Traumatologist-orthopedist of the highest qualification category, Candidate of Medical Sciences Ivan Valentinovich Elizarov
talks about pain in the shoulder joint, causes and treatment methods.
Patients with pathology of the shoulder joint often come to me at an orthopedic appointment with complaints of pain during movement, at rest, night pain (it hurts like a “sick tooth”), limited range of motion in the shoulder or a feeling of instability, “laxness” and a periodic feeling of numbness in hand. Many have had an injury in the past, a fall on the elbow, shoulder, a dog pulled the leash, the patient sharply lifted a heavy object or unloaded a lot of weights, there was a dislocation of the shoulder, playing sports with loads on the arms (volleyball, throwing objects, martial arts with punches, bench press lying barbells). Some people do not remember the fact of the injury. In the last century, they were given a profound diagnosis of “humeral periarteritis” - which literally means “inflammation somewhere in the area of the shoulder and shoulder blade”, they were treated for many months by a neurologist without a significant positive result, they were injected with “blockades” with hormonal drugs from a surgeon or rheumatologist . In fact, these complaints are associated with damage or inflammation of the ligaments of the shoulder joint, the tendons around it, the joint capsule; they vary in volume, size, and quantity, which affects the clinical picture.
Most common causes of pain
The most common causes of pain are injuries to the rotator cuff, the layer of tendons that surround the shoulder joint and are responsible for flexion, abduction, and internal rotation of the shoulder.
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The tendon of the supraspinatus muscle is most often damaged; when falling on the arm, it is partially or completely cut off on the acromial process of the scapula, less often the tendons of the infraspinatus and subscapularis muscles; a fracture of the greater tubercle of the shoulder, to which the tendon of the supraspinatus muscle is attached, causes similar symptoms. These injuries are accompanied by pain in the shoulder joint and shoulder, toothache-type pain at night; there were patients who could only sleep while sitting, holding the patient’s healthy hand. The range of movement in the shoulder is also often reduced, a person cannot raise his arm or comb his hair, but if the tendon is not completely torn, movement in the shoulder can be maintained in sufficient volume.
This is also caused by damage to the ligaments and capsule of the shoulder joint (Bankart injury, SLAP); in this case, pain and limitation of movements are accompanied by a feeling of instability in the shoulder joint, numbness in the arm, and repeated shoulder dislocations are common during normal everyday movements.
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Damage to the ligaments that secure the collarbone to the shoulder blade is also accompanied by pain and dysfunction.
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Similar complaints about the shoulder joint occur in people without injury. The disease gout (a disorder of uric acid metabolism) leads to the deposition of ossification in the area of the rotator cuff tendons and pain.
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Breast surgery is often accompanied by swelling, inflammation of the rotator cuff and surrounding tissues and, as a result, pain and impaired range of motion in the shoulder.
Patients with such complaints should consult an orthopedist
, who, after a detailed conversation and examination, will prescribe the necessary examination, most often this is radiography and nuclear MRI on a machine with a power of at least 1.5 Tesla, and will recommend coming for a follow-up appointment with the results of the examination.
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Shoulder injuries in athletes
SLAP injuries
A SLAP injury is an injury to the superior segment of the labrum of the scapula.
At this point, the tendon of the long head of the biceps muscle is attached to the labrum. Rupture of the labrum occurs posterior and anterior to the tendon. Typical symptoms of this type of injury are a feeling of joint locking and pain with certain movements. Pain in the depth of the shoulder joint and in some positions of the shoulder is also common.
In Fig. ( Left ) The labrum helps deepen the glenoid cavity of the scapula. ( Right ) A typical SLAP injury viewed from the articular surface of the scapula.
Tendinitis and ruptures of the biceps tendon
Sports activities involving constant throwing or throwing of sports equipment can lead to inflammation of the upper segment of the biceps tendon. This condition is called tendinitis. The most common symptoms of this condition are pain along the front of the shoulder joint and weakness of the biceps muscle.
Sometimes long-term inflammation of the tendon leads to its rupture. A tendon rupture occurs suddenly and is accompanied by severe pain in the upper part of the shoulder. Some patients feel or even hear a characteristic pop at the moment of rupture.
In Fig. ( Left ) The biceps tendon helps hold the head of the humerus in the glenoid cavity of the scapula. ( Right ) With tendinitis, the tendon becomes congested and swollen.
Tendinitis and rotator cuff tears
Excessive exercise can lead to inflammation of the tendons and muscles. Athletes often develop rotator cuff tendinitis.
An early symptom of this condition is pain radiating from the front of the shoulder joint to the side of the shoulder. Pain can appear at the moment of throwing, during other types of loads and at rest. As the condition progresses, pain begins to disturb at night, and patients note limited movement in the shoulder joint and decreased muscle strength.
A rotator cuff tear is often preceded by tendon separation. As it progresses, a full-fledged gap forms. When one or more tendons of the rotator cuff are damaged, the latter loses its connection with the head of the humerus. The most common muscle tear in throwing athletes is the supraspinatus tendon.
In Fig. Rotator cuff tears in throwing athletes most often occur through the thickness of the tendons. In some cases, the tendons may be torn from their point of attachment to the head of the humerus.
Problems with the rotator cuff often lead to the development of shoulder bursitis. A bursa is a fluid-filled cavity between the rotator cuff and the acromion of the scapula. The bursa ensures unhindered sliding of the tendons during movements in the shoulder joint. When the rotator cuff tendons rupture, the bursa also becomes inflamed and becomes a source of pain.
Internal impingement
When the arm is abducted to throw from behind the head, the rotator cuff tendons on the back of the shoulder joint can become pinched between the head of the humerus and the glenoid. This condition is called internal impingement. It can lead to partial tendon rupture. Internal impingement can also lead to damage to the labrum, causing part of it to detach from the glenoid.
Internal impingement may be associated with some instability of the anterior stabilizing structures of the shoulder joint, as well as excessive tension in the posterior anatomical structures of the shoulder.
In Fig. Muscles and tendons of the rotator cuff.
In Fig. Entrapment of the infraspinatus tendon between the head of the humerus and the glenoid cavity of the scapula.
Shoulder instability
Shoulder instability occurs when the head of the humerus loses contact with the socket of the shoulder blade (shoulder dislocation). A condition where shoulder dislocations occur repeatedly is called chronic shoulder instability.
In athletes, instability develops gradually over several years and is associated with the fact that constant throwing overstretches the ligaments of the shoulder joint and they lose their former strength. This weakness of the ligamentous apparatus is complemented by dysfunction of the rotator cuff tendons, which lose the ability to hold the head of the humerus in the glenoid cavity of the scapula, as a result of which at the moment of throwing it is slightly displaced relative to the glenoid cavity, i.e. Subluxation of the humeral head occurs.
Early symptoms of instability are pain and decreased throwing velocity, whereas the sensation of humeral head instability usually does not occur at this stage. Sometimes athletes note that their arm feels “numb.” For many years, shoulder instability was called “silent shoulder syndrome.”
Shoulder internal rotation deficit (GIRD)
As already mentioned, for a full high-speed throw, maximum external rotation of the shoulder is required, which, however, leads to stretching and a decrease in the strength of the ligaments of the anterior surface of the shoulder joint. A natural and common result of such movements in the shoulder joint will be excessive tissue tension along the posterior aspect of the shoulder joint, which will lead to limited internal rotation.
Restricted internal rotation increases the risk of labral and rotator cuff injuries in throwing athletes.
Impaired scapular rotation
Correct movement and rotation of the scapula relative to the chest wall is important for a normal throw. The shoulder blade is connected to the body through just one bone - the collarbone. Therefore, the correct position of the scapula is determined primarily by the work of several muscles of the upper back.
When throwing, repeated overuse of these muscles can lead to injury or other changes that affect the position of the scapula relative to the chest wall and increase the risk of injury to the shoulder joint.
Impaired scapular rotation is characterized by drooping of the corresponding shoulder girdle. The most common symptom is pain along the front of the shoulder joint, close to the collarbone.
In many athletes with this condition, excess tension in the chest muscles occurs in response to changes in the muscles of the upper back. Weightlifting and chest exercises may further worsen the symptoms of this condition.
In Fig. Asymmetrical position of the right scapula.
Treatment
The most effective way to solve these problems is through surgery. Modern endoscopic equipment makes it possible to perform such operations with minimal trauma, quickly, with a short hospital stay, good functional and cosmetic results; many of them are simply impossible to perform using classical surgery using incisions. Treatment with injections and tablets does not eliminate the problem, it simply masks it, and, especially after the use of hormonal injections, often makes it completely unsolvable.
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You should contact your doctor if your shoulder hurts for several days.
Headache during exercise
Some people experience headaches during exercise.
Many patients associate their appearance with an increase in blood pressure, which actually turns out to be slightly elevated with physical effort. However, it is known that blood pressure always rises during activity; this is a normal reaction of the body, but its increase does not always cause headaches. Both primary and secondary headaches occur during exercise. In primary cases, there is no connection with structural changes in the body; in secondary cases, diseases are identified, as a result of which pain occurs.
Primary exercise headache
Unpleasant sensations appear during physical stress and disappear after some time, usually 15-30 minutes after stopping the exercise. Occasionally, such pain can last up to 48 hours. They are most often pulsating in nature, bilateral. The onset of primary headaches associated with physical stress occurs at the age of 18-20 years, and they appear mainly in men.
Some experts associate their appearance with pain impulses from overstrained muscles and ligaments of the cervical spine. Others believe that pain during physical activity is caused by obstruction of venous outflow from the cranial cavity. If, during examinations of the brain and its vessels, no pathology is detected, then the patient is recognized as having primary headaches associated with physical activity. This variety is benign and does not pose a danger to humans.
Primary headaches that occur during physical activity do not always require treatment. It can go away on its own if you increase the load gradually so that the body adapts.
The drug indomethacin is effective for treatment and has a positive effect on many primary headaches. The daily dosage of the medicine is selected by the doctor; it ranges from 25 to 150 mg per day. In this case, it is necessary to take drugs that protect the stomach (omeprazole), since indomethacin can disrupt the protection of its mucous membrane from gastric juice. In many cases, these headaches go away on their own after 3-6 months.
Secondary exercise headache
Often headaches with physical effort make themselves felt by brain tumors, hematomas, and Arnold-Chiari anomaly (a congenital structural feature in which the size of the foramen magnum is larger than normal, so the cerebellum begins to descend through it). With these pathologies, during physical activity, the outflow of cerebrospinal fluid (CSF) from the cranial cavity becomes difficult, which causes pain.
When sharp headaches occur for the first time during physical exertion, it is necessary to exclude intracerebral or subarachnoid (blood flows under the arachnoid membrane of the brain) hemorrhage. With physical overexertion in people with atherosclerosis and arterial hypertension, the risk of rupture of cerebral arteries, vascular malformations (pathological additional vessels), and aneurysms (congenital protrusions of the vessel wall) increases.
In such cases, an urgent examination by a doctor and an MRI/CT scan of the brain are necessary. However, you should not decide to perform research on your own; this should be done by a doctor. If the diagnosis of hemorrhage is confirmed, the patient is sent to hospital on an emergency basis.
If an Arnold-Chiari anomaly is detected, decongestants that reduce the formation of cerebrospinal fluid are prescribed, or, in case of severe prolapse and compression of the cerebellum, the patient is referred to a neurosurgeon. When a tumor is detected, treatment tactics vary depending on the type and size of the tumor.
Where can I find a competent doctor who can help with headaches?
Residents of Saratov and the Saratov region can contact the Pain Treatment Clinic, which is located in Saratov at the address: st. Bakhmetyevskaya 26/28. You can contact the administrator by phone +7.
What you need to know about a shoulder injury
A shoulder bruise is most often caused by an unsuccessful landing during a fall or a strong blow from a hard object. You can also hurt your shoulder if you use sports equipment incorrectly in the gym. This injury can also be caused by a fall, a blow, or while playing sports. The signs by which such an injury can be recognized are severe pain in the shoulder at rest, which intensifies with sudden movements of the body or the affected upper limb. Immediately after a fall or blow, it is better to seek medical help, since it is important to differentiate a bruised shoulder from a bruised shoulder joint, as well as a dislocation, fracture and other injuries to soft or bone tissue. Incorrect treatment can lead to the development of complications of varying severity and increase the recovery period of the victim, so even in mild cases it is better to consult a doctor!
Symptoms of a shoulder injury
The main manifestations of a bruise are pain in the injured area, present in a calm state and intensifying with sudden movements. In severe cases, swelling, swelling and hematomas may occur.
A bruise in the shoulder area is distinguished from a bruise of the shoulder joint. In the first case, only soft tissues are injured; joint dysfunction is not observed. The second is obtained through direct impact on the joint, for example, when falling on an outstretched arm.
In both cases, the treatment is not particularly different, but the sensation of a shoulder joint injury may be accompanied by more intense pain.
Based on the severity of the manifestations, the following degrees of severity of bruises are conventionally distinguished:
First
Light bruises, abrasions and scratches, minor discomfort when moving your arm.
There is no need for specialized treatment, symptoms disappear on average after 3–4 days Second
Hematoma, severe pain in the damaged area, intensifying with movement, swelling may appear and body temperature may rise
Third
In addition to severe pain, hematomas are noted, dislocation of the shoulder joint, tendon damage is possible, ligaments
Fourth
Severe swelling of the injured area, which can spread to surrounding tissues, complete lack of sensation in the shoulder
First aid
The first thing you should do if you bruise your shoulder due to a fall or as a result of an impact is to examine the injured arm. If abrasions and scratches are found, they should be quickly treated with an antiseptic solution to avoid further infection.
Next, you need to try moving your fingers, hand and arm. If physical activity causes pain, but remains possible, you can fix your arm with a scarf, towel, scarf, etc. To do this, you need to bend your arm at a right angle at the elbow and secure it in this position with improvised material on your neck.
If the bruised area is very painful, you can use non-steroidal painkillers - Ketonal, Nimesulide and others. In the first 6–12 hours after a fall, it is recommended to apply cold compresses to the injury site.
It is important for the victim, even with a mild injury, to seek advice from a traumatologist in the future. In severe cases, first aid should be provided by a qualified physician.
Diagnostics
During diagnosis, an initial examination of the patient is carried out and symptoms are recorded. Also at this stage, the victim is questioned in detail about the incident that resulted in the injury, and it is noted whether he has any concomitant pathologies.
To avoid the development of complications, it is important to seek medical help in a timely manner.
Next, an external examination is carried out with palpation of the injured area - checking for bone fragments, joint deformation, bruises, scratches or loss of sensitivity.
If severe damage to muscles, joints, bones or ligaments is suspected, the patient is referred for additional instrumental studies, which include:
- Magnetic resonance imaging;
- CT scan;
- ultrasonography;
- angiography;
- arthroscopy;
- arthrography;
- X-ray.