Shoulder sprain (ligaments, muscles of the shoulder joint): treatment and symptoms of tendon tear

The joint structure of the shoulder is one of the largest, most mobile and important blocks of the musculoskeletal system. Its damage is not uncommon, and stretching of its elements - ligaments, tendons - should be the reason for an urgent visit to the traumatology department. Why?

This is one of the most painful types of sprains.
Inflammation of the ligaments leads to serious complications: tendonitis, bursitis may develop, and inflammation may “spread” to other tissues, increasing the risk of straining the arm muscles.
In the case of the shoulder joint, serious injuries are most often observed - ruptures and tears. Control of such consequences of stretching should be very careful.

Causes

A shoulder sprain occurs when a person makes a movement that goes beyond the physiological limits of the ball-and-socket joint. Damage is most typical for athletes involved in traumatic sports and experiencing excessive stress on the joint - shot throwers, bodybuilders, uneven bars gymnasts.

The shoulder joint can be injured in other cases:

falling to the side or forward while leaning on your hands;
a sharp jerk on a limb;
a strong blow to the collarbone area;
bruise, fracture, dislocation.

Shoulder strains do not occur with every injury. For this to happen, a number of factors are necessary that provoke weakening of the tendon-muscular system:

joint damage with the formation of osteophytes;
age-related changes, deterioration of soft tissue trophism;
metabolic disorders;
long-term hormone replacement therapy;
poor nutrition, unhealthy lifestyle, vitamin deficiency;
congenital structural anomalies.

The considered pathologies worsen the trophism of the shoulder ligaments, making them hard and inelastic, not allowing them to stretch to the required state.

How does trauma manifest?

An injury to the shoulder joint appears almost immediately. More often, a sprain occurs as a result of rotation of the arms, a strong blow, a fall on outstretched limbs, or a sharp pull. In 80% of cases, ligament injury occurs as a result of sudden jerking actions or manual pulling/pressing.

First signs of sprain:

shooting pain in the joint (can be reflected in the shoulder blade, spread to the ligaments of the elbow structure);
swelling of the shoulder;
local increase in temperature - palpable in the joint (with this palpation in the shoulder region, the painful syndrome intensifies);
if the ligaments are severely damaged, after 20–120 minutes a bruise may appear in the shoulder region (in case of profuse subcutaneous effusion in the case of a sprain, injection cleaning of the hematoma is performed);
In children, when the ligament is damaged, unnatural joint mobility is observed.

Symptoms

Shoulder strains can occur in the acromioclavicular, sternoclavicular, and superior scapular regions. The symptoms of the lesion depend on which ligaments were torn.

General signs of damage are few:

severe pain in the shoulder area, especially when raising the arm to the side or forward;
swelling of the joint;
hematoma, bleeding into the joint cavity;
limitation of mobility.

The intensity of discomfort directly depends on the degree of damage to the shoulder ligaments. With a normal sprain, rare aching pains are observed that occur when putting on outerwear, combing hair and other active movements of the shoulder. If there is a tear, the sensations become sharp even with a slight load.

In addition to severe discomfort, symptoms in the form of fever, deterioration in general health, and severe swelling indicate a rupture of the ligaments of the shoulder joint. When muscles and tendons are involved in the pathological process, the pain becomes constant and significantly complicates the patient’s life.

Other symptoms of a shoulder sprain—tissue hemorrhage and local hyperthermia—indicate the onset of an inflammatory process. Limited movement in the joint area can be either moderate or pronounced. It all depends on the amount of swelling and the level of pain.

Features of the joint

The shoulder joint has a complex structure that provides a significant range of movements in 3 different planes. Increased strength and prevention of the head of the humerus from popping out is ensured by the presence of structures represented by connective tissue fibers. Since the shoulder performs a significant amount of work, it is often subject to injuries and pathological processes that are accompanied by rupture of ligaments, as well as a cartilaginous structure called the labrum (it also serves to stabilize the joint).

Which doctor treats a shoulder sprain?

If your shoulder muscle is sprained or torn, do not delay visiting a doctor. At the first opportunity, it is recommended to approach a surgeon or traumatologist. If there are no such specialists in the local clinic, you need to postpone the voucher to see a therapist, and with severe damage and severe pain, go to the emergency room. A plaster splint may be required.

Deltoid strain

In the practice of a traumatologist, sprain of the deltoid muscle of the shoulder often occurs not only in athletes, but also in people who have received a domestic injury. A distinctive symptom is the appearance of acute pain when making certain movements with the hand:

rise to shoulder level;
bringing in a raised state to oneself;
touching the supraclavicular area with your fingers.

When the hand is stationary and fixed, there is no pain at all. When you try to make movements involving the acromioclavicular joint, the unpleasant sensations become unbearable.

The primary process of muscle tissue regeneration occurs within 7–9 days. Immediately after this time, rehabilitation must begin. Otherwise, there is a high probability of scar formation and loss of partial function of this muscle.

Diagnostics

If a shoulder sprain is suspected, the doctor palpates and asks the patient about the causes of the injury. Then the patient is prescribed additional research methods:

radiography. Allows you to ensure that there are no dislocations, fractures or cracks in the bone;
MRI and ultrasound. Help determine the presence and extent of damage in the muscle layer; more about MRI →
CT. A fairly informative method that provides a detailed image of the affected tissue.

In rare cases, the patient is referred for arthroscopy for a detailed examination of the ligaments and tendons of the shoulder joint from the inside. If necessary, clinical and biochemical blood tests are performed in differential diagnosis with various types of arthritis.

Types

For the convenience of diagnostics and subsequent determination of treatment tactics, a classification of changes in the ligamentous apparatus of the shoulder was introduced into clinical practice. It involves dividing into types based on several criteria. According to the severity of changes, the following are distinguished:

Complete rupture of a ligament, cartilaginous lip or tendon of one of the muscles.
Partial rupture, in which the integrity of only individual fibers is broken.

Depending on the predominant localization, separate damage to one of the structures or a combination of them may develop. Also, the division of damage is based on the main causative factor, therefore traumatic and pathological ruptures are distinguished.

Treatment

When diagnosed with a sprained shoulder joint, treatment begins with conservative methods. The patient is prescribed rest, ice compresses, medications and rehabilitation exercises. If symptomatic care is ineffective, surgery is resorted to.

Primary therapy

Immediately after the injury, pain in the joint is relieved by applying cold and applying a pressure bandage using the Deso method. This method can be used to treat minor sprains of the shoulder joint.

When pain occurs, analgesics and NSAIDs are used - Aspirin, Pentalgin, Naproxen, Ibuprofen, Nise, Diclofenac, Ortofen. Any of the listed drugs is taken orally as needed, but not more than 3 times a day.

In the treatment of shoulder muscle strain, preference is given to external use. The most commonly used groups of ointments are:

Homeopathic - Traumeel S and Tsel T. The drugs improve metabolism, stop tissue destruction, have an analgesic and restorative effect;
Chondroprotectors - Chondroxide, Teraflex, Chondroitin. Ointments prevent joint dystrophy, accelerate metabolic recovery during sprains;
Warming up - Finalgon, Viprosal, Apizartron, Efkamon, Nicoflex. The compositions activate local blood flow, reduce swelling and inflammation, and have a distracting effect;
NSAIDs for topical use - Phenylbutazone, Ibuprofen, Nise, Piroxekam, Nimesulide, Ketoprofen. Medications eliminate inflammation and other symptoms of shoulder sprains;
Combined agents - Dolobene, Voltaren. They have a resolving effect and prevent the formation of blood clots and bruises.

Medicinal herbs also have some analgesic effect: tansy flowers, yarrow, celery root. A decoction is prepared from the plants and taken warm in the first days after a shoulder injury. For external treatment of shoulder sprains, use an infusion of fresh elderberries with soda. Lotions and compresses are made from it.

Secondary therapy

Typically, a simple shoulder sprain can be dealt with fairly quickly. In this case, symptomatic remedies and simple rehabilitation exercises help well. They can be started 4–5 days after the injury under the supervision of an instructor.

If you are diagnosed with a shoulder ligament tear, treatment will be long and difficult. To speed up the healing of the cords, the patient is prescribed physiotherapeutic procedures: phonophoresis with hormones, electrophoresis, magnetic therapy, ozokerite applications. Therapeutic exercises and the use of absorbable gels are encouraged: Aescin, Venorutan, Troxevasin, Heparin ointment, Traumeel, Troxerutin.

At the last stage of the rehabilitation period, it is useful to take up swimming. Water procedures perfectly develop the shoulder joint and strengthen the muscles, speeding up recovery.

Treatment at home includes wearing a bandage, using traditional medicine recipes, as well as a balanced diet including jellied meats, jellies and dairy products in the diet.

Subscapularis sprain

When the subscapularis muscle of the shoulder is stretched, characteristic pain appears, a decrease in the amplitude of internal rotation of the arm and an increase in external rotation. A number of specific functional tests are used for diagnosis.

The patient is asked to press the palm of the hand on the affected side to the lower back while moving the elbow back as far as possible. In this position, you are asked to tear your hand off your lower back and raise it to the maximum possible distance. The smaller it is, the larger the area of muscle injury.

A similar test can be done by asking the victim to press his or her palm against the anterior abdominal wall. Then he should move his elbow forward as much as possible. If this movement is difficult or impossible, the test is considered positive.

Next test: you need to place the hand on the side of the injury on the opposite shoulder in front of you. The doctor should try to remove the hand from the shoulder, and the patient should try to keep it there. If he fails, the test is considered positive.

Prevention

Sprains of the shoulder joint can be avoided by dosing physical activity and doing all exercises correctly and measuredly, avoiding jerking. Before training, you need to warm up by performing a set of simple movements, including swings and arm rotation.

If shoulder overload occurs due to the nature of your work, you should wear a support bandage and take frequent breaks, during which it is a good idea to do light exercises and stretch your shoulders

It is necessary to avoid muscle damage in everyday life: protect yourself from injuries and falls, especially in icy conditions, follow safety rules when working at home and in the garden.

Shoulder sprains respond well to treatment and rarely lead to serious complications. Despite this, it is necessary to strictly follow the instructions of the attending physician and not forget about them when the condition improves. This will help you recover faster and avoid relapses.

Author: Elena Medvedeva, doctor, especially for Ortopediya.pro

Supraspinatus Strain

The supraspinatus muscle is part of the so-called “rotator cuff”, which provides the ability to rotate and rotate the shoulder joint to the outside. Stretching the supraspinatus muscle of the shoulder leads to the fact that such movements become difficult and sometimes completely impossible.

The clinical symptom is pain that occurs after unsuccessful rotation of the shoulder. Unpleasant sensations are localized in the area of the front of the arm. Pain intensifies at night. During the day, the injury may not show obvious signs. But this does not mean that it can be left without treatment.

The fact is that a sprain of the supraspinatus muscle is always associated with a concomitant strain of the biceps tendon. If this is not treated, then over time the patient's range of motion is limited. In particular, he will not be able to fully move his arm to the side and lift it up. This will make it difficult to comb your hair, fasten your bra, or remove anything from your back pants pocket.

Treatment of rotator cuff injury

For degenerative and inflammatory changes in the muscles of the rotator cuff, as well as for small fresh tears, a course of conservative treatment is prescribed: immobilization of the limb, anti-inflammatory and painkillers, and when the pain subsides, physical therapy to restore normal range of motion in the shoulder. In case of insufficient effectiveness of conservative treatment, in case of tendon damage in young, active patients, in case of severe, and especially complete tendon ruptures, the only adequate method of treating damage is surgical treatment.

Currently, these operations are performed arthroscopically, that is, closed, through several punctures in the joint area. Arthroscopic repair of the rotator cuff tendons is performed. In this case, high-tech equipment and modern anchor clamps (2.5-6 mm in diameter) are used to restore the anatomy and function of the shoulder joint.

Conservative treatment consists of eliminating inflammation and pain. Non-steroidal anti-inflammatory drugs are used for this purpose. To achieve quick results, cortisone injections are given around the joint capsule. They do not always eliminate inflammation 100%, but the pain disappears for several months. Complex therapy uses exercise therapy and physiotherapy. In the absence of results and further development of the disease, surgery is prescribed.

Surgical treatment allows you to restore mobility of the shoulder joint. It is advisable to perform the operation 3 months after the development of the pathology, as the best result is achieved. But you need to assess the risk and conduct an MRI or a complete diagnosis of the patient’s body in advance to identify contraindications. Surgical treatment also eliminates concomitant pathologies, including arthrosis of the acromial clavicular joint and impingement syndrome.

Arthroscopic surgery avoids open surgery and severe tissue damage. The arthroscope has a small diameter and gives the surgeon the opportunity to evaluate the joint from the inside, since a clear image is transmitted through the camera to the monitor. Since the incisions during the operation are minimal, there is no significant trauma and the person can recover faster (you can return home a few hours after the procedure).

During the operation, 5 small incisions are made around the joint capsule. All actions are carried out in an aquatic environment, so the tissues are thoroughly washed from damaged elements and blood. Once the bone has been completely cleared, an anchor or bone anchor is placed to securely secure the rotator cuff to the bone. Installation of microprostheses is carried out through small incisions. They are screwed into the bone, after which part of the torn rotator cuff is fixed to them. Pulling to the bone is carried out using threads and interrupted sutures.

Note! If massive rotator cuff tears or severe defects are diagnosed, open surgery is required. In case of severe defects, transplantation of body tissues (transplantation) is recommended.

Symptoms of a rotator cuff injury

Degenerative changes in the rotator cuff muscles and their tendons manifest themselves in the form of pain. During a rupture, the pain intensifies and weakness appears in the shoulder. It is difficult for the patient to raise his arm up, and sometimes he cannot do this at all. Night pain is often observed. The rupture can be complete or partial; isolated injuries to one of the tendons or damage to several tendons (massive ruptures) of the rotator cuff can also be distinguished. Based on the time of injury, acute and chronic injuries of the rotator cuff tendons are distinguished. The nature and severity of manifestations, and the choice of treatment method depend on this.