displacement
  • In difficult cases – endoprosthetics of the shoulder joint

If after injury the bone fragments remain in a stable position and do not move relative to each other, surgical treatment is not necessary. In this case, a more effective and gentle way is to immobilize the shoulder joint with a shoulder bandage for several weeks.In case of a fracture of the humerus with displacement or damage to the articular surfaces, surgical treatment is required, during which the surgeon stabilizes the bone fragments using special plates and screws. Thus, the separated fragments heal in the desired position, after which a smooth articular surface is formed. In addition to the complete restoration of the functions of the shoulder joint, every experienced doctor tries to do everything possible to avoid arthrosis of the shoulder joint (omarthrosis).

Damage or rupture of the articular capsule of the shoulder (HAGL damage or separation of the brachioglenoid ligaments from the humerus)

  • Sharp pains of the shoulder joint
  • Impaired mobility in the shoulder
  • Swelling
  • Concomitant traumatic injuries of the shoulder joint

Due to the high mobility of the shoulder joint, a very important function is separated from the joint capsule.It not only participates in the metabolism of the articular cartilage, but also helps stabilize the shoulder with the help of glenohumeral ligaments. A sprain or bruise can lead to injury and even rupture of these ligaments.

This pathology is often accompanied by other deformities in the shoulder: Sometimes patients have a dislocation of the shoulder joint.

Treatment of HAGL injuries in the shoulder

  • Immobilization and sparing position
  • Surgical treatment: Arthroscopy of the shoulder joint

First, the treatment of a rupture of the joint capsule, that is, separation of the glenoid ligaments from the humerus, is carried out by immobilizing the shoulder joint.In addition, it is necessary to reduce physical activity and, if possible, keep the joint in a sparing position. If the injuries are more serious and conservative treatment does not bring the desired results, surgical treatment is required, namely shoulder arthroscopy.

Pain in the shoulder after physical exertion and inflammation

In physically active people, professional athletes, as well as workers, inflammatory processes of the shoulder joint due to overload and unilateral overstrain are observed more often than in others.First of all, raising the arm above the head, as for example is done by painters or fitters, causes severe pain due to excessive tension in the shoulder, soft tissues and tendons. Degenerative changes in older patients are also the cause of soft tissue and tendon inflammation.

Calcification of the forearm: stabbing pain due to deposits of calcium salts in the supraspinatus tendon

Shoulder X-ray: Visualization of calcium deposits in the supraspinatus tendon (in red circle).With calcification of the forearm, these deposits, as well as the associated degenerative lesions and inflammatory changes in the rotator cuff, lead to painful sensations and limited mobility in the shoulder. © Gelenk-Klinik

  • Shooting pain
  • Night pain while lying on the shoulder
  • Difficulty raising an arm overhead and brushing the hair

Metabolic disorders can cause calcification of the rotator cuff and calcification of the forearm (Tendinosis calcarea), the formation of calcium deposits in the supraspinatus tendon.In some cases, this fact may remain painless. However, most often, calcium salt deposits cause shooting pains and disrupt the mobility of the shoulder joint. Typically, calcium deposits, which cause shoulder pain, resolve within about three years. Problems with raising the arm above the head, as well as severe pain symptoms at night, restrict the patient’s movements. In this case, you must immediately consult a doctor and start treating the disease.

Accurate diagnosis of forearm calcification is possible with X-ray. If the patient does not feel discomfort in the shoulder, surgery is not necessary. In this case, the disease can be treated conservatively.

Treatment of forearm calcification

  • Physiotherapy and special exercises
  • Shockwave therapy
  • Biological regulatory therapy based on cellular technologies
  • Rare: Surgical treatment (arthroscopy) to remove calcium deposits

Successful treatment of the symptoms of shoulder calcification is often done conservatively.Extracorporeal shock wave therapy can accelerate the disintegration process of the above pathology. Calcification of the forearm is based on metabolic disorders, which leads to necrosis of tenocytes (tendon cells) and their replacement by calcium deposits. Biological regulatory therapy based on cellular technologies promotes the activation of metabolism and the rapid resorption of calc deposits. Surgical treatment of this disease is carried out only in cases where conservative treatment has remained unsuccessful.

Bursitis (inflammation of the mucous membranes): Swelling and stitching pains in the shoulder

  • Sharp shoulder pain
  • Shoulder pain at night and insomnia
  • Pressing pain
  • Discomfort when raising the arm
  • Rare: Redness and overheating

Shoulder bursitis is a painful inflammation of bursae. Mucous bags (lat. Bursa = bag) are fluid-filled connective tissues that act as a shock absorber and serve as a lubricant between overstrained tendons and muscles.The bursae are located between the soft tissues of the body and the bones, namely at the site of movement of the tendon through the adjacent muscle or bone. Thus, the elimination or softening of the friction process occurs. Most often, bursitis affects the mucous bag of the shoulder under the acromion, since this process of the clavicle is most susceptible to stress. Rheumatism and other inflammatory processes can also cause deformation of the bursa. Sometimes bursitis leads to swelling and overheating of the shoulder joint.Since the bursae are located deep in the shoulder joint, there are no external symptoms of the disease at all. With bursitis, the patient has a noticeable impairment of shoulder mobility, especially the process of raising the arm over the head.

Treatment of bursitis of the shoulder joint

  • Cryotherapy
  • Biological regulatory treatment based on cellular technologies
  • NSAIDs – non-steroidal anti-inflammatory drugs
  • Shoulder arthroscopy

Acute and painful inflammation of the shoulder is reduced with cooling compresses.At the same time, the patient is advised to take into account the doctor’s prescriptions and reduce the load on the shoulder. Treatment of inflammatory processes in the mucous bag of the shoulder joint can be carried out with the help of non-steroidal anti-inflammatory drugs. In addition, there are pills that can help relieve pain. Surgical treatment, namely arthroscopy of the inflamed bursa, is rarely performed. As a rule, the tissues of the mucous membrane of the bag of the shoulder joint are restored again within a short time.

Frozen shoulder syndrome (adhesive capsulitis)

  • Severe shoulder pain
  • Feeling numb and limited mobility
  • Night pain lying on the shoulder
  • Shoulder discomfort at rest
  • Limited shoulder mobility

Adhesive capsulitis (frozen shoulder syndrome) causes limited mobility shoulder joint by reducing the joint capsule. At first, the clinical picture of the disease progresses rather slowly.Over the course of several weeks or months, it becomes more and more difficult for the patient to move the arm. After this, sharp stitching pains begin at night, which interfere with sleep. Habitual sports and daily movements are getting harder and harder. The cause of this pathology can be both bruises and blows to the shoulder, after which the patient is strongly advised to give up training for a long time and keep the shoulder in a sparing position. Metabolic disorders such as diabetes also contribute to frozen shoulder syndrome.It is worth noting that this disease sometimes goes away on its own. Despite this, with the duration of the pain syndrome and limited mobility for more than three years, you need to see a doctor and immediately begin treatment for the disease.

Treatment of frozen shoulder syndrome

  • Physiotherapy
  • Drug-based pain relief
  • Biological regulatory treatment based on cellular technologies
  • Step-by-step anesthesia with pills
  • Surgical mobilization of the shoulder joint under anesthesia
  • Surgical splitting of the joint capsule of the shoulder

In most cases, the treatment of this syndrome occurs with the help of physiotherapy procedures (eg.cooling compresses). Biological regulatory treatment based on cellular technologies has been particularly successful. Reactivation of the shoulder joint metabolism significantly reduces the duration of the feeling of numbness in the shoulder.

Medication also helps to overcome the disease. The so-called phased cortisone pain relief shortens the duration of pain and numbness in the shoulder.

Nonsteroidal anti-inflammatory drugs alleviate the symptoms of the disease, but do not shorten the duration of the syndrome.If conservative treatment is unsuccessful, the orthopedic specialists at the Gelenk Klinik in Freiburg perform surgical mobilization of the shoulder joint under general anesthesia. At the same time, the surgeon may perform arthroscopic treatment of the shoulder.

Rheumatic arthritis: painful inflammation of the shoulder joint and a violation of the tendon structure

  • Severe pain in the shoulder
  • Swelling
  • Overheating
  • Pain with pressure on the shoulder
  • Redness
  • Restricted mobility

Rheumatism of the shoulder joint begins with dull and dull pain in the shoulder.In an advanced stage, rheumatoid arthritis destroys the cartilaginous surface of the shoulder joint and leads to arthrosis. It also affects the rotator cuff of the shoulder joint. Rheumatism has many causes that have not yet been fully investigated to date.

Treatment of rheumatism or arthritis of the shoulder joint

  • Antirheumatic drugs
  • Radiosynovectomy (anti-inflammatory X-ray irradiation)
  • Arthroscopic removal of the inflamed synovial membrane of the joint
  • Shoulder joint replacement

In case of rheumatic inflammation of the shoulder joint, the regular observation of pathology and pain is in the foreground.As a rule, various antirheumatic drugs help control the disease. Due to inflammation and destruction of articular structures, surgical treatment may also be required. In our medical center, the patient is offered several methods, for example, arthroscopic removal of inflamed synovial membranes and mucous bags, or shoulder replacement.

Wear of the shoulder joint: Osteoarthritis and degenerative tendon ruptures

In addition to excessive physical exertion, the age factor is undoubtedly the cause of shoulder pain: The older the patient, the more often he will experience wear and tear of bone structures, cartilage and rotator cuff tendons.At the same time, the wear of the shoulder joint with a complex structure is treated with the help of physiotherapeutic procedures. Since many muscles and tendons can be involved in one movement, the disease can also spread to adjacent structures of the shoulder, which can also lose their original functions. In this case, physiotherapy helps. Therefore, conservative treatment of degenerative changes in the shoulder is most successful.

Osteoarthritis of the shoulder joint (omarthrosis): Wear and tear of the joints in the shoulder

Arthrosis of the shoulder joint is characterized by gradual wear of the articular cartilage.The bones of the shoulder no longer slide over the watery cartilaginous surface, but collide with each other. Bone spurs (osteophytes) form on the surfaces of the joints, which make them rough and accelerate the process of wear of the articular cartilage. © Viewmedica

  • Numbness
  • Swelling
  • Dull pain
  • Shooting pain
  • Overheating
  • Discomfort at night
  • Crunching sound in the shoulder (crepitus)
  • Pain at the beginning of walking after rest

Osteoarthritis of the shoulder joint (omarthrosis) is a condition of the shoulder after wear and tear of the cartilaginous surfaces.Doctors point out several causes of shoulder osteoarthritis: Excessive physical exertion, violation of the biomechanics of the shoulder joint by disorders of the tendon structure, genetic weakness of the articular cartilage, inflammation, damage to the articular surface due to fractures, and much more. At first, cartilage deformities appear due to dull and deep pain. Osteoarthritis causes very discomfort in the shoulder, especially in the morning after waking up and starting to walk. As the disease progresses, the patient is unable to move the arm as before.

As in cases of damage to other joints, X-ray examination can confirm the diagnosis of “Arthrosis of the shoulder joint”: The degree of narrowing of the joint space determines the stage of wear of the articular surface.

Treatment of arthrosis of the shoulder joint

  • NSAIDs – non-steroidal anti-inflammatory drugs
  • Physiotherapy (shoulder centering)
  • Biological regulatory treatment based on cellular technology
  • Autologous cartilage cell transplantation
  • Nutritional consultation
  • Arthroplasty 943000 Treatment of arthrosis in the shoulder is carried out using several methods, which are also used to stabilize other joints.In other words, treatment of this disease involves not only medical pain relief and improvement of joint functionality with physical therapy, but also joint-preserving surgical treatment. The latter includes the transplantation of cartilage cells using both autogenous and laboratory-derived cartilage cells. In case of complete wear of the shoulder joint, the only way out is endoprosthetics. This surgical method relieves the patient from pain and restores mobility in the shoulder.It should be noted that shoulder arthroplasty is performed much less frequently than, for example, lower limb arthroplasty).

    Impulsion Syndrome: Narrowing, degeneration and rupture of the rotator cuff of the shoulder joint

    A rotator cuff rupture is an injury to the supraspinatus tendon, which runs under the acromion and covers the top of the humerus from above. As a rule, only a part of the wide tendon is damaged, which, despite severe pain, partially retains the functions of the rotator cuff.© Viewmedica

    • Stitching pains when the arm is abducted to the side in a horizontal position (Painful Arc – painful arc syndrome at an angle of 45 to 160 ° to the longitudinal axis of the body)
    • Shoulder pain under stress
    • Pain when raising the arm above the head
    • Loss of strength in the arm

    To impinge describes the unintentional collision of two bone structures. During impingement of the shoulder joint syndrome, the head of the humerus collides with the bone structures of the acromial process of the clavicle.At the same time, there is a constant compression of the tendons passing through this subacromial cavity (the area under the acromion). So, this pathology affects the tendon of the supraspinatus muscle, covering the head of the humerus from above and the long tendon of the biceps. This fact leads to degenerative wear of the rotator cuff tendons. Even after the smallest injury, such as a fall to the elbow, the weakened tendon can rupture completely and lose its original function.

    In older patients, the cause of rupture of the supraspinatus muscle is degenerative wear of the shoulder joint, and in young people – traumatic effects.

    If the supraspinatus tendon stops working partially or completely, the head of the humerus moves towards the acromion. X-ray examination determines its exact position. The state of the rotator cuff is shown by ultrasound.

    Painful Arc is characteristic of shoulder impingement syndrome – an angle of 60 to 120 ° in which the arm is abducted in relation to the longitudinal axis of the body. © Gelenk-Klinik

    Conservative treatment of shoulder impingement syndrome

    • Pause between loads, immobilization of the shoulder joint
    • Changing behavior: Avoid raising your hand over your head
    • NSAIDs – non-steroidal anti-inflammatory drugs
    • Physiotherapy and exercise therapy
    • Physiotherapy (cooling, ultrasound)
    • Injection treatment with cortisone and local anesthetics (local anesthesia)
    • X-ray irradiation and treatment of chronic inflammation of the supraspinatus muscle of the shoulder
    • Shockwave therapy, especially for calcification of the forearm

    Surgical treatment of shoulder impingement syndrome

    • Acromioplasty: Dilation of the subacromial tunnel by bone removal
    • Rotational cuff interrupted sutures
    • InSpace ™ Biodegradable Implant to restore functionality to the supraspinatus tendon by centering the shoulder joint.

    In the progressive stage of rotator cuff degeneration, arthroscopic treatment no longer helps. In this case, it is possible to center the head of the humerus by implanting a biodegradable balloon for a period of one to two years. An InSpace ™ implant is placed under the acromion during arthroscopic shoulder surgery. During the procedure, the balloon implant is filled with sodium chloride solution to keep it elastic and stable.

    The biodegradable InSpace ™ implant can replace a damaged rotator cuff and act as an anchor to help center the humeral head. After that, the pain in the shoulder goes away, and other muscles of the rotator cuff can take over some of the functions of the supraspinatus tendon. © Orthospace ltd, Israel, Exactech, Germany

    Destruction, painful inflammation and rupture of the biceps tendon

    • Stitching pain when raising the arm
    • Pulling pain in the biceps
    • Limited mobility

    The biceps is a muscle on the front of the shoulder that is responsible for flexing the arm.The biceps muscle of the shoulder joint is formed by a long and short head. The first begins with an articular tubercle (protrusion) on the scapula. The short head runs through the inner region of the humerus and, together with the long head, creates a thick biceps tendon that enters the radius of the forearm. The proximal biceps brachii connects to the superior edge of the glenoid cavity. This part – the tendon of the long head of the biceps brachii – is prone to traumatic injury and inflammation.Another, from a medical point of view, an almost imperceptible part of the biceps fuses with the coracoid of the scapula (coracoid process of the scapula).

    Excessive stress and constant stress of the shoulder joint cause painful inflammation, destruction of the shoulder structures and even rupture of the biceps brachii. … Inflammation of the tendon of the long head of the biceps brachii becomes more likely with impingement syndrome of the shoulder joint, that is, with a narrowing of the space under the acromial process of the clavicle.

    Biceps pain becomes especially noticeable when the arm is extended upward: Activities that require raising the arm above the head, such as assembly work, painting the ceiling, and crawling, accelerate the degeneration process.

    Thus, other diseases of the shoulder joint can spread to the biceps brachii.

    Falling on the elbow injures the biceps under the acromion. With partial or complete rupture of the long biceps tendon, patients feel severe pain and cannot move the arm as before.A total rupture leads to subsidence of the muscular abdomen – the protrusion between the tendon attachment point and the elbow bend. Preexisting injuries increase the likelihood of rupture of the biceps brachii.

    Multifactoriality is the reason that ruptures or injuries in the shoulder can occur at any age. In younger patients, biceps tendon rupture occurs after traumatic injury and overload. In elderly patients, this ailment appears against the background of previously existing degenerative defects.

    Conservative and surgical treatment of degenerative changes and ruptures of the tendon of the biceps brachii

    • Analgesic and anti-inflammatory drugs
    • Physiotherapy (cold treatment))
    • Biological regulatory treatment based on cellular technologies
    • Therapeutic exercises
    • Reducing stress and sparing the position of the shoulder joint
    • Tenotomy of the biceps (cutting off the tendon of the long head muscle) of the biceps)
    • Surgical re-fixation of the long head biceps tendon

    Inflammations or partial tears of the biceps brachii cause prolonged complaints.The latter take some time to decide on the method of therapy. In this case, doctors need to decide whether conservative treatment is appropriate and whether it can restore the muscle’s previous function. Another option may be surgical treatment with biceps re-fixation to restore its performance. Pain and loss of strength indicate the need for surgery. Since after surgery, the patient will need long-term rehabilitation, doctors need to weigh well the pros and cons.

    In case of rupture of the biceps muscle of the shoulder joint, doctors resort to such a technique as biceps tenotomy. If necessary, tenodesis of the biceps brachii is performed.

    Nonspecific shoulder pain: Stressful situations, posture, scapula, cervical spine

    Neuralgic pain often radiates from the cervical spine to the shoulder. Neck and shoulder pain can appear due to stressful circumstances or after dysfunction of the cervical spine.Diseases such as herniated disc and degeneration of the intervertebral disc, as well as stenosis (narrowing) of the spinal canal, contribute to the narrowing of the spinal nerves. © blackday / fotolia

    The shoulder joint is directly involved in the work of the muscles of the trunk, back of the chest, and also the occipital muscles. Therefore, injuries in this area negatively affect the health of the shoulder. Very often, symptoms that we perceive as shoulder pain do not appear in the area of ​​the shoulder itself, but in other structures of the shoulder joint.These traumatic injuries cause constriction and tension of muscle structures, as well as nerve entrapment. That is why this pain radiates to the shoulder ..

    Tension and hardening of the muscles

    • Numbness in the neck and shoulder
    • Muscle hardening
    • Stitching pains

    Shoulder pain is most often caused by tension and hardening of the muscles of the shoulder and neck. In medicine, several reasons for these injuries are noted. Stress, for example, can lead to muscle stiffness.Due to the lack of mobility and sedentary work, the muscles in certain areas of the shoulder joint are shortened: The back is rounded, the scapula is extended, and the body bends forward. In addition, the sternal muscles are shortened and the space under the acromion is narrowed, which leads to degeneration and inflammation of the tendons of the shoulder joint.

    How is shoulder pain due to hardening and muscle contraction treated?

    Physiotherapy and special exercises aimed at restoring the cervical muscles, as well as the muscles of the shoulder, back and chest, help to get rid of pain caused by incorrect posture and lack of movement.

    Pain in the shoulder: Herniated disc and stenosis of the spinal canal

    • Neck pain
    • Pain in the arm and shoulder
    • Disorders of sensitivity and tingling
    • Muscle weakness in the arm, hand and shoulder

    Pain in the shoulder is not always occurs as a result of dysfunction of the shoulder joint: Narrowing of the nerves after a herniated disc or stenosis of the spinal cord in the cervical spine also affects the condition of the shoulder and causes narrowing and loss of strength in the muscles.Sometimes it is difficult to determine the cause of shoulder pain. Therefore, specialized clinics recommend neurosurgical differential diagnosis, during which a clinical imaging examination of the cervical spine is performed. Diagnosis of a herniated disc is aided by magnetic resonance imaging (MRI).

    How is nerve entrapment in the cervical spine treated?

    • Physiotherapy and massage
    • Nucleotomy (removal of hernia)
    • Surgical treatment (arthrodesis of the cervical spine)
    • Endoprosthetics

    Hernia of the cervical spine, that is, the protrusion of the shock-absorbing intervertebral disc from the spinal canal or spinal stenosis, is treated with physiotherapy.If this treatment is unsuccessful, doctors are conducting surgical treatment, namely, the operative release of the nerves. During this operation, an experienced surgeon removes the hernia from the spinal canal. This technique helps to remove the narrowing at the point where the nerve leaves the spinal cord. In the last stages of the disease, only endoprosthetics can help.

    Painful disorders of the scapula mobility (scapular dyskinesia, “thrower shoulder”)

    • Disorders in the mobility of the scapula
    • Changes in the position of the scapula
    • Chronic pain of the shoulder joint
    • Lack of strength

    Pain of the shoulder joint is sometimes explained by impaired mobility of the scapula, namely scapular dyskinesia.The lack of intensity of movement of the scapula has many reasons. So, this disease can appear due to impingement syndrome, rotator cuff injuries, or due to instability of the shoulder joint. In addition, there are common factors that lead to scapular dyskinesia: If the patient’s torso is tilted strongly forward, the scapula is pulled up. The contraction of the sternum muscles (deltoid muscle) contributes to the chronicity of this fact. For this reason, differential diagnosis of scapular dyskinesia is not an easy procedure.It is important to know that the shoulder blade plays a decisive role in the transfer of energy between the arm and the torso.

    How is scapular dyskinesia treated?

    At the first suspicion of scapular dyskinesia, a differential examination of shoulder pain should be performed. In this case, it is necessary to examine everything: Muscles, tendons, neuralgia, bone structures, as well as the interaction of the muscles of the trunk, shoulder joint and neck. In most cases, physiotherapy or biological regulatory treatment based on cellular technologies is carried out.

    90,000 important rules, how to help at home

    What is a bruise

    Contusions are the most common type of domestic trauma affecting children, athletes, and people involved in hard physical labor. It is damage to internal organs and tissues without significant disruption of their structure, abrasions are possible. In case of bruises, the dermis and the vessels located under it are most vulnerable, which leads to the formation of hematomas and edema.A severe bruise is a serious hazard, as internal organs can be injured.

    To prevent the development of necrotic processes, it is important to be able to competently provide first aid for bruises of various origins.

    Signs of contusion

    The main signs of a bruise are:

    • soreness in the damaged area;
    • hemorrhage due to damage to capillary vessels;
    • formation of hematoma and edema.

    Depending on the site of the injury, cyanosis and swelling may appear immediately, as occurs in the case of damage to the subcutaneous tissue and the upper layers of the skin. In the case of bruises of deeper tissues, the hematoma may appear after several hours or even days. The accompanying injury, edema, reduces the mobility of the injured organ, creating discomfort when moving.

    The victim experiences the most severe pain immediately after a soft tissue injury, and after a couple of hours it subsides.Soreness increases with pressure. The swelling can increase over several hours, sometimes days.

    Degree of contusion

    Bruises vary in severity:

    • first – minor injury that does not require treatment;
    • second – contusion of muscle tissue, accompanied by severe pain, the formation of edema and hematomas;
    • third – as a result of a bruise, tendons may be damaged;
    • fourth – contusion of internal organs with severe swelling and painful sensations.

    A severe bruise can be accompanied by a closed fracture, therefore, in this case, it is especially important to immediately consult a doctor for a thorough diagnosis and treatment.

    Difference between fracture and contusion

    Symptoms of a bruise and a closed fracture are very similar to each other: severe pain, swelling, limitation of the mobility of the injured organ. But if in the case of a bruise the pain subsides within 2-3 hours, then with a fracture this does not happen, on the contrary, the pain may even increase somewhat.

    Therefore, in case of suspicion of a fracture, it is better to contact a medical facility to make the correct diagnosis and prescribe adequate treatment.

    The use of folk remedies

    Competent first aid in case of injury, provided in a timely manner, greatly facilitates the condition of the victim, accelerates the healing process, and reduces the risk of possible complications.

    In case of injury, it is advisable to apply cold to the injured area, for example, a bag of frozen vegetables from the freezer wrapped in a clean cloth.Ice can be kept for up to 40 minutes, avoiding hypothermia, then take a break for 20 minutes. Repeat several times for 4-5 hours. This event allows you to relieve puffiness and prevents the inflammatory process from developing. If the victim has severe pain, you can give him pain reliever.

    It is not recommended to resort to folk remedies such as raw potatoes, oil dressing and others. If the bruise is accompanied by abrasions and scratches, which is often found in children, then in this case, the likelihood of infection is high.

    PAUL HARTMANN has developed special products that can be used as first aid for bruises.

    First, you should treat your hands with Sterillum antiseptic. Then you need to clean the area around the abrasion or the site of the injury. On a small abrasion, you can apply a bandage with Peruvian Branolind N balm and leave it in place of the abrasion for up to three days without dressing.

    For better fixation of the bandage, use the Peha-Haft self-fixing bandage.It is securely attached by simply pressing one layer to another, does not stick to hair and skin, is economical (1.5–2 turns are enough for secure fastening), and is available in different colors.

    For bruises with abrasions, you can use the “Cosmopor Antibacterial” bandages. The soft pad well absorbs the discharge from the abrasion, and the silver-containing layer reliably protects the site of the injury from infection. Cosmos Kids plasters with different patterns are produced for children.

    For people with sensitive skin, special plasters of the Omni series have been developed.Their adhesive surface is made of rubber glue, and the plaster itself is made of non-woven hypoallergenic material or rayon.

    In case of a sprained injury, use a cotton Pütterbint compression bandage to improve blood circulation and relieve swelling.

    First aid for bruises

    To speed up the resorption of the hematoma, you will need a bandage with a special ointment. The medical compress is fixed with a special bandage.Manufacturers produce dressings that are economical and comfortable to use. Self-locking bandages have a number of advantages:

    • Crepe weave and micro-dot impregnation with a special adhesive ensure precise and reliable fixation of the dressing;
    • the initially high cost pays off with an economical expense – two turns of the bandage are enough to fix it;
    • 85% elongation provides freedom of movement and prevents the bandage from slipping;
    • aesthetics.The special bandage is available in different colors, no fringe is formed around the edge.

    If the bruise is accompanied by capillary bleeding, the procedure includes antiseptic treatment and application of a bandage. The modern approach is to use an atraumatic ointment bandage as first aid for bruises. The sequence of actions is as follows – initially, the wound must be treated with an antiseptic and dried. Then apply an atraumatic dressing, which has a number of advantages:

    • good air exchange due to the cellular structure;
    • antiseptic impregnation, accelerating healing;
    • hydrophobic base with ointment, thanks to which the dressing does not stick to the wound surface and relieves pain;
    • the effect of the ointment dressing for 3 days, which reduces the number of dressings;
    • the possibility of using for the treatment of children.

    If the bruise is accompanied by abrasions, it is fraught with tissue infection and inflammation. Even small damage should be treated with an antiseptic. To do this, you can use an antibacterial ointment dressing. The advantages of such a dressing:

    • impregnation acts on gram-positive and gram-negative bacteria;
    • wound edges are protected, retain elasticity;
    • dressing can be done once a week.

    First aid for bruises of various localization


    First aid for bruises of an arm or leg is to apply a tight bandage. Sometimes, with bruised limbs, there may be a limitation of joint mobility. In this case, cold is applied, a bandage is applied and bed rest is provided.


    First aid for foot bruises should include the use of a cold compress or ice and fixation with an elastic bandage.Bandaging must be carried out evenly and tightly, but without disturbing blood circulation. Pain medication can be taken if the pain is very severe. The use of cold compresses is recommended on the first day, after which you can go to warm baths or wraps to reduce pain and speed up the resorption of the lesion. To disinfect abrasions and scratches, it is necessary to treat with chlorhexidine and apply a sterile dressing.


    In case of eye injuries, the following measures should be taken:

    • apply cold for a short time (about 20 minutes), moisten a handkerchief or cotton wool in water;

    • provide the patient with complete rest, do not load the injured eye, do not make head turns;

    • bandage the eye with a sterile bandage;

    • seek help from a qualified ophthalmologist.


    As a result of a head injury, a complication can develop – a concussion. Its main symptoms are severe headache, muscle weakness, nausea and dizziness. This condition requires bed rest and urgent medical attention.


    If a joint is injured in the elbow, ankle or knee, it is worth applying ice to the affected area, fixing the joint in an elevated position and limiting its mobility with a pressure bandage.It is impossible to carry out flexion-extension movements, massage the site of injury and carry out warming measures.

    First aid for severe bruises is carried out in the same way as for minor injuries: local exposure to cold is applied, a tight bandage is applied at the site of injury, and rest is provided. After these procedures, it is advisable to take the victim to a medical facility to receive first aid for bruises.

    The first medical aid for bruises includes the diagnosis and treatment of the victim, preventive measures and medical rehabilitation, which is carried out by qualified medical personnel.

    An important condition for the treatment of injuries is the timely application of measures that will reduce local manifestations (edema, pain, inflammation). Further, depending on the injury and well-being, the patient is prescribed medication with the appointment:

    • non-steroidal anti-inflammatory drugs – to relieve fever, pain, swelling, inflammation;

    • medicines containing heparin – for resorption of bruises;

    • vasodilating ointments;

    • remedies for pain in the form of capsules or tablets – for severe injuries in the first days of their receipt;

    • enzyme drugs – for resorption of hemorrhagic infiltration, reduction of edema, restoration of joint function.

    In case of skin exfoliation, multiple injuries, joint injuries, internal injuries, it is important to immediately transport the victim to the nearest medical institution, and in the absence of spontaneous breathing and cardiac activity, perform artificial ventilation of the lungs and chest compressions with an immediate call to the ambulance team.

    Correctly treating injuries of children

    Children are often injured due to high activity.Roller skating, cycling and swings, even simple outdoor games are accompanied by falls and, as a result, injuries, sprains, bruises and abrasions. To provide first aid in case of a bruise, it is advisable to keep several proven means and dressings in the first-aid kit.

    Minor injuries bother for several minutes, and then the child continues to actively have fun. In order for the infection to get into an abrasion on a bruised knee or elbow not to cause inflammation, proper treatment is required.A special self-fixing bandage will protect damage from additional mechanical stress and the penetration of pathogens.

    If the bruise is accompanied by an abrasion, an antibacterial sterile dressing with an adhesive base or a bright plaster with pictures will do. The central area of ​​the dressing and plaster is impregnated with special compounds that promote rapid healing and absorption of oozing fluid from the wound surface.

    For very painful bruises, first aid is provided with a hydrocolloid patch.It will relieve pain and promote wound healing by creating an optimal environment. The material absorbs the discharge from the bruised wound and protects against infections. After dressing, you can go to a medical facility.

    General advice on filling the first aid kit

    In order for first aid for severe injury to be effective, it is necessary to have several effective medical devices and tools on hand. The first step is to quickly get rid of puffiness, normalize blood and lymph flow.For this, there are compression elastic bandages that do not cause skin irritation. Manufacturers produce products with a cooling effect. This option is much safer than applying ice, since it does not cause frostbite of the tissues and at the same time provides cooling of the bruised area for 2 hours.

    In addition to an elastic bandage, it is advisable to have in the first-aid kit:

    • Antiseptic liquid or spray;
    • hemostatic agent;
    • ointments for bruises and sprains;
    • atraumatic ointment dressings;
    • sterile gauze or self-adhesive dressings;
    • self-fixing bandage.

    This list is especially relevant for families with children, since babies are often injured. The competent use of special tools will reduce pain and speed up recovery. If the bruise is accompanied by a serious hematoma, deep wound and dangerous injuries, you should immediately see a doctor. With minor abrasions and bruises, you can cope on your own.


    Neuropathy is a disease or dysfunction of a nerve or an individual nerve.Any nerve fibers in all parts of the body can be damaged due to injury or illness. Neuropathy is classified according to the type and location of the nerve injury that occurs. In addition, this disease can be divided into subgroups based on the type of disease that caused the dysfunction of the nerve (for example, neuropathy resulting from changes in the body due to diabetes mellitus is called diabetic neuropathy).

    Types of neuropathies

    • Peripheral neuropathy: Disruption of nerves outside the brain and spinal cord (peripheral nervous system).Accordingly, this type of neuropathy affects the nerve endings of the extremities – toes, feet, legs, fingers, palms, hands. The term proximal neuropathy is used to describe nerve damage that results in pain in the hips and buttocks.
    • Cranial neuropathy: This type of disease occurs when any of the twelve pairs of cranial nerves (originating directly from the brain) malfunction.There are two specific subtypes of cranial neuropathy: visual (optical) and auditory (classroom). Optic neuropathy occurs when the optic nerve, which carries signals from the retina to the brain, is damaged or diseased and is responsible for vision. Auditory neuropathy occurs when the auditory nerve that carries signals from the inner ear to the brain and is responsible for hearing is damaged or diseased.
    • Autonomic neuropathy is characterized by damage to the nerves of the autonomic nervous system responsible for heart function, blood flow (including blood pressure), digestion, bladder function and bowel movements, sexual function, and sweating.Damage to the nerves of other internal organs is possible.
    • Local neuropathy occurs when a disease or damage to one nerve or a group of nerves, one part of the body. Symptoms of this type of neuropathy appear suddenly.
    • Reasons. Damage to nerve fibers can be caused by a variety of diseases, injuries, infections and even vitamin deficiencies.
    • Diabetes mellitus very often contributes to the development of neuropathy.The characteristic manifestations of peripheral nerve damage in patients with elevated blood glucose levels are often referred to as diabetic neuropathy. The risk of this type of nerve damage increases with age and the duration of diabetes symptoms. Peripheral neuropathy occurs in patients who have suffered from high blood sugar levels for decades. Especially often this problem affects those people who face difficulties in controlling the course of the disease, are overweight, suffer from high blood lipids, high blood pressure.
    • Deficiency of vitamin B12 and folic acid , other B vitamins can contribute to the development of damage to nerve fibers.
    • Autoimmune neuropathy : Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Guillain-Barré syndrome can cause neuropathy. Infections : Some infections, including HIV / AIDS, Lyme disease, leprosy and syphilis, can cause nerve damage.
    • Postherpetic neuralgia is a complication of herpes zoster (varicella-zoster virus).
    • Alcoholic neuropathy : alcoholism is often accompanied by peripheral neuropathy. The exact causes of nerve damage from alcohol abuse are not clear. It is assumed that the disease develops due to the toxic effect of alcohol itself and due to poor nutrition, vitamin deficiency, characteristic of alcoholics.
    • Genetic or congenital diseases can affect nerves and in some cases contribute to the development of neuropathy. Examples are Friedreich’s ataxia and Charcot-Marie-Tooth disease.
    • Amyloidosis is a disease in which abnormal protein fibers are deposited in tissues and organs. These changes lead to various damage to internal organs, can lead to neuropathy.
    • Uremia (high concentration of waste products from the body due to renal failure) causes nerve damage.
    • Toxins and poisons can damage nerve fibers. For example, gold compounds, lead, arsenic, mercury, some industrial solvents, nitric oxide, phosphate fertilizers are not safe for the human nervous system.
    • Medications: Certain medications can damage nerve fibers. For example, anticancer drugs (vincristine) and antibiotics (metronidazole and isoniazid) have a detrimental effect on neurons.
    • Injury / damage to nerves , including prolonged compression of a nerve or group of nerve fibers, is often the main cause of neuropathy. Decreased blood supply (ischemia) to nerve fibers can cause long-term damage.
    • Tumors : Benign or malignant neoplasms of the nerves and nearby structures can cause direct damage to neurons or create pressure on nerve fibers.Both of the above problems lead to neuropathy.
    • Idiopathic neuropathy – damage to nerve fibers without a specific cause. The term idiopathic origin is used in medicine to describe any process, the cause of which cannot be determined.

    Symptoms. Regardless of the cause of the disease, neuropathy is characterized by a number of characteristic symptoms. In some patients, this pathology does not manifest itself, but general signs of neuropathy still exist.
    The degree of manifestation of the disease in each patient can vary greatly.

    Damage to the sensory nerves is characteristic of peripheral neuropathy. Symptoms usually occur in the area of ​​the foot, the patient is worried about loss of sensation, numbness, tingling or pain that spreads down the leg towards the body. Often, the neuropathy affects the arms and legs. Sometimes there is an inability to determine the position of the joint, which leads to clumsiness and frequent falls.Another symptom of neuropathy may be oversensitivity to touch. The feeling of numbness and tingling of the skin is called paresthesia in medicine. Loss of sensation in the area of ​​the foot threatens the development of wounds and calluses, which may go unnoticed. Due to the low sensitivity to pain, the resulting damage becomes worse and can become infected. Infection with microorganisms spreads to deeper tissues, including bones. In some cases, limb amputation is required.When the motor nerves (which control all movement) are damaged, the following symptoms occur: weakness, loss of reflexes, loss of muscle mass, seizures, and / or lack of coordination. Autonomic neuropathy, which is based on damage to the nerve fibers responsible for the functioning of internal organs and glands, can manifest itself in a variety of symptoms:

    • Nausea, vomiting, bloating after eating
    • Disorder of the genitourinary system: urinary incontinence, difficulty urinating, feeling of incomplete emptying of the bladder
    • Impotence (erectile dysfunction) in men
    • Dizziness and fainting
    • Constipation and diarrhea
    • Blurred vision
    • Heat intolerance or decreased sweating

    Asymptomatic hypoglycemia: a decrease in blood glucose levels is accompanied by hand tremors, increased sweating, and heart palpitations.People with autonomic neuropathy can tolerate hypoglycemia asymptomatically, which threatens health and even human life.

    Diagnostics. Diagnostic measures are prescribed based on the initial manifestations and symptoms of neuropathy. The diagnosis is made on the basis of data from a thorough medical examination, study of the history of the disease, clarification of the cause of the disease and the severity of neuropathy. Neurological examination, reflex testing, and sensory and motor nerve function are an important part of the diagnostic process.There are no specific blood tests to indicate the presence of neuropathy. At the same time, this type of diagnosis is carried out in order to clarify the cause of the disease and concomitant diseases (for example, diabetes mellitus and deficiency of B vitamins), which play an active role in nerve damage. Imaging research methods, such as radiography, computed tomography, magnetic resonance imaging, are performed to determine if pathological pressure has arisen on the nerve fibers of the body.To determine the dysfunctions of the nervous system, the following methods are carried out: Electromyography is a study of the function of nerves and muscles. For this test, a thin needle is inserted through the skin and into the muscle. A small electrode inserted into the game measures the electrical activity of the muscle fibers. The speed of a nerve impulse is another important parameter that indicates how quickly signals travel through nerve cells. This study is carried out in conjunction with electromyography. The nerve impulse conduction test begins with the attachment of special sensors with electrodes to the skin of different parts of the body.Each patch creates a small electrical impulse (a series of impulses) that stimulates a nearby nerve. The electrical activity of the nerves is used to judge the speed of transmission of the nerve impulse between the electrodes.

    Treatment. The course of treatment for neuropathy consists of measures to control the symptoms of the disease and to combat the cause of the disease. Specialized treatment of diabetes, autoimmune diseases, infections, kidney diseases, vitamin deficiencies, and other therapies are aimed at eliminating a specific cause of neuropathy.In many cases, fighting the root cause can help reduce or eliminate the symptoms of the aforementioned disease. Some patients suffering from mechanical compression of the nerve fiber by a tumor or other structures require surgical intervention. Controlling blood glucose levels is an essential part of treating diabetic neuropathy and helps prevent further nerve damage. In the treatment of neuropathies, drugs of the following groups are used:

    • Antidepressants,
    • Anticonvulsants,
    • Antioxidants.
    • From non-medication means in the treatment of neuropathies, physiotherapeutic methods of treatment, acupuncture, play an important role.

    Prevention . If it is possible to exclude the occurrence of the cause of this disease, only then they talk about the possibility of preventing the neuropathy itself. To protect yourself from diabetes, studies show, you should strictly control your blood glucose levels. This measure will avoid the development of diabetic neuropathy and other complications.It is possible to prevent neuropathy developing due to inadequate or insufficient food intake, alcohol dependence, by doing everything possible to organize a proper healthy diet. Genetic and inherited neuropathies cannot be prevented.

    Prognosis of the disease depends on the underlying cause of neuropathy. In the event that a concomitant disease or other reason that can be eliminated with drugs, surgery has led to the above problem, then the prognosis of recovery from neuropathy is excellent or very good.A nerve damaged by pathological processes takes time to recover even after getting rid of the root cause. With genetic causes of neuropathy, treatment is ineffective. Severe damage to the nerve fiber cannot be repaired.

    Diseases of the musculoskeletal system

    Magnitude of the problem

    Disorders and diseases of the musculoskeletal system are more than 150 health disorders affecting the musculoskeletal system. They range in a wide range: from acute and short-term events – fractures, sprains and dislocations – to lifelong impairments, accompanied by a permanent decrease in functionality and disability.Disorders and diseases of the musculoskeletal system are usually characterized by pain (often permanent), decreased mobility, deterioration of motor skills and functional capabilities in general, which limits a person’s ability to work.

    Disorders and diseases of the musculoskeletal system include disorders affecting:

    • joints, in particular osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis;
    • Bone tissue, in particular osteoporosis, osteopenia and related fractures resulting from bone fragility or injury; 90,030 90,025 muscles, in particular sarcopenia;
    • spine, in particular lumbago and cervicalgia;
    • Various parts of the body or body systems, in particular regional and common pain syndromes and inflammatory diseases such as connective tissue diseases and vasculitis, characterized by symptoms of the musculoskeletal system, or systemic lupus erythematosus.

    In addition, disorders and diseases of the musculoskeletal system are the most important factor determining the global need for rehabilitation services. They are among the main reasons for the demand for such services for children, and about two thirds of the adult population in need of rehabilitation services are people suffering from disorders and diseases of the musculoskeletal system.

    Prevalence of the problem

    Data from a recent Global Burden of Disease (GBV) study indicate that approximately 1.71 billion people worldwide suffer from musculoskeletal disorders and diseases (1).Although the prevalence of diseases of the musculoskeletal system varies by age and diagnosis, they affect people of all ages throughout the world. High-income countries (441 million) are most affected by such diseases, followed by the Western Pacific Region (427 million) and South-East Asia (369 million). Disorders and diseases of the musculoskeletal system also occupy a leading place among the factors of disability in the world: they account for approximately 149 million years of life lived with disabilities, which globally accounts for 17% of all years lived with disabilities due to various causes.

    Lumbago accounts for the bulk of the total burden of disorders and diseases of the musculoskeletal system. Other factors contributing to this burden include fractures (436 million), osteoarthritis (343 million), other injuries (305 million), cervicalgia (222 million), amputations (175 million) and rheumatoid arthritis (14 million people) (1).

    Although the prevalence of disorders and diseases of the musculoskeletal system increases with age, they also affect younger people, often in the years of greatest economic activity.Lumbago, for example, is a major cause of early termination of employment. The adverse social consequences of this are truly enormous, not only in terms of direct health care costs, but also in terms of indirect costs (such as absenteeism, reduced productivity). In addition, disorders and diseases of the musculoskeletal system are closely associated with a significant deterioration in mental health and decreased functionality.The number of people suffering from lumbago is projected to only increase in the future, with the fastest growing rates in low- and middle-income countries (2).

    The WHO Rehabilitation Need Estimator developed by WHO provides a unique opportunity to obtain data on the prevalence of disorders and diseases of the musculoskeletal system in individual countries, regions and in the world as a whole, as well as data on years of life lived with disabilities caused by disorders and diseases of the musculoskeletal system.

    What WHO does

    In 2017, WHO launched Rehabilitation 2030: A Call to Action to raise awareness of the urgent unmet need for rehabilitation services worldwide and the importance of strengthening health systems to deliver rehabilitation services. This initiative marks a new strategic approach to the global rehabilitation community, emphasizing that:

    • Rehabilitation services must be accessible to the entire population throughout life.This also applies to all people with disorders and diseases of the musculoskeletal system.
    • Efforts to strengthen rehabilitation services should focus on supporting health systems in general and integrating rehabilitation services at all levels of health care.
    • Rehabilitation is an essential health service and essential to achieving universal health coverage.

    This initiative was established in large part because many countries do not have adequate capacity to meet existing needs for rehabilitation services, including the needs of people with musculoskeletal disabilities and diseases, not to mention projected growth demand for such services due to observed trends in health and demographics.Countries often do not prioritize the issue of rehabilitation, and this area continues to be under-resourced. As a result, countless people do not have access to rehabilitation services, which leads to a deterioration in their health, further complications and consequences that they will feel throughout their lives. In some low- and middle-income countries, more than 50% of the population does not receive the rehabilitation services they need.

    WHO supported more than 20 countries in all regions of the world to strengthen their health systems to improve rehabilitation services.The number of countries requesting technical support from WHO is growing steadily.

    For more information on Rehabilitation 2030: A Call to Action, please visit the following link.

    In addition, WHO is developing a package of rehabilitation interventions (including for limb fractures, osteoarthritis, rheumatoid arthritis, lumbago and amputations), which contains a list of priority evidence-based rehabilitation interventions and the resources needed to deliver them safely and effectively. …These interventions will remain relevant for people throughout life and across the health care continuum, across all service delivery platforms and in all regions of the world, with a particular focus on issues that arise in low to moderate resourced settings.

    The package will be an open access online resource for a variety of target audiences. Ministries of health will be able to plan for the integration of rehabilitation interventions into their national health service systems; researchers will be able to identify gaps in research related to rehabilitation; university teachers will be able to develop training programs for training specialists in the field of rehabilitation; healthcare providers will be able to plan and incorporate specific rehabilitative interventions into their rehab programs.

    Further information on the package of rehabilitation interventions for disorders and diseases of the musculoskeletal system can be found at the following link.

    WHO plans to hold a stakeholder meeting in early 2022 on musculoskeletal disorders and diseases. The purpose of the meeting is to outline a roadmap for further, more specific work by WHO to strengthen rehabilitation services for musculoskeletal disorders and diseases in different countries and to identify factors that contribute to and hinder the successful implementation of the global rehabilitation agenda.

    (1) Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396 (10267), 2006-2017.

    (2) Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391: 2356-67.

    Muscle pain: causes and symptoms.Diagnostics, prevention and treatment

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    Date of last update: 29.06.2021

    Average Read Time: 13 minutes


    Causes of pain
    Symptoms of muscle pain
    Distinguish between acute and chronic myalgias
    Drug therapy

    Muscle pain or myalgia is one of the most common reasons for seeking medical attention 1 .About 30% of patients at a doctor’s appointment complain of pain, which is often associated with skeletal muscles 2 . This is because the muscular system is one of the largest in the human body. In total, there are more than 600 muscles in the human body 3 , their mass is 35-40% 3 of the total weight, and in a certain category of people, for example, athletes, this figure can reach 60% 3 .

    Muscles are divided according to the type of structure into skeletal, which make up most of the muscle mass, and smooth, mainly represented in the muscles of the internal hollow organs (stomach, intestines, bronchi, vascular wall).

    Causes of pain

    Determining the cause of muscle pain can be quite difficult, since myalgias can be caused not only by the pathology of the muscle itself, but often become a mask for other diseases – rheumatic, endocrinological, infectious and neurological 1 .

    Main causes of muscle pain 1 :

    1. Injury: contusion, sprain, rupture, muscle tear. It is especially common in sports, usually does not pose a direct threat to life, is not always diagnosed in a timely manner and can lead to complications in the form of hematomas, inflammation, and the development of contractures.and have a clear localization.

    2. Excessive physical activity, especially if the muscles are not warmed up or poorly trained.This is soreness or delayed muscle soreness, weakening after a maximum of 7 days.
    3. Rheumatic and systemic diseases (polymyalgia rheumatica 5 , fibromyalgia, osteoarthritis and others). They are characterized by damage to the musculoskeletal system and connective tissue, intense and stiffness of movements, especially in the area of ​​the shoulder girdle, neck and back.
    4. Inflammatory processes in muscle tissue – myositis 7 . They can be infectious (enterovirus infection, toxoplasmosis, tuberculosis) and non-infectious origin.
    5. Taking certain medicinal substances (for example, statins to lower cholesterol levels 8 ). The severity of these symptoms can range from discomfort and minor pain to inflammation (myositis) and even death of muscle fibers (myonecrosis). Similar symptoms develop in 3-5% of patients 8 and often become the reason for refusal of further treatment with drugs of this group.
    6. Toxic effect, including viral. In these cases, the symptoms characteristic of viral infections come to the fore: fever, sore throat, nasal congestion, cough, etc. Muscle pain can be an indicator of the severity of the disease.
    7. Neurogenic pains (myopathies). Chronic, sometimes severe muscle pain, which is complemented by muscle weakness and other neurological manifestations.
    8. Electrolyte disturbances (lack of potassium, magnesium). A deficiency of trace elements can lead to impaired transmission of nerve impulses to muscle fibers, their pathological contractions, and as a result, pain.
    9. Vascular pathology. With circulatory disorders, the muscles suffer from a lack of oxygen.
    10. Endocrine diseases and metabolic disorders. In hypothyroidism, one of the symptoms is swelling, which can cause muscle pain.
    11. Hypothermia or mechanical stress associated with poor posture, maintaining a non-physiological posture, skeletal asymmetries 11 .
    12. Stress. Anxiety that accompanies stressful situations leads to muscle spasm, a decrease in the pain threshold and the formation of chronic pain syndrome 11 .

    One of the most common problems is back pain. At the same time, the role of osteochondrosis of the spine is often overestimated and most of the pain manifestations are of muscle or myogenic origin 9 and are associated with the involvement of soft tissues, that is, muscles, fascia – muscular membranes – or ligaments in 99% of cases 10 . Experts combine this phenomenon into myofascial pain syndrome, which has its own characteristics of the course and requires a special approach to treatment.

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    Symptoms of muscle pain

    Patients describe the most typical muscle pain as 10 :

    • aching,
    • compressive,
    • pulling,
    • boring,
    • spilled.

    Most often, the cause of muscle pain is associated with increased stress, which can lead to microtrauma, spasm or increased tone. After rest, muscle pain can resume, which distinguishes them from joint pain 10 .

    Such sensations can be accompanied by stiffness during movement. Those muscles that are in tension for a long time, for example, “static”, that is, those that are involved in maintaining a certain posture or body position, can give stronger pain sensations, they are most often found seals and soreness during examination.

    Muscle pain can be local or widespread, it can also have zones of reflection (irradiation), sensitivity disorders can accompany it 10 , especially when the pain is related to myofascial syndrome (MFS).

    Additional criteria of the IFS: limitation of range of motion, tight muscle cord, reflected pain.

    With an increase in temperature and pain in the muscles, inflammatory processes usually occur – myositis, including those of rheumatic origin, as well as viral infections – influenza, Coxsackie virus and others.

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    Distinguish between acute and chronic myalgias

    Acute pain is most often observed with injuries, overloads, infectious diseases.It can have different intensity – from mild to pronounced, usually disappears in 2-7 days.

    Chronic pain can last for more than a month and usually indicates the development of myofascial syndrome.

    These degrees of muscle pain are distinguished 9 :

    1 degree . Local or local pain that manifests itself only when the muscle is exposed to pressure or stretching. On palpation, a seal can be found, and in response to palpation, there may be slight convulsive twitching.Muscle strength is normal.

    2nd degree . The pain is spontaneous, pulling, throughout the muscle, the corresponding skin zones with increased pain activity are found. Muscle strength may decrease slightly, by about 25% 9 .

    3rd degree . Spilled severe pain at rest, a whole group of muscles is involved, their strength is reduced by 30% or more.

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    The diagnosis and the choice of treatment depend on what kind of muscle pain is observed in the patient.The main diagnostic criteria for myogenic, that is, having a muscle origin, pain are:

    • seal, which manifests itself by changes in shape, size, configuration, length and consistency,
    • increase in contractile activity, especially in response to palpation,
    • impaired coordination between individual muscle groups.

    It is not always easy to identify a specific lesion in the muscles, therefore, a thorough interview and examination must be carried out.

    So, myogenic pain in the area of ​​the muscles of the shoulder girdle can manifest itself as pain in the temples, a feeling of a “heavy” head, loss of balance, painful sensations in the shoulder joint even at night, at rest 9 .

    For the diagnosis of myalgias, laboratory and instrumental examination methods are prescribed.

    Laboratory Methods 1 :

    • general detailed blood test: changes in the leukocyte formula, erythrocyte sedimentation rate can indicate the presence of an inflammatory process, a decrease in hemoglobin (anemia) can also cause muscle pain;
    • blood test for electrolytes and trace elements: potassium, magnesium, iron, calcium and others 7 ;
    • determination of acute phase indicators (C-reactive protein) – their increase speaks in favor of rheumatic diseases;
    • determination of the level of thyroid hormones to exclude hypothyroidism;
    • immunological tests – to identify autoimmune processes in the body;
    • determination of the level of specific “muscle” enzymes – CPK (creatine phosphokinase) 1 , when muscle cells are damaged, CPK enter the blood and the indicator turns out to be increased.

    CPK is one of the important indicators for the diagnosis of myalgias.

    Distinguish between myalgias with and without increased creatine phosphokinase activity.

    The first include: inflammation of muscle tissue (myositis), toxic damage, trauma, the consequences of excessive physical exertion.

    Of the instrumental methods, ultrasound and myography are used 1 .

    Most often, chronic myalgias in myofascial syndrome require differential diagnosis with rheumatic and systemic diseases, such as polymyalgia rheumatica and fibromyalgia 1 .

    Polymyalgia rheumatica is mainly diagnosed in people 55-60 years old.

    To match:

    • prolonged fever, weight loss,
    • stiffness of movement,
    • minor joint pain,
    • a sharp increase in laboratory parameters such as C-reactive protein and ESR;
    • muscle pain is localized in the area of ​​large joints, neck, hips, is observed constantly,
    • there is no weakness with muscle pain;
    • Significant improvement occurs after prescribing even small doses of hormonal drugs (glucocorticoids) 1 .

    Features of Fibromyalgia :

    • women from 40 to 60 years old are more likely to suffer;
    • pain is symmetrical, constant, spreads to several muscle groups, ligaments and bones;
    • is always accompanied by psychological disorders: anxiety, depression;
    • improvement occurs after the appointment of antidepressants.

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    Treatment of muscle pain is always complex with a combination of medication and non-medication methods and must take into account the cause.

    How to relieve muscle pain: general principles 1 :

    1. Rest the affected muscle.
    2. Use local anesthetic.
    3. Take non-steroidal anti-inflammatory drugs internally and locally in the form of gels, ointments, creams.
    4. Use hot, wet compresses and wraps.
    5. Do physical therapy: exercises for gentle stretching and muscle relaxation.
    6. Go for a relaxing massage.
    7. Treat the underlying disease or correct electrolyte and vitamin deficiencies.

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    Drug therapy

    The action of drugs for myalgia should be aimed at reducing pain, relieving spasm and inflammation 1 . To do this, first of all, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed, including Motrin®.

    Motrin® is available as an oral tablet.The drug is indicated for muscle pain associated with inflammation, injury, overload. It has analgesic, anti-inflammatory and antipyretic effects that can last up to 12 hours 12.13 . If you do not have the opportunity to visit a doctor in the near future, and the pain causes significant discomfort, then you can take Motrin® as follows: 2 tablets as a starting dose and then 2 tablets every 12 hours or 1 tablet every 8 hours. The course of admission without consulting a doctor, no longer than 5 days.If the intensity and nature of the pain does not change, then you must immediately contact a specialist (therapist, traumatologist, rheumatologist) to find out the cause of myalgia and complete treatment.

    How else to get rid of muscle pain?

    Folk remedies are most often used for chronic pain syndrome. Most of them are associated with distracting procedures, have an irritating or warming effect 11 . Such irritants can be: capsicum, essential oils of pine, fir, eucalyptus, mint and others.Also used are products based on bee and snake venom 11 . When applied to the skin, a feeling of warmth or burning sensation occurs, which can distract from the painful sensations.

    When using such methods, it should be remembered that these methods are not a treatment for the cause of the disease, but can help to temporarily relieve the symptoms a little due to the irritating effect.

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    For the prevention of myalgias, it is necessary to strengthen the muscle frame, perform stretching and relaxation exercises 2 .This effectively protects against microtrauma and sprains. In case of chronic muscle pain, a change in lifestyle may be necessary: ​​revision of load, physical activity, change of occupation, prevention of stress, changes in diet to correct the deficiency of vitamins and trace elements.

    Periodic massage courses also help maintain muscle tone.

    Any muscle pain that is not associated with a specific injury or overload should be a reason for seeking medical attention and careful diagnosis, as it can mask many serious diseases.

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    The information in this article is for reference only and does not replace the professional advice of a physician. Consult a qualified professional for diagnosis and treatment.


    1. N.A. Shostak. Myalgia: approaches to differential diagnosis, treatment. Modern rheumatology, 2013, No. 3, p.21-24.
    2. O.V. Vorobyova. Back and limb pain in the practice of a therapist (focus on non-inflammatory myalgias).Outpatient doctor’s reference book. 2014; 06: 6-12.
    3. I.V. Gaivoronsky, G.I. Nichiporuk, A.I. Gaivoronsky. Human Anatomy and Physiology, 6th Edition. Textbook. Moscow. Publishing Center “Academy”, 2011, 498s.
    4. Prof. Francisco Biosca Director of the Department of Medicine and Sports Adaptation of FC Shakhtar (Donetsk, Ukraine). Muscle injuries. Actual aspects of sports medicine, Moscow, 2009. P.48-55.
    5. I. B. Bashkova, E. I. Buslaeva. Polymyalgia rheumatica: a rarely diagnosed but common condition.RMJ “Medical Review”, No. 1, 04.12.2017, p.48-52.
    6. G.A. Ivanichev. Pathogenetic aspects of the formation and manifestation of classic muscle pain syndromes. Manual therapy, 2009. No. 3 (35), pp. 3-12.
    7. T.A. Zakharycheva, A.S. Shirokova, N.V. Levun, M.V. Lazareva. Myogenic pain in the practice of a doctor. Far Eastern Journal of Infectious Pathology, No. 34, 2018. P.84-88.
    8. M.G. Bubnova *. Adverse Effects of Statin Therapy: Real Evidence. Cardiosomatics. 2019; 01: 51-61
    9. G.