Shoulder pain | Causes, symptoms, treatments

Each shoulder problem has its own pattern of symptoms that can help your doctor or a physiotherapist make a diagnosis. Most conditions make it painful to use or move your shoulder, but some make your shoulder feel stiff.

Your doctor or physiotherapist will need to see which movements are the most painful, as this could show where the problem is. They will usually ask how the problem started, how it has developed and how it affects your daily activities.

If you can, try to write a few notes about when and how the problem started and what makes it feel worse before your appointment. This will help you get a more accurate diagnosis.

Usually your physiotherapist or doctor can recommend the best course of treatment once they’ve diagnosed what your condition is. However, they may send you for further tests if they suspect your problems are being caused by arthritis or a more complicated condition.

What tests are there?

Blood tests aren’t usually needed for most shoulder problems, but they’re sometimes used to rule out other conditions, including some types of arthritis.

X-rays are good for looking for problems with the bones in your shoulder and minor changes in the joints. However, small changes are quite common and may not be the cause of your trouble.

X-rays can only show bones and other hard substances, but they won’t show injuries to soft tissue like muscles.

An ultrasound scan can show swelling, as well as damage and problems with the tendons, muscles or other soft tissues in the shoulder. It uses high-frequency sound waves to examine and build pictures of the inside of the body.

You may be referred for magnetic resonance imaging (MRI) scans if your doctor suspects a more complex problem with the soft tissue in your shoulder. An MRI uses radio waves to build a picture to show what’s happening to the bones and soft tissue, such as the muscles and tendons, inside your shoulder.

Sometimes dye is injected into the shoulder before the MRI to get a clearer picture – especially in cases of shoulder dislocation.

Nerve conduction studies can show whether your problems are being caused by the nerves in your arm being pinched or irritated.

They measure the electrical activity in the muscles and nerves. It’s common to feel slight pain or discomfort, like a tapping on the skin, but the test doesn’t last long.

Shoulder Problems and Injuries | Michigan Medicine

Do you have a shoulder injury or other shoulder problem?

Yes

Shoulder problem or injury

No

Shoulder problem or injury

How old are you?

Less than 5 years

Less than 5 years

5 years or older

5 years or older

Are you male or female?

Why do we ask this question?

• If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had shoulder surgery in the past month?

If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it.

Yes

Shoulder surgery in the past month

No

Shoulder surgery in the past month

Have you had a major trauma in the past 2 to 3 hours?

Yes

Major trauma in past 2 to 3 hours

No

Major trauma in past 2 to 3 hours

Have you had a shoulder injury in the past month?

Yes

Shoulder injury in the past month

No

Shoulder injury in the past month

Are you having trouble moving your shoulder?

Pain and swelling can limit movement.

Yes

Difficulty moving shoulder

No

Difficulty moving shoulder

Can you move the shoulder at all?

Yes

Able to move the shoulder

No

Unable to move the shoulder

Have you had trouble moving for more than 2 days?

Yes

Difficulty moving for more than 2 days

No

Difficulty moving for more than 2 days

Have you had numbness, tingling, or weakness in your arm, hand, or wrist for more than an hour?

Weakness is being unable to use the arm or hand normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.

Yes

Numbness, tingling, or weakness for more than 1 hour

No

Numbness, tingling, or weakness for more than 1 hour

Did the shoulder or collarbone get twisted out of shape or pop out of its normal position?

Yes

Shoulder was out of normal position

No

Shoulder was out of normal position

Is the shoulder back in place now?

Yes

Shoulder back in place

Has the shoulder popped out of place before?

Yes

History of dislocation

Has sudden, severe weakness or severe numbness affected the whole arm or the whole hand?

Weakness is being unable to use the arm or hand normally, no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.

Yes

Severe or sudden numbness or weakness in the whole arm or hand

No

Severe or sudden numbness or weakness in the whole arm or hand

Are you having trouble moving your shoulder?

Pain and swelling can limit movement.

Yes

Difficulty moving shoulder

No

Difficulty moving shoulder

Is it very hard to move or somewhat hard to move?

“Very hard” means you can’t move it at all in any direction without causing severe pain. “Somewhat hard” means you can move it at least a little, though you may have some pain when you do it.

Very hard

Very hard to move

Somewhat hard

Somewhat hard to move

How long have you had trouble moving your shoulder?

Less than 2 days

Difficulty moving shoulder for less than 2 days

2 days to 2 weeks

Difficulty moving shoulder for 2 days to 2 weeks

More than 2 weeks

Difficulty moving shoulder for more than 2 weeks

Has the loss of movement been:

Getting worse?

Difficulty moving is getting worse

Staying about the same (not better or worse)?

Difficulty moving is unchanged

Getting better?

Difficulty moving is improving

Is the arm blue, very pale, or cold and different from the other arm?

If the arm is in a cast, splint, or brace, follow the instructions you got about how to loosen it.

Yes

Arm blue, very pale, or cold and different from other arm

No

Arm blue, very pale, or cold and different from other arm

Is there any pain in the shoulder?

Has the pain:

Gotten worse?

Pain is increasing

Stayed about the same (not better or worse)?

Pain is unchanged

Gotten better?

Pain is improving

Does your child seem to be protecting the arm or not using it normally?

Yes

Favoring arm or not using arm normally

No

Favoring arm or not using arm normally

Do you have any pain in your shoulder?

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

How long has the pain lasted?

Less than 2 full days (48 hours)

Pain less than 2 days

2 days to 2 weeks

Pain 2 days to 2 weeks

More than 2 weeks

Pain more than 2 weeks

Has the pain:

Gotten worse?

Pain is getting worse

Stayed about the same (not better or worse)?

Pain is unchanged

Gotten better?

Pain is getting better

Do you think that the shoulder problem may have been caused by abuse?

Yes

Shoulder problem may have been caused by abuse

No

Shoulder problem may have been caused by abuse

Do you think the problem may be causing a fever?

Some bone and joint problems can cause a fever.

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?

“Hardware” includes things like artificial joints, plates or screws, catheters, and medicine pumps.

Yes

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

No

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

How long have you had problems with the shoulder?

Less than 1 week

Symptoms for less than 1 week

1 to 2 weeks

Symptoms for 1 to 2 weeks

More than 2 weeks

Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.

There are other reasons for color and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal color returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.

Symptoms of infection may include:

• Increased pain, swelling, warmth, or redness in or around the area.
• Red streaks leading from the area.
• Pus draining from the area.
• A fever.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

• Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
• Long-term alcohol and drug problems.
• Steroid medicines, which may be used to treat a variety of conditions.
• Chemotherapy and radiation therapy for cancer.
• Other medicines used to treat autoimmune disease.
• Medicines taken after organ transplant.
• Not having a spleen.

Pain in adults and older children

• Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
• Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
• Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Major trauma is any event that can cause very serious injury, such as:

• A fall from more than 10 ft (3.1 m)[more than 5 ft (1.5 m) for children under 2 years and adults over 65].
• A car crash in which any vehicle involved was going more than 20 miles (32 km) per hour.
• Any event that causes severe bleeding that you cannot control.
• Any event forceful enough to badly break a large bone (like an arm bone or leg bone).

With severe bleeding, any of these may be true:

• Blood is pumping from the wound.
• The bleeding does not stop or slow down with pressure.
• Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

• The bleeding slows or stops with pressure but starts again if you remove the pressure.
• The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

• The bleeding stops on its own or with pressure.
• The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

• Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
• Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
• Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

• Severe pain (8 to 10): The pain is so bad that the child can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
• Moderate pain (5 to 7): The pain is bad enough to disrupt the child’s normal activities and sleep, but the child can tolerate it for hours or days.
• Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Feeling very dizzy or lightheaded, like you may pass out.
• Feeling very weak or having trouble standing.
• Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Being very sleepy or hard to wake up.
• Not responding when being touched or talked to.
• Breathing much faster than usual.
• Acting confused. The child may not know where he or she is.

Symptoms of a heart attack may include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

• Make an appointment to see your doctor in the next 1 to 2 weeks.
• If appropriate, try home treatment while you are waiting for the appointment.
• If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Postoperative Problems

Why Does My Shoulder Hurt When I Lift My Arm?

You lift your arm, and you feel intense pain that brings you to your knees. You haven’t had a recent injury, so you wonder: “why is my shoulder hurting just from lifting my arm?”

Several factors may be contributing to the discomfort. Before resorting to shoulder surgery, your doctor will often first recommend several sessions of physical therapy.

What Could Be the Cause of My Shoulder Pain?

Before starting physical therapy, work with a physician to find the source of the problem. Any one of the following conditions can be the reason you have pain and are experiencing impairment.

Shoulder Impingement

Shoulder impingement is a syndrome where the tendons of the shoulder are inflamed. The tendonitis often occurs around the rotator cuff muscles or the supraspinatus muscles. In effect, patients have weakness, mobility limitations, and severe pain.

Rotator Cuff Injury

A common known cause of shoulder pain is a rotator cuff injury. Tendonitis in the rotator cuff can occur with injury and sometimes without. There is also a condition called rotator cuff bursitis, where the bursa, the lining that provides cushioning between the bones and tendons, becomes inflamed.

The cause can be underlying degenerative conditions such as rheumatoid arthritis. Rest, ice, anti-inflammatories, and physical therapy can all be helpful treatment options.

Eventually, if left untreated, the tendonitis results in a tear or torn rotator cuff. If not properly cared for, surgery may be necessary.

Frozen Shoulder

Frozen shoulder is another very common reason for shoulder pain with lifting. The pain is caused by inflammation in the lining of the ball socket joint. The condition is often progressive with no known cause.

Physical therapy is an excellent remedy for patients with a frozen shoulder. The exercises focus on increasing range of motion and improved mobility, so you find relief and can get back to the daily grind of life.

How Can Physical Therapy Help My Shoulder Pain?

The goal of physical therapy for shoulder pain is mobility improvement, which often goes hand-in-hand with pain relief. The therapist will start with an assessment to measure strength, functional mobility, and your current range of motion.

When rotating your shoulder in a circular motion, you might feel a sharp pain. With rotator cuff tendonitis, the ball of the shoulder joint will move slightly upwards. This can pinch the tendons or bursa underneath, usually producing a pinching sensation. Exercises can help strengthen surrounding muscles while you learn how to move the arm for relief.

If you are experiencing shoulder pain when lifting your arm, it is time to have an evaluation by a sports medicine doctor or physical therapist. Pinnacle Orthopaedics specializes in a range of injuries and ailments, including hip, spine, foot and ankle, hand and wrist, and of course, shoulder pain.

Physical Therapy is offered on-site at the following locations:

Our doctors not only treat the community, but we serve the community. They provide education and awareness to local schools and at sporting events.

If you have any additional questions about orthopaedic conditions or therapy, contact us.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health

Shoulder Pain | Advocare Main Line Pediatrics

Is this your symptom?

Causes

There are many possible causes of shoulder pain. Some common minor causes are:

• Muscle overuse
• Muscle strain
• Muscle aches that occur with the common cold, the flu, and other viral illnesses.

Sometimes shoulder pain can be from arthritis. Arthritis means joint (“arthr”) inflammation (“itis”). There are different types of arthritis. The most common type of shoulder arthritis is osteoarthritis:

• This is also called “wear and tear” arthritis.
• As people get older the cartilage in the joints wears down.
• This type of arthritis often affects both sides of the body equally. The joints hurt and feel stiff.
• Osteoarthritis is seen more often after age 50. Nearly everyone will get some wear and tear arthritis as they get older.

Other causes of shoulder pain are:

• Biceps tendinitis
• Bursitis
• Cervical radiculopathy (pain from pinched nerve in neck)
• Polymyalgia rheumatica
• Rotator cuff tear
• Rotator cuff tendinitis (shoulder impingement)

When Should You Seek Medical Help Right Away?

Here are some signs that the shoulder pain might be serious.

You should call 911 or go to the emergency department right away if shoulder or arm pain occurs with:

• Chest pain lasting longer than 5 minutes
• Trouble breathing or unusual sweating (such as sweating without exertion)

You should seek medical help right away if:

• Signs of infection occur (such as spreading redness, red streak, warmth)
• Joint swelling with fever occurs
• Entire arm is swollen

Pain Scale

• None: No pain. Pain score is 0 on a scale of 0 to 10.
• Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
• Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
• Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

When to Call for Shoulder Pain

Care Advice

Mild Shoulder Pain

1. What You Should Know:
   • Shoulder pain can be caused by many things. Muscle aches can occur with the common cold, the flu, and other viral illnesses. Muscle strain and overuse can cause shoulder pain. Shoulder pain can also be caused by arthritis, tendinitis, or a pinched nerve in the neck.
   • The best way to treat arm pain will depend on the exact cause.
   • Here is some care advice that should help.
2. Cold or Heat:
   • Cold Pack: For pain or swelling, use a cold pack or ice wrapped in a wet cloth. Put it on the sore area for 20 minutes. Repeat 4 times on the first day, then as needed.
   • Heat Pack: If pain lasts over 2 days, apply heat to the sore area. Use a heat pack, heating pad, or warm wet washcloth. Do this for 10 minutes, then as needed. For widespread stiffness, take a hot bath or hot shower instead. Move the sore area under the warm water. Caution: avoid burns. Make sure it is warm, not hot. Never sleep on, or with, a heating pad.
3. What to Expect:
   • Muscle aches from the common cold, the flu, and other viral illness most often last just 2 to 3 days.
   • Minor muscle strain and overuse should start to get better in a couple days. The pain should go away within one week.
   • Pain and stiffness from osteoarthritis (wear and tear arthritis) can be chronic. That is, it can last weeks, months or years. Sometimes the pain can flare up and then get better after a couple days.
   • What to expect in other cases will depend on the cause of pain.
4. Call Your Doctor If:
   • Severe pain
   • Pain keeps you from doing normal activities (such as school, work)
   • Pain lasts more than 7 days
   • Signs of infection occur (such as spreading redness, red streak, warmth)
   • You think you need to be seen
   • You get worse

Muscle Strain or Overuse

1. What You Should Know – Muscle Strain:
   • A muscle strain occurs from over-stretching or tearing a muscle. People often call this a “pulled muscle.” This muscle injury can occur while playing a sport or lifting something. Sometimes it can also occur while doing normal activities.
   • People often describe a sharp pain or popping when the muscle strain occurs. The muscle pain worsens when moving the arm.
   • Here is some care advice that should help.
2. What You Should Know – Overuse:
   • Sore muscles are common following vigorous activity (such as sports, weight lifting, and moving furniture). This can happen when your body is not used to this amount of activity.
   • Shoulder and upper arm muscles often feel achy and sore all over.
   • Here is some care advice that should help.
3. Apply a Cold Pack:
   • Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes. Repeat this in 1 hour and then every 4 hours while awake.
   • Do this for the first 48 hours after an injury.
   • This will help decrease pain and swelling.
4. Apply Heat to the Area:
   • Beginning 48 hours after an injury, apply a warm washcloth or heating pad for 10 minutes three times a day.
   • This will help increase blood flow and improve healing.
   • Caution: avoid burns. Make sure it is warm, not hot. Never sleep on, or with, a heating pad.
5. Hot Shower:
   • If stiffness lasts over 48 hours, relax in a hot shower twice a day.
   • Gently move the shoulder under the falling water.
6. Rest vs. Movement:
   • Rest the shoulder as much as possible during the first day or two.
   • Staying active helps muscle healing more than resting does.
   • Continue normal activities as much as your pain permits.
   • Avoid heavy lifting and active sports for 1 to 2 weeks or until the pain and swelling are gone.
7. What to Expect:
   • Minor muscle strain and overuse should start to get better in a couple days.
   • The pain should go away within one week.
8. Call Your Doctor If:
   • Severe pain
   • Pain keeps you from doing normal activities (such as school, work)
   • Pain lasts more than 7 days
   • You think you need to be seen
   • You get worse

Over-the-Counter Pain Medicines

1. Pain Medicine:
   • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   • Use the lowest amount of a drug that makes your pain feel better.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
   • Read the instructions and warnings on the package insert for all medicines you take.
2. Call Your Doctor If:
   • You have more questions
   • You think you need to be seen
   • You get worse

And remember, contact your doctor if you develop any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Symptoms of Shoulder Problems You Shouldn’t Ignore: Steven E. Nolan, M.D.: Orthopedic Surgeon

Let’s face it. Every one of us is already so busy that adding another task to the chore list — like getting your shoulder pain checked out — is daunting. So even though you’ve noticed that your shoulder aches, pinches, or isn’t moving as fluidly it should, you’ve been ignoring the symptoms.

Don’t. Like that old adage “a stitch in time saves nine,” taking care of shoulder symptoms as soon as they appear prevents them from worsening and causing severe or even irreversible damage.

As a board-certified orthopedic surgeon practicing sports medicine in Sugar Land, Texas, and the Houston area, Dr. Steven E. Nolan, is an expert at treating both acute and chronic shoulder pain. Following are some symptoms that mean your shoulder’s been injured and needs evaluation and treatment.

Your shoulder feels stiff or sore

Maybe you just slept on your shoulder the wrong way. But if your shoulder stiffness persists for more than a day, you may have injured it while lifting, playing sports, or engaging in a repetitive activity.

A stiff shoulder may be caused by inflammation that arises when your body is trying to heal an injury. You could also be in the early stages of osteoarthritis — a chronic condition that’s caused when the protective cartilage on your bones erodes from overuse or when the joint lining becomes inflamed.

If your shoulder feels swollen, stiff, and painful, your tendency might be to use it less. However, over time, refraining from healthy shoulder movement could cause the soft tissues to stiffen and limit your range of motion.

Your shoulder hurts

Your shoulder is a complex ball-and-socket joint with a lot of anatomical features, any of which can become injured or inflamed. If your shoulder hurts when you try to accomplish everyday tasks, such as combing your hair or getting dressed, you may have:

• Tendinitis —inflamed tendons
• Tendon tears
• Bursitis — inflamed bursae (cushions between bones and soft tissues)
• Arthritis — eroded or inflamed joint linings
• Impingement — shoulder blade rubs against soft tissues and nerves
• Fracture — broken bone

Mild-to-moderate shoulder pain that limits your motion and doesn’t resolve in a day or two should be evaluated. Severe pain needs immediate medical attention.

You can’t move your arm or lift it over your head

When shoulder pain or stiffness limits your movements, you may not be able to perform your job or carry out everyday tasks, such as zipping up a dress behind your back. A “frozen shoulder” is often a sign of a rotator cuff tear or another injury that’s become inflamed and swollen.

The rotator cuff is a set of four muscles and their corresponding tendons that hold your shoulder in its joint and allow you a great range of motion. When caught early, rotator cuff tears can be healed with physical therapy and prescription medications. If your rotator cuff injury worsens, Dr. Nolan may need to repair it through minimally invasive arthroscopic surgery.

You suffer shoulder pain at night

If pain in your shoulder prevents you from sleeping at night, you may have a rotator cuff tear or inflammation in one of your tendon sheaths. Tendon sheaths become inflamed when they don’t produce enough lubricant during motion. See Dr. Nolan for a shoulder pain evaluation.

Your shoulder or arm feels weak

You might have a rotator cuff tear or other injury. When the muscles or ligaments in your rotator cuff are torn or inflamed, your arm isn’t able to carry weight or lift. Muscle weakness may be a sign that your soft tissues are being impinged upon by your bones.

Your shoulder dislocates or looks deformed

A dislocation is when your upper arm bone (humerus) slips partially or completely out of the socket joint in your shoulder. A partial slippage is called a subluxation. Both subluxations and full dislocations can be extremely painful.

A dislocated shoulder may occur suddenly as a result of a swift movement during sports play or from a fall or collision. Or it may develop over time because your rotator cuff muscles and tendons have weakened due to overuse. Frequent shoulder dislocations raise your risk for osteoarthritis.

You have intense shoulder pain or sudden swelling

Intense pain in your shoulder, especially when accompanied by swelling or warmth, requires immediate medical attention. You may have torn your tendons or muscles, dislocated your shoulder, or fractured one of your shoulder bones.

Take care of your shoulders so they can take care of you. If you have acute, severe shoulder pain or mild-to-moderate shoulder pain that doesn’t resolve within a few days, contact Dr. Nolan. You can book a consultation by phoning up his friendly staff or using the online form.

Shoulder Tendonitis | Johns Hopkins Medicine

What is shoulder tendonitis?

Tendonitis of your shoulder is an inflammation of your rotator cuff or biceps tendon. Your rotator cuff consists of the muscles and tendons in your shoulder. They connect your upper arm bone to your shoulder blade.

Your injury may range from mild inflammation to severe inflammation of most of your rotator cuff. When your rotator cuff tendon becomes inflamed and thickened, it is also called rotator cuff tendonitis. Your rotator cuff tendon may get trapped under the roof, or the highest point, of your shoulder. This is called your acromion. It is formed by a part of your shoulder blade, called your scapula.

What are the symptoms of shoulder tendonitis?

The following are the most common symptoms of shoulder tendonitis. However, you may experience symptoms differently. Symptoms may include:

The symptoms of shoulder tendonitis may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is shoulder tendonitis diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for shoulder tendonitis may include:

• X-ray. Invisible electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.

• Magnetic resonance imaging, or MRI. Large magnets and a computer produce detailed images of organs and structures within your body.

• Ultrasonography. High-frequency sound waves create an image of some part of the inside of your body.

Treatment for shoulder tendonitis

Your healthcare provider will discuss with you specific treatment for shoulder tendonitis, based on:

• Your age, overall health, and medical history

• The extent of the condition

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

What are the complications of shoulder tendonitis?

If treatment is not started when your pain and discomfort are relatively mild, complications may develop. These may include:

• Pain that interrupts your sleep.

• Loss of strength or motion in your affected arm.

• Difficulty doing things that require moving your injured arm behind your back or overhead, such as fastening zippers or buttons, or placing objects in high places.

When should I call my healthcare provider?

Notify your healthcare provider if:

• Your pain worsens

• It becomes more difficult to move your injured arm

• Your pain interrupts your sleep

• Your pain and discomfort keep you from doing your normal activities

Shoulder Pain and Problems | Cedars-Sinai

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What are shoulder problems?

Shoulder pain and problems are common. There are many types of
shoulder problems that are caused by injuries and sudden (acute) or long-lasting
(chronic) inflammation of the shoulder joint. The shoulder is a complex joint that
has great mobility. This ability to move also increases the chances that it can be
injured.

The shoulder is made up of several layers, including the
following:

• Bones. The collarbone
  (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
• Joints. These help with
  movement, including the following:
  • Sternoclavicular joint (where the clavicle meets the
    sternum)
  • Acromioclavicular (AC) joint (where the clavicle
    meets the acromion)
  • Shoulder joint (glenohumeral joint). A
    ball-and-socket joint that aids forward, circular, and backward movement
    of the shoulder.
• Ligaments. A white, shiny,
  flexible band of fibrous tissue that binds joints together and connects bones
  and cartilage, including the following:
  • Joint capsule. A group of ligaments that connect the
    humerus to the socket of the shoulder joint on the scapula to stabilize
    the shoulder and keep it from dislocating.
  • Ligaments that attach the clavicle to the
    acromion
  • Ligaments that connect the clavicle to the scapula
    by attaching to the coracoid process
• Acromion. The highest point
  (roof) of the shoulder that is formed by a part of the scapula.
• Tendons. The tough cords of
  tissue that connect muscles to bones. The rotator cuff tendons are a group of
  tendons that connect the deepest layer of muscles to the humerus.
• Muscles. These help support and
  rotate the shoulder in many directions.
• Bursa. A closed space between 2
  moving surfaces that has a small amount of lubricating fluid inside. It is
  located between the rotator cuff muscle layer and the outer layer of large,
  bulky muscles.
• Rotator cuff. Made up of
  tendons, the rotator cuff (and related muscles) holds the ball of the
  glenohumeral joint at the top of the upper arm bone (humerus).

What causes shoulder problems?

The shoulder is the most movable joint in the body. But it is also
an unstable joint because of its range of motion. Because the ball of the upper arm
is larger than the socket of the shoulder, it is at risk of injury. The shoulder
joint is supported by soft tissues. These are the muscles, tendons, and ligaments.
They are also subject to injury, overuse, and degeneration.

Progressive diseases that break down tissues in the body over time
may also play a role in shoulder problems. Or they may cause pain that travels along
nerves to the shoulder.

Common causes of shoulder problems include the following:

• Dislocation. The shoulder joint
  is the most often dislocated major joint of the body. This is often caused by a
  strong force that separates the shoulder joint’s ball away from the joint’s
  socket. The ball is the top rounded part of the upper arm bone (humerus). The
  socket is called the glenoid.
• Separation. The AC joint becomes
  separated when the ligaments attached to the collarbone (clavicle) are torn, or
  partly torn, away from the shoulder blade (scapula). Shoulder separation may be
  caused by a strong blow to the shoulder or a fall.
• Bursitis. Bursitis often occurs
  when tendonitis and impingement syndrome cause inflammation of the bursa sac
  that protects the shoulder.
• Impingement syndrome. This is
  caused by the excessive squeezing or rubbing of the rotator cuff and shoulder
  blade. The pain is from an inflamed bursa (lubricating sac) over the rotator
  cuff. Or it may be due to inflammation of the rotator cuff tendons. And it may
  be due to calcium deposits in tendons due to wear and tear. Impingement syndrome
  can lead to a torn rotator cuff.
• Tendinosis. Tendinosis of the
  shoulder is caused when the rotator cuff or biceps tendon become worn out and
  inflamed. This is often a result of being pinched by nearby tissues. The injury
  may vary from mild inflammation to most of the rotator cuff. When the rotator
  cuff tendon becomes inflamed and thickened, it may become trapped under the
  acromion.
• Rotator cuff tear. A rotator
  cuff tear involves 1 or more rotator cuff tendons becoming inflamed and torn
  from overuse, aging, a fall on an outstretched hand, or a collision.
• Adhesive capsulitis (frozen
  shoulder).
  This condition is often caused by injury that leads to lack
  of use due to pain. Not enough use may cause inflammation and scar tissue to
  grow between the joint surfaces. This further limits motion. There is also a
  lack of synovial fluid to lubricate the gap between the arm bone and socket.
  This fluid normally helps the shoulder joint to move.
• Fracture. A fracture is a
  partial or total crack or break through a bone. It often occurs due to an impact
  injury.

What are the symptoms of shoulder problems?

Shoulder pain may be only in 1 area. Or it may spread to areas
around the shoulder or down the arm. The location and type of symptoms depend on the
injury or the location of the inflammation. Below are symptoms of some common
shoulder problems.

A rotator cuff injury will often cause pain in the front or
outside of the shoulder. The pain gets worse when you raise your arm or try to lift
an object over your head. Rotator cuff pain can be severe. It can make even simple
tasks impossible and wake you up at night.

If you have shoulder instability, pain can start suddenly, for
example, just as you throw a ball. You may have numbness all the way down your arm.
If the instability happens slowly, you may have mild pain only at certain times.
Your shoulder might feel weak, sore when you move it, or “loose” in your joint.
Shoulder instability is different than a shoulder dislocation.

The symptoms of a dislocated shoulder include intense pain,
inability to move the joint, a visibly out of place shoulder, and swelling or
bruising. The dislocation can cause numbness, tingling, or weakness near the injury
or down your arm. A dislocated shoulder requires immediate medical care.

If shoulder pain is caused by inflammation, such as bursitis, it
may feel stiff, achy, and hurt more when you move it. Sometimes it can look swollen
or red.

How are shoulder problems diagnosed?

A healthcare provider will ask about health history. They will
give you a physical exam. The exam is to look at the range of motion, area of pain,
and level of joint stability. You may have tests such as:

• X-ray. This imaging test uses a
  small amount of radiation to make images of tissues, bones, and organs onto
  film.
• MRI. This imaging test uses
  large magnets, radio waves, and a computer to make detailed images of tissues in
  the body. It can often find damage or disease in and around ligament, tendon, or
  muscle.
• CT scan. This imaging test uses a series of X-rays
  and a computer to make horizontal images of the body. A CT scan shows detailed
  images of any part of the body, including the bones, muscles, fat, and organs.
  CT scans are more detailed than general X-rays.
• Electromyogram (EMG). This is a
  test to evaluate nerve and muscle function.
• Ultrasound. This imaging test
  uses high-frequency sound waves to create an image of the internal organs.
• Laboratory tests. These can help
  to figure out if other problems may be the cause.
• Arthroscopy. This is a minimally
  invasive procedure used for joint conditions. This procedure uses a small,
  lighted, optic tube (arthroscope) that is put into the joint through a small cut
  (incision). Images of the inside of the joint are projected onto a screen. It is
  used to look at any changes in the joint, to find bone diseases and tumors, and
  to figure out the cause of bone pain and inflammation.

How are shoulder problems treated?

The goals of treatment are to ease pain and restore your shoulder
to normal function. To do this, a variety of treatments may be used, including:

• Changing how you do some daily activities (activity
  modification)
• Rest
• Physical therapy
• Medicines such as ibuprofen, naproxen, and other
  nonsteroidal anti-inflammatory medicines (NSAIDs)
• An injection of anti-inflammatory steroids
• Surgery (when other options fail or are not advised for the
  injury or condition)

Key points about shoulder problems

Shoulder pain and problems are common.

• The shoulder is the most movable joint in the body. But its
  ability to move increases the chances that it can be injured or damaged.
• Common causes of shoulder problems include dislocation,
  separation, and fracture.
• Shoulder pain may be localized in a specific area. Or it may
  spread to areas around the shoulder or down the arm.
• Treatment may include medicines, rest, physical therapy,
  surgery, and changing how you do some daily activities.

Next steps

Tips to help you get the most from a visit to your
healthcare provider:

• Know the reason for your visit and what you want to
  happen.
• Before your visit, write down questions you want
  answered.
• Bring someone with you to help you ask questions and
  remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the
  results could mean.
• Know what to expect if you do not take the medicine or have
  the test or procedure.
• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.
• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Thomas N Joseph MD

Medical Reviewer: Raymond Turley Jr PA-C

Medical Reviewer: L Renee Watson MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Pain in the shoulder joint – GBUZ LO “Vsevolozhsk KMB”

Pain in the shoulder joint.

It is with such a complaint that people over 40 years old often turn to a traumatologist who do not associate their suffering with any serious injury. During the conversation, it turns out that the person has already turned to both a surgeon and a neurologist, underwent more than one course of treatment, but there is no result.

What exactly worries patients under the wording “shoulder hurts”? Anatomically, the shoulder is the part of the upper limb, located from the shoulder joint to the elbow.If you ask a person to pat on the shoulder, then he will knock on the place that is more correctly called the shoulder.

And most often the AREA OF THE SHOULDER JOINT hurts. There is nothing to hurt in the joint itself – the articular cartilage, the articular lip do not have pain receptors. The thin joint capsule has mechanoreceptors that respond to tension and pressure. The pain occurs as a result of muscle ischemia (lack of blood supply). Similar pains occur in the heart (myocardial ischemia), in the stomach, intestines, uterus, bladder, etc.with muscle spasms located in the walls of these organs. Muscle spasm causes compression of the vessels that feed the muscles and the smallest nerve endings located in them. At the same time, we feel severe pain – remember the convulsions that, sometimes, happen to many. Only cramps are an example of an acute muscle spasm, and pain in the shoulder joint is a prolonged spastic tension.

What muscles are under such tension and why?

Our muscles perform two activities:

• dynamic movements that facilitate the movement of our body and its parts in space;
• static tension, which helps us to maintain a certain position of the body and its parts.

A muscle working in a dynamic mode is similar to a pump that pumps blood through the body. In a dynamic mode of operation, the muscle drives the maximum amount of blood through itself. Under static stress, the muscle experiences oxygen deprivation. Prolonged starvation of muscle tissue leads to pain, aseptic inflammation, atrophy, and scarring (fibrosis). The atrophied and fibrosed muscle is not capable of full-fledged physical activity. The elasticity of such a muscle is lost – it is not able to fully contract and stretch.Therefore, the range of motion in the joint decreases.

Shoulder joint is one of the most common localizations of tendon and muscle pain. It consists of two bones, more precisely from their parts: the head of the humerus and the articular process of the scapula. The shoulder joint is muscular. The upper limb is suspended on muscles, which are attached at one end to the scapula and clavicle, the other to the humerus at different levels. These muscles are under static tension most of the time and provide stability to the shoulder joint.

With age, there is a process of muscle degeneration, muscle atrophy and fibrosis. Loads that were previously habitual become excessive. This causes damage to individual muscle bundles, inflammation of the muscle tendons, and pain. Inflammation of the muscle tendons is called tendonitis.

Shoulder tendinitis is a disease in which the soft tissues and structures surrounding the shoulder joint become inflamed. This inflammation restricts movement and causes severe shoulder pain.Usually, tendinitis does not occur out of the blue. The most common cause of tendinitis is prolonged static stress on the muscles. It is tendinitis that is called the disease of builders, athletes and gardeners. According to statistics, 1 out of 50 people over forty years old suffers from this disease. Women get sick a little more often than men, due to hormonal changes during menopause. Athletes are at risk: tennis players, basketball players, shot throwers (hammer, javelin). Painters also suffer from this disease quite often.Shoulder tendinitis is accompanied by inflammation and thickening of the joint capsule and surrounding tissues. As a result, the range of motion in the shoulder joint is dramatically reduced due to severe pain. The patient has to keep the joint at rest, which is why adhesions appear in the capsule, which subsequently prevent the damaged limb from developing normally. You can notice the development of tendonitis in everyday life: the patient is not able to get the cup out of the cupboard, take the item from the shelf fixed at a certain height; pain appears during sleep (which causes a lot of problems), when putting on sweaters and sweaters, in the bathroom when taking a shower.If these symptoms appear in a person’s life, then he needs to see a doctor. Pain sensations can be different: from not very strong, to sharp and prolonged. Restriction of motor activity leads to a sharp decrease in the range of motion in the joint. Even passive movements are extremely difficult to perform (during the examination, the doctor cannot raise the patient’s arm in a relaxed state). The patient is unable to raise the limb higher than at a right angle, or to put his hand behind his back on his own, the biceps and deltoid muscle begin to atrophy.In this case, the disease has passed into an advanced stage, which, at times, cannot be completely cured. Dull and aching pain can become acute and move to the area of ​​the elbow joint. With tendinitis, pain usually occurs abruptly, but as the inflammation develops, the discomfort may intensify: When probing the damaged tendon, hypersensitivity appears. A squeaking or clicking sound may be heard during movement of the affected limb. Inflammation leads to a weakening of the tendon and joint capsule, which can lead to their partial rupture.One of the most unpleasant symptoms of tendinitis is the growing pain in the late afternoon – it can be the cause of sleep disturbance due to the forced position of the body.

A chronic form of the disease appears due to repeated damage to tendons and muscles. This is inevitable if, after the disappearance of the first symptoms of acute tendonitis, a strong load on the tendon immediately resumes, since it is very sensitive to sprains and other injuries for another 1.5-2 months. It gives a lot of discomfort, since it is impossible to perform simple physical exercises.Unpleasant sensations arise even at rest. In order to eliminate an error in the diagnosis, the doctor may prescribe the necessary examinations:

• X-ray
• MRI
• Diagnostic arthroscopy

More than 90% of people with tendinitis need a fairly simple treatment – physical education. It is important not to load the damaged joint, but to develop it, that is, to increase the amplitude and number of movements in the joint.

To prevent exacerbations, it is important to exclude prolonged static stress, especially when working at a computer.

So, the pain in the shoulder joint is the result of age and prolonged static stress. If pain occurs, you need to consult a doctor for examination and treatment. Physical education and an active lifestyle reduce the likelihood of repeated exacerbations.

I wish you all good health!

Head of the traumatology and orthopedic department No. 1 Gulev Yu.N.

Arthroscopic treatment of a ruptured rotator cuff of the shoulder

Damage to the rotator cuff of the shoulder.

The shoulder joint is the most mobile joint in the human body. It allows us to raise our hand, lead it behind our back, reach our own back of the head. It is believed that it was thanks to labor and his hands that man became a man, but it would not be an exaggeration to say that all the diversity of the function of the human hand is based precisely on the tremendous mobility of the shoulder joint.Movements in the shoulder joint are carried out in all three planes, but we have to pay for an increase in the range of motion in the joint with a decrease in its stability and a high risk of damage to its structures, which include the rotator (rotational) cuff of the shoulder.

Anatomical structure of the normal shoulder joint.

The shoulder joint is formed by three bones: the head of the humerus, the glenoid cavity of the scapula and the clavicle, which is not connected anatomically with the joint, but significantly affects its function.

The head of the humerus corresponds in shape to the glenoid cavity of the scapula, also called the glenoid cavity (from the Latin term cavitas glenoidalis – glenoid cavity). Along the edge of the glenoid cavity of the scapula, there is an articular lip – a cartilaginous ridge that holds the head of the humerus in the joint.

The strong connective tissue that forms the capsule of the shoulder is essentially the shoulder ligament system that helps the head of the humerus to stay in the correct position in relation to the glenoid cavity of the scapula.The ligaments are firmly fused with the thin capsule of the joint. These include the coracohumeral and articular-humeral ligaments (it has three bundles: upper, middle and lower). Also, the shoulder joint is surrounded by powerful muscles and tendons, which actively provide its stability through their efforts. These include the supraspinatus, infraspinatus, small round and subscapularis muscles, which form the rotator cuff. Each of these muscles performs its own function: the subscapularis rotates the arm inward, the supraspinatus – raises the shoulder and “anchors” it, i.e.That is, it presses the head of the humerus into the glenoid cavity of the scapula when the shoulder is abducted to the side. In this case, the main abduction force is determined by the deltoid muscle, and the supraspinatus muscle works as a commander, directing the efforts of the deltoid muscle. The infraspinatus muscle rotates the shoulder outward, and the small round muscle also rotates outward and brings the arm to the body.

Together they function as a rotator cuff.

Rotator cuff of the shoulder

The supraspinatus muscle is located above all in the rotator cuff, while its tendon passes in a narrow space between the acromial process of the scapula and the head of the humerus, which determines the tendency to injury to the tendon.

Rotator cuff of the shoulder: general view, tenopathy and entrapment of the rotator cuff tendons in the subacromial space (impingement syndrome)

You can find out more about the anatomy of the rotator cuff and the anatomy of the shoulder joint on our website (click the mouse to go to the articles on anatomy).

Causes of diseases and injuries of the rotator cuff

Tendons of the rotator cuff muscles, like all other tendons, have a relatively poor blood supply.Insufficient blood supply to the rotator cuff tendons leads to the frequent development of degenerative changes: the so-called tenopathy occurs. It should be noted that not only insufficient blood supply contributes to the development of tenopathy (a number of scientists generally deny the role of blood supply in the development of tenopathy). Another reason for the development of tenopathy is hereditary connective tissue pathology. Tendons are mainly composed of a special protein called collagen, which is of 4 types. With an abnormally high percentage of collagen of types 3 and 4, tenopathy develops more often.In general, tenopathy can develop in any of the tendons of the rotator cuff (and in several tendons at the same time), which can lead to pain in the shoulder joint during movements in which the corresponding muscle is involved. For example, with tenopathy of the supraspinatus tendon, the pain increases when the arm is abducted to the side, with tenopathy of the subscapularis muscle – when a spoon or fork is brought to the mouth, when combing, when placing the hand behind the back. Often these tenopathies are called periarthritis of the shoulder scapula , but this is an absolutely illiterate diagnosis, which was abandoned all over the world several decades ago.”Shoulder periarthritis”, manifested by pain in the shoulder, can actually be not only a tenopathy of one or another rotator cuff tendon, but also a number of other diseases, which deserves consideration in a separate article. In addition, the use of certain antibiotics (fluoroquinolones) contributes to the development of tenopathy.

The most common cause contributing to the development of tenopathy is chronic tendon trauma, which is possible with two principal options:

Three types of anatomical shape of the acromial process (side view).The hook-shaped form of the acromial process contributes to trauma to the rotator cuff tendons

With age, degenerative changes in the tendon progress, tenopathy becomes more pronounced, the tendon weakens and it may rupture. The most common tendon rupture occurs between the ages of 35 and 55. However, with a sufficiently severe injury (fractures of the large tubercle of the humerus, other fractures of the proximal part of the humerus, dislocations in the shoulder joint, etc.)rupture can occur without prior tenopathy, i.e. in relatively young people.

Complete rupture of the supraspinatus tendon and partial rupture of the subscapularis tendon

Symptoms

As we have already noted, most often rupture of the rotator cuff tendons due to trauma occurs against the background of previous degenerative changes (tenopathy). The gap is characterized by a sharp increase in pain and a weakening of the arm, up to the complete inability to move the arm.Tears are partial or complete, when the tendon of one or another muscle is completely detached from the place of attachment to the humerus. The intensity of pain depends on the extent of the tear – as a rule, the larger the tear, the stronger the pain, and the greater the limitation of movements. With partial breaks, the ability to move the hand is retained.

The location of the pain depends on which rotator cuff tendon is damaged. Most often, the supraspinatus tendon is damaged, which is usually manifested by a complete inability to move the arm to the side (with a complete rupture) or increased pain when the arm is pulled to the side in an amplitude of 30 to 60 degrees.Many patients report that they cannot sleep on the side of the sore shoulder joint.

Diagnostics

To make a diagnosis, the doctor will ask you about the mechanism of the injury, the duration of the injury, the nature of the pain in the shoulder, whether and how long the shoulder hurt before the injury. Recall once again that with significant tenopathy, tendon rupture can occur without injury at all.

Next, the doctor conducts an examination, during which he conducts special tests (moves your hand or asks the patient to make a special movement), during which it is most likely that it is possible to find out which tendon is damaged.

As a rule, if the tendon is completely ruptured (or if it is torn off from the place of attachment to the bone), the movement for which this muscle is responsible is impossible.

In case of partial ruptures, the ability to move the arm is preserved, but the movements are painful.

It is imperative to perform an X-ray, in which, with ruptures of the rotator cuff tendons, you can find characteristic signs on the lower surface of the acromial process – the so-called subchondral sclerosis.It is formed as a defense reaction of the bone against repeated impacts of the head of the humerus and the lower surface of the acromion (impingement syndrome), and these impacts lead to damage to the rotator cuff tendons, cause their tenopathy, and, ultimately, rupture. Of course, the absence of these signs on the radiograph does not mean that the rotator cuff tendons are intact, but the presence of these radiological signs is highly likely to indicate problems with the rotator cuff tendons.On the X-ray, it is important to evaluate the acromioclavicular joint: arthritis of this joint can cause similar pain.

Radiograph: Impact of the head of the humerus (blue arrows) and the lower surface of the acromial process (red arrows) leads to damage to the supraspinatus tendon passing between them.

In the case of an unclear diagnosis and in order to clarify the extent of the damage, an ultrasound examination or magnetic resonance imaging is performed, which allows using magnetic waves to see and imprint soft tissues and bones in the form of layer-by-layer sections.

Magnetic resonance imaging showing complete rupture of the supraspinatus tendon

Treatment

Initial treatment for acute, recent rotator cuff rupture consists of pain relief. As a rule, non-steroidal anti-inflammatory drugs are used, such as aspirin, voltaren, ksefokam, etc. Also, in the acute period, it is necessary to keep the sore hand at rest – the hand is immobilized on a kerchief bandage or on a special abduction splint.To reduce pain and swelling, it is effective to apply ice packs wrapped in a towel to the shoulder.

Rules for applying a scarf

Special abduction splint used to treat rotator cuff tendon ruptures. Most often, the tendons of the supraspinatus muscle are detached from the place of its attachment to the humerus. Immobilization of the hand in the abduction position brings the end of the severed tendon closer to the place of its attachment to the humerus.The same abduction splint is used after operations for rotator cuff tendon ruptures

Complete rupture of the supraspinatus tendon and partial rupture of the subscapularis tendon. When the arm is pulled to the side, the torn ends of the tendon come closer together. The red arrow shows the axis of the humerus. On the left – the shoulder is brought to the body, on the right – the shoulder is laid to the side.

Conservative therapy. With tenopathies and minor, small ruptures, when movements in the shoulder joint are preserved, conservative therapy is prescribed.After the pain is relieved, light exercise is prescribed to develop the joint. In a later period, strength exercises are added to these exercises, aimed at strengthening the muscles of the upper limb. This will allow you to gradually return the affected arm to its previous range of motion. Usually the duration of conservative therapy is 6 to 8 weeks. During this time, the pain in the shoulder completely stops, and there is a partial restoration of strength in the muscles of the arm.

Surgical treatment. With significant gaps, conservative treatment is futile, since the torn ends simply cannot heal. However, the size of the rupture and the very fact of the rupture itself are not at all criteria by which the need for surgery is assessed, since sometimes, even with complete ruptures, the movements in the shoulder joint are preserved or practically painless due to the fact that the function of the ruptured tendon is partially taken over by the neighboring tendons. However, with full breaks, this is not common.

Operation shown if:

• there is a complete rupture, which makes movement in the shoulder joint impossible or restricts some of the movement;
• there is a partial tear that restricts movement, causes pain;
• conservative treatment was unsuccessful.

During the operation, the torn tendon is pulled back to the insertion site and sutured.

The essence of the operation is that the rupture is sutured, and if the tendon is detached from the place of fixation, then the suture is performed using special “anchor” fixators.At the first stage of the operation, all nonviable, degeneratively changed tissues of the rotator cuff are removed. Then the area of ​​the humerus where the rotator cuff was torn or torn off is cleaned of soft tissue residues so that the tendon grows back. Breaks are different in shape. The most common are U-shaped and L-shaped breaks.

Quite often, 2-3 anchors already mentioned are required to fix the torn off tendon. This retainer consists of an anchor and threads.The anchor is attached to the bone, and the tendon is stitched with threads. The choice of a specific type of anchor fixture is carried out by the operating surgeon, but in general, the patient should also be informed about which fixture is planned to be used in his case. We recommend using clamps from world-renowned companies that have proven themselves for a long time. First of all, FASTIN®, PANALOK, VERSALOK ™, BIOKNOTLESS ™, GII, HEALIX ™ from DePuy Mitek (a Johnson and Johnson division), PushLock® Knotless Anchor from Arthrex and TWINFIX ™ from Smith & Nephew can be distinguished.

Repairing a ruptured rotator cuff tendon is a rather complicated operation. Reconstruction of the rotator cuff can be performed both by the open method through the incision and by arthroscopic technique, i.e. without the traditional cut. Through one puncture 1-2 centimeters long, a video camera (arthroscope) is inserted into the joint and all injuries are examined from the inside. Through 1-2 other small punctures, special instruments are inserted into the joint, with which the tendons are sutured.

Repair of a torn tendon is not possible in all cases.If a sufficiently long period of time has elapsed between the moment of injury and the operation, then cicatricial degeneration of the muscle and tendon may occur, as a result of which it will be impossible to pull this tendon to anchor to the bone during the operation. In other cases, pronounced degenerative processes can be observed in the tendon, which leads to a significant decrease in the breaking load. In this case, even after successful reconstruction of the tendon, a relapse of the disease is likely in the near future. In these cases, during the operation, the surgeon removes all damaged tissue and tries to eliminate all other problems that can cause or worsen shoulder pain.

Rehabilitation

After the operation, the arm is immobilized in the abduction position for several weeks using a special splint, which we have already written about earlier. This immobilization reduces the tension on the tendons and reduces the risk of re-rupture. The duration of immobilization is determined by the surgeon who performed the operation, since only he can assess the condition of the tendons and the strength of the performed suture. Usually a splint (orthosis) is applied for 3-6 weeks.

After that, they begin rehabilitation exercises, the intensity and sequence of which will be selected by the doctor.In general, the postoperative and rehabilitation period can be divided into three periods:

1) Tendon protection period. The arm is immobilized so that the gap heals;

2) period of restoration of the amplitude of movements;

3) period of restoration of strength.

Physiotherapie Berlin Mitte | Physiotherapy practice Christian Marsh

Physiotherapie Berlin Mitte | Physiotherapy practice Christian Marsh

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90,000 Pain in the forearm – what can cause this symptom? Pain in the left and right forearm, causes and treatment of pain in the forearm.Pain in the joint and muscle of the forearm

Pain in the left or right forearm is very common. The term “forearm” is used to refer to the part of the arm between the elbow joint and the wrist. If your shoulders and forearms hurt and you do not know what to do, contact the CELT multidisciplinary clinic. We employ experienced specialists who will quickly establish the cause of this phenomenon and select an effective treatment.

Causes of forearm pain

The causes of pain in the left or right forearm can be very different.They can be caused by injuries and damage to muscles, bones, ligaments, tendons, joints, blood vessels and nerves of the forearm.

Pain with muscular lesions of the forearm

Pain in the muscle of the forearm with their lesions may result from:

• Inflammation – with a disease such as myositis, pain in the right / left forearm is local in nature. It manifests itself more clearly when a muscle is squeezed or motor loads. Its “companions” are “local” redness of the skin, pain in the forearm due to climatic changes and muscle weakness.
• Crash syndrome or muscle squeezing syndrome – occurs due to prolonged pressure on the forearm and at first has practically no pain symptoms, but after internal hemorrhage in the damaged muscles, a hematoma appears and unbearable pain occurs.
• Sprains – the consequences of sudden strong movements of the arms and, in particular, of the hands during sports. They are accompanied by painful sensations, including when feeling, and muscle tension. Such clinical manifestations can be felt up to 2 – 3 weeks.
• Tears – characterized by sharp pain with the sensation of applying a strong direct blow to the forearm; the pain symptom increases as the spasms intensify and the hematoma grows.
• Prolonged, repetitive stress on the muscles of the forearm – can cause pain that is localized on the outside. It manifests itself more clearly during physical activity and covers the inner side.
• Spasms / convulsions – are expressed in involuntary sharp repetitive contractions of one muscle or a group of them, which are accompanied by sharp unbearable pain.

Pain in case of damage to the joints and bones of the hands

Pain in the joint of the forearm can be caused by:

• Dislocations – one of the bones that form the joint is displaced; there is a sharp pain, accompanied by a decrease in mobility and deformation of the joint;
• Fractures – in addition to severe pain, they are accompanied by an unnatural position of the hand, abnormal mobility in places where it should not be, crunching of bone fragments;
• Osteomyelitis – occurs as a result of an infection entering the body, leading to the development of purulent-necrotic processes in the bones and soft tissues.It is accompanied by pronounced pain, inability to move the affected limb, local redness of the skin, an increase in the general body temperature;
• Arthritis is an inflammatory process that is characterized by pain symptoms along with joint deformation, crunching in it, and decreased mobility.

Pain due to damage to ligaments and tendons:

• Inflammatory processes (tendinitis, tendinosis) – accompanied by painful symptoms arising from active movements; the pain subsides when the hands are at rest.In addition, there is a crunching, local redness of the skin and an increase in temperature;
• Diffuse fasciitis – affects the membrane connecting the muscles of the forearm, and is characterized by a decrease in motor activity, “local” coarsening of the skin and loss of elasticity; the force of contractions in the hand and fingers of the sore hand decreases.

Pain due to lesions of nerves and blood vessels

Treatment of pain in the forearm may also be required due to damage to blood vessels and nerves in the following diseases:

• venous thrombosis
• post-thrombophlebitic syndrome;
• damage to nerve fibers;
• osteochondrosis of the spine and herniated intervertebral discs;
• plexite.

Diagnosis of forearm pain

CELT specialists recommend not to endure pain, but to immediately seek professional help. Everyone can become our patient!

According to the nature of the disease, they will conduct diagnostic tests, which may include the following:

• collection of anamnesis;
• carrying out a visual examination with palpation of the painful area;
• radiography;
• ultrasound examination;
• magnetic resonance imaging;
• blood test for infection, lack of vitamins in the body.

Treatment of forearm pain

Treatment of pain in the forearm is prescribed in accordance with the results of the diagnosis. CELT specialists practice an individual approach, which takes into account a number of factors.

Professional treatment of pain in the forearm allows you to eliminate inflammation, improve blood circulation in the affected upper limb, normalize metabolic processes in the body and increase the amount of intra-articular fluid.