Treatment of the shoulder joint, treatment of pain in the shoulder joint of the arm

The anatomy of the shoulder provides an impressive range in terms of joint mobility. It can rotate around three axes; such movements do not cause pain if there are no health problems. The shoulder in modern medicine is described as a ball-and-socket joint. It has a complex structure and is susceptible to various diseases. Treatment of the shoulder joint is prescribed for bursitis, arthrosis, sprained ligaments, tendons, inflammation, plexitis and other pathologies. The most common causes of pain are injuries and inflammation. For recovery, drug therapy, special orthoses, and physical therapy are used. In difficult cases, surgical intervention is resorted to.

What to do if your shoulder is bothering you

From an anatomical point of view, the shoulder area is a very complex biological mechanism. The joint is capable of full rotation, this makes it unique and one of a kind. When something goes wrong in the joint, the shoulder stops functioning normally. The injury can be serious or minor, and the degree of impairment will also vary. The main thing to understand is that pain always has a provoking cause. If nothing is done, the situation will worsen.

Treatment of pain in the shoulder joint of the arm due to periarthritis, impingement syndrome, osteoarthritis, tendinitis, and polyarthritis should begin as early as possible. Therapy should be selected by a doctor based on the results of the examination. Visit a traumatologist first; if necessary, he will refer you to other specialists for consultation. If you cannot immediately seek medical help, take a wait-and-see approach. Reduce current loads and give your shoulder a rest. You can use anti-inflammatory ointments (Voltaren, Menovazin, Bodyaga, etc.). If the situation does not improve within 2 weeks, be sure to go to the doctor.

The specialist will conduct an examination and ask you about your complaints. His main task is to find out what exactly is bothering the patient. It is likely that the problem lies not in the shoulder joint, but in the cervical spine. The discs between the vertebrae can become displaced and compress the nerve roots, causing severe pain. The syndrome spreads through the arm all the way to the fingertips. A characteristic sign that problems should be looked for in the back is a feeling of numbness and pain when there is no load. A neurologist treats such pathologies.

If the cause of pain is the condition of the joint, damage to anatomical structures, inflammation, discomfort will not affect the lower third of the forearm. You definitely need to make sure that the tendons are in order. Rupture of the long head often occurs in people involved in sports or simply active people. Tendons get damaged and ruptured even for no particular reason; do not forget that with age they become less elastic. If there are problems with the tendons, pain will appear when performing certain movements.

Make sure there is no damage to the so-called rotator cuffs. This is the name of a group of muscle tendons responsible for the mobility of the arm in the shoulder area. Patients begin to complain of pain that intensifies with physical activity at night. If the tendon is partially or completely separated from the bone, the function of the hand is preserved, but some movements cannot be performed. Only a doctor can make an accurate diagnosis after a comprehensive examination. The sooner you seek help, again, the better. Six months after a tendon injury, irreversible processes may begin, and it will no longer be possible to restore the functionality of the arm.

The feeling of instability is a consequence of injuries that are caused by rapid movements, improper exercise, falls and other similar factors. If you feel like your shoulder is sometimes popping out of its socket and hurting, this is a warning sign. Around the flat articular surface there is a cartilaginous lip - it resembles the edges of a plate. When one edge is “broken off” (damaged), the humeral head begins to slip out, causing pain to the person. The problem is damage to the bankart, most likely along with the tendons. Surgery is required for complete recovery. Do not waste time - the more often the humeral head is displaced, the greater the damage to the joint capsule and the more pronounced the pain. After a few years, arthrosis will develop and irreversible cartilage damage may occur. At this stage, surgery will not help; you will first need to restore the cartilage structures.

What can you do to help yourself if you have severe shoulder pain?

If you constantly feel severe pain, take action - you don’t have to run to the doctor right away, but you shouldn’t do nothing in the hope that the problem will solve itself. Home remedies and pharmaceutical preparations will help (many can be bought without a prescription). When there has been a serious domestic or sports injury or, for example, an accident, you should consult a doctor in any case. It would be better for him not to confirm your fears than for the situation to remain without proper attention, and the pathology of the shoulder joint will begin to progress if left untreated.

First self-help measures:

remove all stress on the joint;
immobilize the affected arm;
Apply cooling compresses regularly to the problem area.

You can take medications, including without a doctor’s prescription (although this is not recommended). For example, for severe pain in the limbs, you can buy anti-inflammatory non-steroidal drugs. They are used topically in the form of gels, ointments, or internally in tablets, drops, and powders. The most common options are Diclofenac, Ibuprofen. They will not only reduce pain, but also stop the inflammatory process, if any. Triggers for inflammation can be trivial hypothermia or drafts, so everyone is at risk.

When medical attention is required

Start with home treatment if you can’t see a doctor right away. But consultation with a specialist will still be required in the following cases:

severe stabbing pain;
increased temperature in the problem area, redness;
numbness in the hand that does not go away for several days;
restriction of mobility of the problem area;
traumatic injuries, development of chronic pain against this background;
clicking and crunching in the joint;
irradiation of pain to the arm, neck;
noticeable change in the shape of the shoulder joint.

Treatment of arthrosis of the shoulder joint , muscle damage of varying degrees, dislocations, and inflammation requires different approaches. Don't let the situation get worse.

Treatment of arthrosis of the shoulder joint

Treatment of arthrosis of the shoulder joint

is selected individually for each patient, taking into account the degree of the disease, the individual characteristics of its course, further prognosis and concomitant diseases.
If the process is secondary to the underlying disease (gout, diabetes mellitus, rheumatoid arthritis), then treatment of arthrosis of the shoulder joint
is carried out with the involvement of specialized specialists.

At stage 1, shoulder arthrosis can be completely stopped with the help of competent treatment and strict adherence to clinical recommendations. At stage 2, its development can be significantly slowed down with the help of complex therapy (physiotherapy, pharmacotherapy, exercise therapy, healthy lifestyle). At stage 3, with massive destruction of the joint architecture, most patients can only be helped by surgery.

Surgical treatment of arthrosis of the shoulder joint

At the last stage of arthrosis, irreversible changes in bone tissue occur, so to eliminate pain and restore mobility, doctors suggest installing an endoprosthesis. In this case, the diseased joint is replaced with a titanium or other implant.

Usually, surgery must be resorted to only in cases of advanced, untreated arthrosis. However, if the course of the disease is unfavorable and conservative therapy is ineffective, surgical solution may be the only solution even with full therapy. Such operations are carried out even at young and middle age.

After installation of the implant, the patient's condition improves significantly, but he must follow an orthopedic regimen. Despite their “endurance,” implants cannot 100% replace a healthy joint.

If the degree of arthrosis allows for minimally invasive intervention, the patient may be prescribed:

joint puncture (removal of inflammatory exudate followed by administration of the drug);
arthroscopy of the joint (“cleaning” the joint of osteophytes and fragments of dead tissue through a small incision).

Physiotherapy for arthrosis of the shoulder joint

Physiotherapeutic techniques alleviate the symptoms of arthrosis of the shoulder joint and the patient’s condition, and slow down the course of the disease. Some types of physiotherapy help destroy osteophytes, improve the delivery of drugs directly to the lesion, stimulate blood circulation and help maintain the volume of muscle tissue. They also have an indirect effect on the rate of regeneration of cartilage tissue, eliminate swelling and inflammation.

The most effective procedures for relieving symptoms of shoulder arthrosis include:

magnetic therapy;
laser therapy;
shock wave therapy;
electromyostimulation;
medicinal electro- and phonophoresis;
massage and manual therapy;
exercise therapy;
balneotherapy (especially turpentine, sodium chloride baths);
cryotherapy;
ozone therapy;
mechanotherapy.

Exercise therapy for arthrosis of the shoulder joint

Gymnastics for the treatment of arthrosis of the shoulder joint

includes mainly static exercises (when you need to stay in a given position).
Such exercises help strengthen muscles and ligaments and allow you to transfer the load from the sore joint (active movements in the joint can only injure it). Exercise therapy is used to treat arthrosis of the shoulder joint
only in a state of remission, i.e., in the absence of symptoms of inflammation. If you feel pain, stop doing gymnastics.

Smooth exercises for the shoulder complex, which are performed in a standing or sitting position, can be considered optimal. They should be performed daily, preferably 2-3 sessions a day, to provide relief to the joints. The exact set of exercises should be selected by a physical therapy instructor or a rehabilitation physician, taking into account the age, build, anatomical features and condition of the patient.

Diagnostic methods

To make a diagnosis, advanced hardware examination techniques are used. The most informative option in terms of assessing the condition of bones is radiography. If soft tissue needs to be checked, ultrasonography (or ultrasound) is prescribed. The technique allows you to assess the condition of the shoulder joint in motion, make sure that the injury has not affected the tendons, and that limitations in mobility are caused by swelling of the soft tissues or their damage. The accuracy of ultrasound diagnostics will depend on the quality of the equipment and the qualifications of the specialist. The cost of the method is affordable, which determines its high demand.

When, as part of an ultrasound examination, serious damage to the bones, cartilage, and rotor cuff was diagnosed, the doctor will refer you for an MRI. Magnetic resonance imaging will allow more accurate assessment of damage to deep cartilage and tendons. The method provides anatomical images of the shoulder joint, indicating exact distances to certain structures. This will help the orthopedist-traumatologist accurately plan the volume and course of the operation, and prescribe quality treatment.

When you are concerned not only about shoulder pain, but also about general weakness and other unpleasant symptoms, visit:

a cardiologist - he will rule out heart pathologies;
oncologist – malignant tumors cause severe pain;
gastroenterologist - sometimes shoulder pain comes from the gastrointestinal tract.

You can simply make an appointment with a therapist - he will determine the circle of specialists to whom you should contact first.

Possible pathologies

Shoulder pain can be caused by injuries, infections, tumors, and inflammation. Here is a basic list of possible problems in the presence of characteristic symptoms:

arthrosis - accompanied by the destruction of cartilage, as a result of which the structure of the joint changes, pain occurs when moving, inflammation;
arthritis – pain appears, mobility suffers;
osteochondrosis - in this case, the cervical spine, pathological changes in the structure of the spinal column lead to disruption of the functioning of nerve endings;
tendonitis - inflammation of the tendons and other soft tissues around the shoulder joint;
capsulitis – bones, tendons constantly press on the inflamed part of the joint capsule, pain occurs;
bursitis – inflammation around the joint, causing pain and discomfort during movement, often damaging the synovial protective bursa;
neuritis - an inflamed brachial nerve leads to problems with sensitivity of the limbs;
tumors - neoplasms negatively affect the degree of mobility, inflammation can spread to neighboring areas and require timely diagnosis.

Sometimes the destruction of cartilage begins against the background of serious hereditary pathologies - autoimmune nature, articular hypermobility, etc.

Symptoms of adhesive capsulitis of the shoulder joint

Shoulder capsulitis is quickly identified by the characteristic symptoms characteristic of each of the three stages of the disease.

The first stage - due to severe inflammation and the appearance of changes in the affected joint, sharp pain occurs, more often at night or with sudden movements. This condition lasts up to three months.
The second stage - the inflammation process weakens, but the resulting adhesion of adhesions and scars in the shoulder capsule limits and fetters the movements of the limb (it is difficult for the patient to raise his arm, although the elbow joint and hand work normally). This stage can last 4-12 months. If proper and effective treatment is started, the next stage begins.
The third stage is the beginning of the recovery stage. At this time, the mobility of the joint is gradually restored, the pain practically disappears, and the shoulder begins to function normally.

In total, adhesive capsulitis of the shoulder joint can last for several years. If treatment is started on time, the recovery process is significantly shortened and the mobility of the arm is restored, but if treatment is delayed, the shoulder may not function fully in the future.

Conservative therapy

The main method of treating pain in the shoulder joint. It involves mobilizing tendons, muscles, and working with a chiropractor. This will restore shoulder mobility and relieve Dupel syndrome (“freezing”). In the absence of contraindications, manual therapy is the most gentle and effective method.

Physiotherapy gives good results. It aims to stabilize the shoulder by restoring rings of tendons and muscles. Since shoulder pain occurs due to muscle imbalance, independent training, adequate rest, and normalization of metabolism will help.

In recent years, doctors have increasingly begun to use the method of regulatory biological therapy. It involves the use of advanced cellular technologies that are aimed at tissue restoration and relief of inflammation. Functional disorders and the consequences of injuries are treated as a result of exposure to a special vibrating device.

How is the procedure performed?

If there are no contraindications, your attending physician will obtain informed consent from you for the procedure. The puncture to prepare the fraction occurs in the supine position. The doctor treats your stomach with an antiseptic, anesthesia is applied to the sides of the navel (on both sides), then a solution of local anesthetic (Novocaine) is injected into the abdominal fat through a special needle. The fat is drawn through a thick needle into special syringes and spun twice in a centrifuge. If the volume of the resulting product (SVF, ACA) is small, it is diluted with autoplasma. Punctures on the abdomen are sealed with adhesive tape.

As of 2021, this is the only legal, officially registered technology for obtaining the stromal-vascular fraction in Russia. The method was developed and implemented by Arthrex, a world leader in the field of high performance sports medicine. We use only 100% original disposable consumables - Tulip lipoaspiration kit, double ACA-ACP syringes, Hettich Rotofix 32a centrifuge, sterile disposable linen.

ACA SVF contains a large number of regenerative factors such as adipose stem cells (AdSCs) as well as endothelial progenitor cells embedded in the extracellular matrix. They have the same properties as stem cells derived from bone marrow. They can differentiate into various tissues such as bone, fat, cartilage and muscle, and secrete large amounts of cytokines and growth factors that are involved in tissue regeneration.

ACA SVF can be mixed with PRP (autologous conditioned plasma) before application to the orthopedic site. ACP SVF combines both the proliferative effects of PRP and the regenerative potential of ACA SVF. This technology is excellent for the treatment of severe arthrosis and allows one to avoid joint replacement in many cases.

Workouts at home

There is special physical therapy that will help restore problem joints after injuries. If you are worried about hardening, problems with mobility, or pain, start doing exercise therapy. The exercises are simple and will not harm your health, but you must follow the instructions.

The complex includes:

Swaying - the arm hangs along the body, tension without loads is responsible for the movement of the heads of the humerus bones. With your healthy hand, rest against the back of a chair or table. Relax your sore shoulder, then lower it down and begin to swing it while hanging. Repeat circular movements with your hand. You can use weights - a water bottle or a small weight.
Shrugs – you need to move your shoulders alternately up and down. Sit or stand with your back straight. Raise your shoulders to your ears, move them slowly, then fix the position for 10 seconds, relax, lower your hands down, also wait 10 seconds. This is a light stretch that is ideal for restoring joint mobility; 10 repetitions are enough.
Stretching – You can do exercises on a door frame. Stand inside the doorway, rest your elbows on the door frames. Hands should be above your head. Bend forward there to feel a stretch in the front of your chest. Hold the position for about 30 seconds, maybe a little less, do 3 approaches. Stretching is contraindicated in the treatment of shoulder impingement.

Shock wave therapy: panacea or myth?

The shock wave therapy technique is used in the treatment of pathological changes in joints and cartilage; it is suitable for the treatment of shoulder pain. Shock waves are essentially high-energy sound waves that are specifically sent to the affected tissue areas. The liquid media of the body itself transfer the energy of wave impulses. Solid, foreign bodies are destroyed under the influence of shock waves.

The method helps with inflammation in the shoulder joint. It starts metabolism, causes mechanical irritation of tissues, and promotes their restoration.

Mechanism of action of PRP therapy

Plasma rich in platelets, after injection into the joint cavity, spreads evenly over the articular surfaces, reducing friction between the bones. Platelets concentrate in the cracks of the cartilage, as if filling them. Blood platelets contain many active substances that stimulate the regeneration of articular cartilage and restoration of its smooth surface.

When using stromal vascular fraction (ACA SVF), the patient's own stem cells obtained from his adipose tissue are injected into the joint capsule. These cells have the ability to transform into any other tissue depending on the environment. Once in the joint cavity, they are embedded in the structure of the cartilage, leading to complete restoration of the articular surface. Preparation of the stromal fraction is a more complex process than the creation of platelet-rich plasma, but the effect of such treatment is maximally long-lasting. In practice, we usually suggest a combination of PRP and ACA SVF to achieve the best results in the treatment of arthrosis. The cost of PRP therapy is significantly lower than the production of stromal vascular fraction, but the effect of their combined use is the best.

When is surgery indicated?

In case of severe injuries to the cartilage and tendons of the cartilaginous joint, surgical intervention is indicated. about the symptoms and treatment of the shoulder joint of the left and right shoulder in case of dislocations and ligament ruptures, but a comprehensive diagnosis is still required to confirm the diagnosis.

Arthroscopy

If a specialist recommends arthroscopy, you should undergo treatment. This is a minimally invasive method that gives good results. It involves the creation of 3 to 5 incisions up to 5 mm in length. Through these incisions, a small camera connected to a personal computer and an instrument are inserted into the joint. An experienced surgeon will be able to clear salt deposits, remove tissue compactions, and restore damaged muscles and tendons.

The technique is gentle, low-traumatic, and requires minimal rehabilitation. The incision sites heal quickly. Through the use of advanced technologies, the surgeon assesses the condition of the joint as accurately as possible, even in those areas that cannot be carefully examined during standard surgery. The operation using an arthroscope lasts no more than an hour and a half, usually less (it all depends on the complexity and extent of the damage). Performed on an outpatient basis, as part of a day hospital.

Minimal rehabilitation is required, but this does not mean that you can ignore your doctor’s orders. The patient is recommended to wear a scarf bandage for a month (sometimes a little more or less, taking into account individual indications). Afterwards, under the supervision of a therapist, therapeutic exercises may be prescribed. Rehabilitation takes up to 3 months; pain may be bothersome during this time. To fully restore mobility and eliminate unpleasant symptoms, it takes time - at least six months. You cannot put the usual loads on your shoulder immediately after surgery.

Open operations

Arthroscopy is not suitable for shoulder reconstruction for all patients, and you may have to undergo standard surgery. It involves creating a standard large incision - it will open up a field for the doctor to work on. The essence is the same as with arthroscopy, but the morbidity will be much higher, and the rehabilitation will be longer and more difficult.

Features of prosthetics

Arthrosis of the shoulder joint is usually treated conservatively with the use of painkillers and physical therapy. But sometimes more serious measures are needed. If the pain is severe, mobility is noticeably limited, and conservative therapy does not bring relief for a long time, doctors recommend implantation of artificial joints. Total and partial prosthetics are possible. In the first case, two surfaces of the joint are replaced with a prosthesis; in the second, the surgeon works only with the affected area of the joint, leaving other tissues untouched. In relatively simple situations, rodless prostheses are used; they help preserve the volume of bone tissue as much as possible.