Damage to the shoulder joint!

Damage to the shoulder joint is a complex of disorders of the physiology of the shoulder joint, in which it loses its functionality and integrity, and the articular capsule or labrum, tendons are also damaged. All these deformations lead to discomfort in the shoulder joint, severe pain both when moving the shoulder and at rest.

As the long-term practice of doctors who treat and diagnose diseases of the musculoskeletal system caused by injuries and its changes due to degenerative anomalies shows, these damages are caused by both injuries and improper trophism of tissues, which increases the likelihood of damage.

Human shoulder joint

- This is a complex anatomical structure that ensures rotation of the limb in three planes, due to the specific structure of the joint and muscle attachment. It is the complexity of this design that is the main reason for its vulnerability, since even the slightest violation of the integrity of the bone, joint capsule, tendons and muscles leads to severe pain, loss of joint mobility and the need for treatment.

1.What are the types of injuries to the shoulder joint?

The shoulder joint is one of the most mobile and frequently used.

It has a complex structure, since it is designed to provide mobility of the limb in different planes. Shoulder injuries give a similar clinical picture, which does not allow us to assess exactly what is damaged and to what extent without additional research.

The shoulder joint is surrounded by muscles, cartilage and ligaments that provide mobility and stability. That is why a shoulder joint injury is considered to be any impairment of the functionality of the shoulder, which may be associated with damage to:

glenoid cavity;
humeral head;
acromion;
bags;
corcoacromial ligament;
rotator cuff;
tendons of the long head;
infraspinatus, supraspinatus, teres minor, subscapularis muscles.

The most common causes of damage to the shoulder joint: falling to the side or forward with a reflex support on the hands; road accident; work injuries; playing sports related to wrestling and strength exercises; squeezing or hitting the shoulder; a sharp jerk with the hand during an emergency or when lifting heavy objects.

There are 4 types of shoulder injuries:

injury;
stretching;
dislocation;
fracture

In case of severe injury, a combination of such disorders can be diagnosed. After providing first aid, the patient must consult a traumatologist to determine the nature and severity of internal injuries. Untreated injuries to the shoulder joint can lead to irreversible impairment of arm function.

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What to do if you have a bruised soft tissue of the shoulder?

First aid for bruises is cold. Applying ice or a heating pad with cold water to the injured area helps stop the development of swelling and reduce the intensity of pain. Cold causes vasospasm, which reduces hemorrhage.41

If shoulder pain is severe, more serious injuries may be suspected, especially if there is a significant limitation in the mobility of the injured limb. In this case, you need to immobilize the arm and go for examination.41

With bruises, the integrity of the skin is usually not compromised. But if this happens, it is necessary to apply a sterile bandage to the injury site.18, 41

2. Symptoms and diagnosis of injuries to the shoulder joint

Differential diagnosis for shoulder injuries is based on a physical examination, assessment of the totality of developed symptoms, study of the medical history, nature and degree of traumatic exposure.

The clinical picture may include:

pain (sharp, dull, shooting, paroxysmal);
limitation of limb performance (weakness, imprecision of movements, complete loss of functionality);
visually detectable shoulder deformity;
open tissue wound;
bleeding;
edema;
convulsions;
hematoma, bruises;
numbness of the hand;
general symptoms (nausea, dizziness, fainting, fever, chills).

The traumatologist most often makes only a presumptive diagnosis, since the symptoms are typical and differ only in the severity of the manifestations. Due to the complex structure of the shoulder joint and adjacent structures, it is difficult to say what exactly is damaged and to what extent. The clearest picture is provided by x-ray diagnostics, computed tomography, and MRI. You should not refuse these studies if your doctor insists. Any inaccuracy in the diagnosis and management tactics of patients with damage to the shoulder joint carries the risk of complications that can reduce the functionality of the limb for life.

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Minimally invasive methods for treating injuries and diseases

Center for Traumatology and Orthopedics of the Main Military Clinical Hospital named after N.N. Burdenko is the largest multidisciplinary medical institution in Russia, which rightfully bears the title of the flagship of military medicine. For more than 300 years, within the walls of our institution, the traditions and principles created by previous generations of military doctors have been carefully preserved and passed on. This allows us to maintain and increase the high scientific and professional potential of our center and all medical personnel.

The high professional level of the hospital’s medical staff deserves special attention. Assistance to patients is provided by honored healthcare workers of the Russian Federation, highly qualified doctors, candidates of medical sciences and two doctors of medical sciences. High expertise is supported by the use of modern high-tech medical equipment.

Today, thanks to the introduction of new technologies, surgical intervention has become possible using minimally invasive techniques - through two skin punctures. In this case, there is minimal impact on the body as a whole and there is virtually no tissue injury. This is especially important when performing surgeries on the shoulder joints. In addition, the minimally invasive technique ensures faster joint recovery than with classic open surgical treatment.

The most common shoulder injuries and diseases are Bankart injury, rotator cuff tear, and rotator impingement syndrome.

Damage to Bankart

A Bankart injury is a tear in the labrum of the shoulder joint, which is responsible for its stability. As a rule, a rupture of the labrum occurs at the time of injury and is accompanied by a dislocation of the shoulder. However, there are labral tears without shoulder dislocation. They manifest themselves as pain and clicking in the shoulder joint. The only treatment for Bankart damage is surgery.

Currently, in the conditions of the Central Technical and Technical Center of the GVKG named after. N.N. Burdenko, it is possible to fix the labrum arthroscopically. It is carried out through two minimally invasive punctures of the skin and soft tissues, in which absorbable anchors are installed in the articular process of the scapula and the suture of the articular labrum (Fig. 1). This operation can significantly speed up recovery and return a person to sports or physical activity.

Rotator cuff tear

A rupture of the rotator cuff, or tendon, can also occur. Most often - the supraspinatus tendon. Less commonly, the supraspinatus muscle. Sometimes two tendons or the subscapularis tendon may rupture. In most cases, rotator cuff tears occur in middle-aged and elderly people with minor injuries. In young people, it can occur due to injury during sports. A rotator cuff tear causes pain and inability to raise the arm.

A rotator cuff tear requires surgical treatment. In the Center for Technical and Occupations of the GVKG named after. N.N. Burdenko surgery is performed by creating an arthroscopic suture of the rotator cuff tendons by installing high-tech anchors into the head of the humerus (Fig. 2). Early surgical treatment allows for rapid restoration of function and resumption of physical activity. Later surgical treatment (6-12 months after the injury) no longer gives such good results due to muscle atrophy.

Rotator impingement syndrome

Rotator impingement syndrome (formerly called glenohumeral periarthritis) is a condition that occurs when the rotator cuff tendons become compressed between the head of the humerus and the acromion of the scapula. A person experiences pain in the shoulder joint. Sometimes the pain radiates to the forearm and hand. At first it appears when you raise your arm, then it becomes constant and interferes with sleep at night.

The disease most often develops in middle-aged and elderly people, less often in young people. The causes of the development of impingement syndrome can be injuries, increased or unusual physical activity, hypothermia, diseases such as arthrosis of the shoulder joint and acromioclavicular joint.

This is a common disease that is often treated on an outpatient basis in clinics with conservative measures, for example, taking anti-inflammatory drugs, ointments, physiotherapeutic procedures, and blockades. Conservative measures often do not give the expected effect: the pain persists, and movement in the shoulder joint becomes limited. Therefore, you should not wait until the disease begins to cause discomfort. If there is no effect from conservative treatment within 1-2 months, surgical treatment is necessary.

The positive effect of the operation depends not only on the qualifications of the surgeon, but also on the equipment and equipment used. In the main military clinical hospital named after. acad. N.N. Burdenko minimally invasive operations are performed using endoscopic complex systems “Arthrex”, the quality of which meets international standards and is confirmed by the Russian Federation control system.

In addition, the high quality of Arthrex equipment and the professionalism of the doctors of the Center for Traumatology and Orthopedics of the Hospital named after. N.N. Burdenko provide a quick and easy recovery process. Within 2-3 days after surgery, the pain stops, and the range of motion in the shoulder joint gradually increases. The duration of rehabilitation treatment depends on the severity of movement disorders in the shoulder joint before surgery. To speed up the recovery process and to adapt after surgery, patients undergo a rehabilitation course, which includes drug therapy, physiotherapeutic procedures and physical therapy.

Often people are not aware of the surgical treatment options for shoulder impingement syndrome or shoulder impingement syndrome. For several months, and sometimes even years, they have been trying unsuccessfully to receive treatment on an outpatient basis or on their own. They resort to surgery in advanced cases, having lost sleep. But even in these cases, there is always the opportunity to help patients get rid of their illness and achieve good treatment results as a result of the use of highly effective endoscopic techniques.

At the Center for Traumatology and Orthopedics of the Hospital named after. acad. N.N. Burdenko you can get qualified advice from specialists in the field of arthroscopy. The full picture of the disease can only be clarified after a full examination and adequate consultation.

The sooner the disease is diagnosed and treatment is started, the faster the recovery will occur, and the negative consequences of the disease will not have time to develop.

You can find out more detailed information about the specifics of treatment directly during your consultation. The team of doctors from the Central Clinical Hospital of the State Military Clinical Hospital is ready to help you.

The collaboration of doctors from the Center for Traumatology and Orthopedics of “New Medicine” and “TeleMed” opens up new opportunities for high-quality rehabilitation using professional high-tech rehabilitation equipment for patients with damage to the musculoskeletal system.

New medicine is a modern approach using innovative technologies in the field of medicine. The company offers unique home rehabilitation services, including the use of telemedicine, rental of high-tech, “smart” rehabilitation equipment, and provision of professional care to seriously ill, disabled and elderly people. The company brought together the best specialists and manufacturers of medical equipment.

TeleMED is a service for remote consultations with a variety of doctors. It allows you to consult a doctor at any time when a question arises about health (yours or your loved ones) and immediately receive advice and a clear algorithm of actions. All 24 hours a day. By phone or via the Internet, as is convenient for you. This will not replace going to the doctor, but it will make your path to recovery easier.

3.First aid for injuries to the shoulder joint

Immediately after an injury, the victim requires outside help, because due to the pain syndrome he is not able to take the necessary measures. The arm should be immobilized and fixed in a bent state using a scarf. If a dislocation or fracture is suspected, a splint is applied to the forearm. For internal bleeding and sprains, a tight bandage is indicated.

If necessary, the victim should be given painkillers.

Wounds should be treated with antiseptic agents. If there is a risk of hematoma formation, ice is applied. If the patient has lost consciousness, he should be placed on his healthy side and an ambulance should be called. In other cases, after the acute pain has been relieved, the victim should be taken to the emergency room.

The traumatologist evaluates the clinical picture, carries out the necessary diagnostics and develops treatment and rehabilitation tactics. Severe cases may require surgery, and full recovery may take months. Light bruises are treated with rest for 1-2 weeks.

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Features of treatment of shoulder bruise

Treatment of injury is aimed at restoring blood circulation, lymph flow, and resolving the hematoma. Physiotherapy is usually prescribed for this. To reduce the risk of fibrous adhesions, the injured arm should be developed gradually.41

To relieve pain and reduce the risk of tissue inflammation, non-steroidal anti-inflammatory drugs are prescribed. Typically, in the post-traumatic period, topical forms are used, which cause fewer side effects than oral ones. The drugs used must be highly effective against inflammation and pain. It is important that the ointment or gel used for topical treatment of a bruise has an analgesic effect.42,57

4.Treatment

For any injury to the shoulder joint, after pain and swelling are relieved, the mobility of the arm is restored using physical therapy methods, gradual development of the joint, passive and strength training. A rehabilitation program should be prescribed by an experienced doctor. At the same time, the patient regularly undergoes intermediate diagnostics to assess the effectiveness of the measures taken.

The following modern techniques can speed up the recovery process:

UHF therapy;
massage;
magnetic therapy;
electrophoresis;
Ultrasound therapy;
warm wraps with paraffin and ozokerite;
procedures using diadynamic current.

Impeachment syndrome[edit | edit code]

Shoulder rotators (rotator cuff)

is a group of muscles that work together to rotate the shoulder and provide stability to the shoulder joint.
In strength sports, when performing exercises in which the shoulder is worked, the rotator muscles are most often injured, resulting in a disease called impeachment syndrome
.

Development mechanism[edit | edit code]

There are no exercises in bodybuilding or powerlifting that can cause significant damage to the rotator cuff, but if you notice pain in the shoulder joint when performing the bench press, this may indicate weakness in the rotator cuff muscles or an already developed impeachment syndrome.

The most dangerous exercises:

pull-ups on the horizontal bar, lat pull-downs and military presses.

Troubleshooting[edit | edit code]

Use less or eliminate dangerous exercises
Train your rotator cuff muscles
Never perform rotator cuff exercises before doing pectoral exercises.
Do a thorough warm-up

Recovery[edit | edit code]

Warm up the shoulder joint

Do not put stress on the shoulder joint for 10-14 days
To relieve pain and suppress the inflammatory process, use Diclofenac, Ibuprofen or Ketanov
When the pain disappears (at rest), you can gradually begin training.
At the first stage, you can only warm up the joint without weights (circular movements and abduction of the arm).
At the second stage (the transition is possible when the pain disappears, if it persists, do not use weights) perform the exercises following the video
At the third stage, begin to include strength exercises involving the shoulder joint, progressively increasing the weight. The duration of the third stage is 15-40 days, depending on the severity of the injury.
Remember that the main principle of proper recovery is a progressive increase in load, active warm-up and refusal to work “through pain”.
Use ligament and joint supplements to significantly speed up shoulder recovery. Take preventive courses 1-2 times a year in order to strengthen the tendon system and restore cartilage.

Symptoms

Before starting treatment, it is necessary to understand whether the patient really has a dislocation, therefore, for an accurate diagnosis, the doctor must carry out:

interviewing the patient - under what circumstances the injury occurred, what pain he feels;
prescribe an x-ray or MRI to ensure the diagnosis is correct. This is also necessary to understand what form the dislocation is;
prescribe comprehensive treatment.

A dislocation of the shoulder joint is accompanied by a number of characteristic symptoms, which make it possible to distinguish it from other injuries:

characteristic swelling forms on the shoulder joint, which is accompanied by severe pain;
physical activity of the limb is greatly reduced;
the organ loses its smoothness, a small protrusion appears;
tissues in this area lose their sensitivity.

At the first symptoms, you should contact a medical facility. You should not self-medicate - this can lead to the organ completely ceasing to perform motor function.