Shoulder pain

What is shoulder pain and what are its causes?

The shoulder joint, connecting the upper limb with the torso, consists of several joints and shows the largest range of movements from all joints of the body. Bone structures (humerus, scapula, clavicle and sternum) are surrounded by numerous ligaments, muscles, tendons and bursa, which ensure stabilization of the shoulder and fluidity of movements. The most important role is played by the so-called a rotator cuff, i.e. a group of four muscles and their tendons surrounding one of the joints, i.e. the brachioradriatic shoulder.

Ailments from the shoulder joint are common. Their most common causes are overloads, repetitive micro-overloads and injuries of the surrounding soft tissues (mainly rotator cuff) that arise during everyday activities or sports activities. The underlying cause of shoulder joint pain may be age-related degenerative changes, although degenerative shoulder disease occurs less frequently than other joint disease. One should also remember about various inflammatory rheumatic diseases, such as rheumatoid arthritis or polymyalgia rheumatic; in addition to shoulder pain in their course, other symptoms of the disease are also common. Less often the shoulder pain is a manifestation of diseases of other organs, including myocardial infarction or lung tumor.

Below are some of the most common causes of shoulder joint discomfort

Damage to the rotator cuff. The so-called rotator cuff is formed by four muscles and their tendons surrounding the shoulder of the glenohumeral joint, keeping it in the right position. While performing monotonous, repetitive activities (eg with hands over your head, like hanging curtains or playing volleyball), these structures are overloaded and even broken (usually the supraspinatus hamstring is damaged). A common cause of damage to the rotator cuff are injuries, even small ones (eg when a sudden jerk during a tram ride). The most common manifestation of a rotator cuff injury is shoulder pain, especially when lifting the arm or putting a hand on the back. Pain is often located in the anterior and lateral region of the arm; may occur at night and prevent sleeping on the affected shoulder.

Complex of sub-grid tightness. The sublot space is located under the shoulder process, and the bursa located there allow smooth movement of joint structures during the lifting of the arm. If there is “cramping” in the subarachal space, for example as a result of bursal inflammation or the formation of bone growth, the movement of the humeral bone slipping under the shoulder process is blocked; You will feel strong pain, the most severe when visiting in the range of 60-110 (the so-called painful arch).

Damage to the tendon of the head of the long biceps muscle. This tendon runs vertically in the front of the arm; its damage is manifested by pain in this area, especially during movements at the bent elbow. For the inflammation of the sheath of this tendon occurs in the case of mechanical damage, as well as as a result of various inflammatory diseases of the joints.

The frozen shoulder is caused by a decrease in the susceptibility of the shoulder joint capsule, making it impossible to perform a full range of movements (mainly abduction and rotation, for example when trying to comb or scratch the back). The feeling of joint stiffness prevails, although pain can also occur. The frozen shoulder (or sticky inflammation of the joint capsule) may occur as a result of damage to the rotator cuff (most often) or for other reasons (also unrelated to the shoulder joint, eg due to a heart attack). Most often the symptoms gradually disappear, usually within 6-18 months. The basis of treatment are appropriate exercises, sometimes it is necessary to perform steroid injections, as well as the use of NSAIDs and other drugs.

Inflammatory joint disease. Inflammation of the shoulder joint may be one of the symptoms of diseases such as rheumatoid arthritis, psoriatic arthritis or gout. There is then an overgrowing lining of the synovial joint and often accumulation of fluid inside the joint. As a rule, it is accompanied by other symptoms of the disease and the diagnosis does not cause problems. If the joint is very warm and there is a fever, the joint infection should be ruled out (especially if a joint puncture or blockage has been performed before).

What should you pay attention to?

In the case of shoulder joint pain, it is worth remembering whether in the past there has been any injury to this joint (even a small one, such as a violent jerk), and whether we have recently performed activities that could cause it to overload (such as working with your arms over your head , pushing and lifting heavy objects, gardening and home work requiring repetitive movements of the shoulder joint). It should be noted when the pain is the most severe and what actions cause it. Disturbing symptoms are swelling and excessive warming of the joint, pain of other joints and general symptoms.

How to proceed?

The procedure depends on the cause of the complaint, so it is worth consulting the doctor (most often an orthopedist, a rehabilitator or a rheumatologist). In the period of severe aggravation, pain-intensifying activities should be avoided, it is worth using ice packs (15-20 min once a day). Often, despite the ailments, it is advisable to start appropriate exercises as soon as possible in order to strengthen the stabilization of the joint and prevent its further damage.

When and to which doctor to apply?

It is worth to go to an orthopedy doctor when the shoulder pain is caused by a “mechanical” cause, especially when they do not pass despite the cessation of activities affecting the joint, and also if there is a sudden pain associated with the injury. If the pain of the shoulder is accompanied by swelling and stiffness of the joint, pain of other joints or general symptoms (feelings of breakdown, low-grade fever or fever, unreasonable weight loss, malaise), please go to a rheumatologist.

What tests should be performed to determine the cause of shoulder pain?

The search for the cause of shoulder pain usually starts with a selected imaging test – x-ray (especially after trauma) or ultrasound (which is very helpful in imaging soft tissues around the joint). If necessary, other tests (eg magnetic resonance) are performed. In the case of suspected inflammatory diseases of the joints, laboratory tests should be performed (eg OB, CRP, morphology, RF, aCCP, uric acid – the doctor will decide on the selection of tests). If the fluid is found in the joint, the doctor may suggest puncturing the joint to decompress it, assess the nature of synovial fluid and, if necessary, administer the drug intra-articularly.

How is the shoulder pain treated?

The basic method of treatment of shoulder pain associated with its mechanical damage is rehabilitation, only sometimes there are indications for surgical treatment. Transitional improvement can bring so-called blockages, involving the injection of a drug (a corticosteroid, a local anesthetic) into the area that causes the discomfort (eg, bursa pod). Oral drugs (paracetamol, NSAIDs, weak opioids) can be used as supportive devices, but remember that they should not be taken chronically. In the case of inflammatory diseases of the shoulder joint, the treatment should be decided by a rheumatologist.

Written by

Gregory Taylor