Treatment of shoulder tendinitis [symptoms and diagnosis]

What is shoulder tendinitis?

The main function of the tendons is to strengthen the socket of the scapula and the head of the humerus. In turn, the muscles located here are responsible for the motor activity of this area. There is also a tendon here, which is involved in the processes of extension and flexion of the limb. And in the area of the articulation of the clavicle and the oblong process of the scapula, the acromioclavicular joint is located.

In case of injury, excessive loads and increased tension, the gap between the joints is reduced, as well as damage to the shoulder cuff by the acromioclavicular joint. In the area of ruptures, cell death occurs, which contributes to the release of substances that cause inflammation. In addition, metabolic processes deteriorate in the affected area, swelling occurs and fluid secreted by inflamed tissues accumulates. Also, this area is characterized by the appearance of a sudden pain syndrome and limitation of movements, which is considered to be a consequence of irritation of the nervous tissue.

This process involves: muscles, the joint capsule and the inner lining of the tendon sheaths. It's called calcific tendonitis of the shoulder.

The most undesirable consequences include the destruction of tendons and the replacement of functional tissue with non-functional tissue. This can occur as the patient reduces the load on the joint and the appearance of adhesions in the area of damage. In this case, tendonitis of the shoulder joint is transformed into tendinosis.

Shoulder myalgia symptoms

Pain in shoulder myalgia, in particular in the presence of myofascial pain syndrome, is often described by patients as aching, dull, tight, boring pain, which can intensify with load on this muscle, and in some patients it can manifest itself in sleep, when the impact occurs in a certain position to a trigger point in the muscle. A trigger point is a compaction of muscle fibers, which, upon palpation, is felt as a dense muscle cord or as a dense round formation and is accompanied by severe pain. Pain can manifest itself at a specific point (localization can be indicated with a finger), or it can be reflected; in this case, trigger points located in different muscles have certain zones where pain can spread.

Often, myalgia in the shoulder area is accompanied by a functional limitation of active movements in the limb, for example, it is painful for the patient to move his arm to the side beyond a certain degree.

The muscles most commonly presenting with localized or referred pain in the shoulder area.

Scalene muscle. Although the anterior scalene muscle belongs to the muscles of the neck, the pain from the trigger point located in it spreads to the upper limb. In this case, characteristic spread paths are noted: along the anterior and posterior surfaces of the shoulder girdle, the upper medial edge of the scapula, the outer surface of the shoulder and forearm, and onto the thumb and index fingers.

In the figure, the areas of most intense pain are marked in red. Spasm of these muscles can lead to a feeling of stiffness and limited movement in the cervical spine. The cause of tension in the flattering muscles can be, for example, carrying heavy bags in the hands, a prolonged cough, lung pathology that requires the inclusion of auxiliary respiratory muscles (chronic obstructive pulmonary disease, bronchial asthma).

A neurovascular bundle passes between the anterior and middle scalene muscles, and spasm of these muscles contributes to pinching of the bundle, which will manifest itself in the form of numbness, a tingling sensation, which is most pronounced in the hand, especially after physical work with this hand. This pathology is called scalenus syndrome or scalenus syndrome.

Pectoralis major and minor muscles. The localization of the trigger point in the clavicular part of the pectoralis major muscle and the pectoralis minor muscle are manifested by similar symptoms, namely: the reflected pain is localized along the anterior surface of the shoulder joint (the area of greatest pain intensity is indicated in red in the figure). Active movements that cause tension or stretching of these muscles, especially when lifting a weight forward with an outstretched arm, can increase pain; also, when sleeping in a prone position, trigger points can be affected, which leads to the occurrence or intensification of pain and frequent awakenings. There may be limited movement of the arm moving to the side.

When trigger points are localized in the left pectoralis major muscle, the pain can imitate angina attacks and a feeling of tightness in the chest.

With severe hypertonicity of this muscle, infringement of the lateral trunk of the brachial plexus and axillary artery often occurs, which is manifested by impaired sensitivity along the inner surface of the shoulder, forearm, ring finger and little finger.

One of the main causes of myofascial syndrome in these muscles is incorrect posture: a slouched back, in which the shoulders move forward, which leads to shortening of the pectoral muscles.

Infraspinatus muscle. With myofascial syndrome of the infraspinatus muscle, pain is localized in the anterior, lateral and posterior surfaces of the shoulder joint, and can descend along the anterior surface of the shoulder. The pain is often characterized as deep, feeling inside the joint (the places with the most intense pain are indicated in red in the figure). Patients note difficulties when servicing the posterior hemisphere of the body: it is difficult to wash the back, fasten the bra lock; attempts to comb your hair or brush your teeth cause sharp pain in the shoulder.

Coracobrachialis muscle. Referred pain in the presence of trigger points in this muscle is localized along the anterior surface of the shoulder joint and spreads down the outer surface of the shoulder, dorsum of the forearm and hand. The pain, as in the case of the infraspinatus muscle, will intensify when the arm is moved behind the back. Trigger points in this muscle, as a rule, appear secondary, i.e. in the presence of active pain points in the muscles adjacent to it, inflammation of the tendon of the head of the biceps, pathology of the shoulder joint, etc.

Factors Causing Shoulder Tendonitis

In 80% of situations, calcific tendinitis of the shoulder joint is due to increased physical activity and injuries that occur during it.

In some cases, inflammatory processes in the tendon area appear against the background of:

Congenital abnormal development of joints;
Infection caused by bacteria entering from the affected area or through a wound;
Rheumatic pathology caused by the deposition of uric acid salts;
Deficiency of sex hormones during menopause;
Forced limitation of shoulder motor activity in the postoperative period;
Dystrophic disorders in articular bones and cartilage of a chronic nature;
Diseases characterized by pathological production of autoimmune antibodies;
The use of certain hormonal agents (Hydrocortisone, Prednisolone).

Factors that can lead to rotator cuff tendonitis :

Persons over the age of 45 years (the risk of developing pathology doubles, which is due to the loss of tissue elasticity and strength);
Professional factor (people involved in sports activities; representatives of the construction profession; loaders; dancers);
Deterioration of the immune system (after viral infections, stressful situations, during pregnancy, etc.);
Exposure to thermal irritants (hypothermia);
The influence of hormonal factors (during menopause).

Symptoms of shoulder tendinitis

As a rule, shoulder tendinitis has symptoms similar to other pathologies in this area, and treatment does not always give the desired effect. This especially happens when pain radiates to nearby areas.

However, there are specific features that make it possible to clearly judge the presence of tendinitis of the supraspinatus tendon of the shoulder joint. This is a pain syndrome that:

Considered the main symptom of the disease;
It appears when making movements: if the patient puts his hand behind his back or raises it up;
Has a short-term and dull character;
Irradiates from the tendon to the muscles;
It worsens at night, when changing body position;
Accompanied by severe discomfort when palpating the affected area;
Has clear localization and does not spread to distant areas;
Localized mainly in the anterior upper part of the limb.

Increased symptoms of the disease and its rapid development are associated with excessive stress. Moreover, even despite the pain and limitation of motor activity, a person remains able to perform passive movements.

When the inflammatory process intensifies, the following may occur:

Rising temperature in the affected area;
The appearance of redness on the skin;
Suppuration - in rare cases;
Minor swelling.

If there is chronic tendinitis of the shoulder joint, then this process may be accompanied by the appearance of calcareous deposits in the tendons. In this case, a characteristic crunch and creaking occurs, the muscles become sluggish, and significant stiffness is felt when moving.

Etiology

Inflammation is a complex pathophysiological reaction that develops as a result of tissue damage. In the area of the pathological process, cells of the immune system accumulate, which produce certain biologically active compounds (prostaglandins) that respond to the characteristic manifestations of the inflammatory reaction (pain, tissue swelling, hyperemia). The main provoking factors leading to inflammation are:

Intense physical activity on the shoulder.
Previous injuries that affect the cuff to varying degrees (fall on an outstretched arm, bruise, dislocation, fractures of the upper third of the humerus).
Infectious inflammation, which is the result of the activity of pathogenic (disease-causing) or opportunistic microorganisms.
Aseptic inflammation developing against the background of local hypothermia in the shoulder area.
An autoimmune process is a pathology of the immune system in which antibodies are “erroneously” produced to one’s own tissues, in particular the structures of the musculoskeletal system.
Degenerative-dystrophic processes in which the nutrition of the tissues of the structures of the musculoskeletal system is disrupted, leading to their destruction with the subsequent development of an inflammatory reaction.

After the doctor has diagnosed tendinitis of the supraspinatus tendon, treatment is prescribed taking into account the causes that led to the inflammation.

Types, stages and forms of shoulder tendonitis

To determine the type of pathology, the localization of the source of inflammation should be taken into account. Most patients are diagnosed with supraspinatus , and treatment in this case should be aimed at strengthening the tendon.

There are also the following types of pathology:

Tendinitis of the head of the biceps shoulder joint . Localized in the tendon area between the shoulder and biceps muscle;
Tendinitis of the rotator cuff tendon . Provokes pain and inflammation in the immediate vicinity of the cuff. Usually occurs against the background of increased physical activity.

There is another type of disease - calcific tendinitis of the shoulder joint, which is identified as a separate item, and the treatment of this disease should be selected taking into account its form:

Reactive. The deposition of calcifications is caused by injury, infections and excessive physical exertion;
Degenerative. The accumulation of calcium salts is associated with age-related factors and deterioration of blood flow in the joint area.

The above form of the disease is characterized by three stages of development:

1. Precalcification. The conditions for the appearance of calcium deposits are formed under the influence of risk factors.

2. The appearance of calcifications. Calcium crystals enter the tendon fibers and settle.

3. Postcalcification. Characterized by the replacement of tendon tissue with scar fibers.

Moreover, there is chronic tendinitis of the shoulder joint, and its acute form , which necessitates treatment adjustments.

diagnostics

Diagnosis
Regardless of origin, most diseases of the shoulder joint components have a similar clinical picture. Reliable determination of the extent of changes is carried out using various modern imaging techniques (X-ray, tomography, arthroscopy, ultrasound). To find out the cause of inflammation, a laboratory test is prescribed.

Based on the results that make it possible to establish a diagnosis of tendinitis of the supraspinatus muscle of the shoulder, treatment is prescribed by an orthopedic doctor. In case of autoimmune pathology, diagnosis and prescription of therapeutic measures is carried out by a rheumatologist.

Symptoms at different stages of shoulder tendinitis

Initially, signs of the disease appear exclusively when the load on the shoulder joint increases. A person develops a pronounced pain syndrome, which goes away on its own after relaxation.

As the disease progresses, discomfort increases even with the simplest movements of the limb. This stage is characterized by difficulty raising the affected arm, taking a shower, combing hair, and putting on clothes.

In advanced stages of the disease, even slight movements of the hand are difficult for the patient.

If at the initial stages pain occurs in paroxysms, then over time they can become more prolonged (up to 8 hours in a row) and radiate to other organs - to the elbow or forearm.

We described in detail the characteristic symptoms of tendinitis above. In case of a chronic process, the following signs are added to the indicated symptoms:

The appearance of multiple scars under the skin;
The appearance of a crunching sound when making movements;
Feeling of stiffness in the joint area.

It should be noted that if a patient is diagnosed with tendonitis, then bursitis of the shoulder joint may be detected at the same time. As a rule, these pathologies appear during the same period. In case of tendon rupture, the patient is given a more serious diagnosis - tendinosis.

Diagnosis of shoulder tendonitis

If tendinitis of the shoulder joint occurs, the success of treatment largely depends on the accuracy and timeliness of diagnosis of this pathological process. At the same time, in order to establish the specific form of the disease, it is imperative to undergo laboratory tests and perform a thorough examination of the patient. The disease can also be detected using the following diagnostic methods:

Ultrasound of the shoulder joint;
Magnetic resonance imaging;
X-ray.

A prerequisite for identifying metabolic pathologies and rapid recovery of the patient is a biochemical blood test.

All the above studies are carried out in honey. In this case, innovative technology is used, and highly qualified specialists are involved in deciphering the test results. This allows you to quickly diagnose the disease, correctly draw up a treatment plan and eliminate the occurrence of complications.

Types of treatment for glenohumeral periarthritis

The effectiveness of therapy largely depends on how correctly the cause of the disease has been identified. For example, if the inflammatory process started as a result of osteochondrosis of the cervical spine, then in addition to standard anti-inflammatory therapy, agents are used that improve the nutrition of nerve fibers and relieve muscle spasms.

The main task in the treatment of glenohumeral periarthritis is to relieve inflammation of the periarticular tissues and improve mobility in the joint.

They usually start with non-steroidal anti-inflammatory drugs orally and locally, in the form of ointments. Most often prescribed:

diclofenac;
piroxicam;
ketoprofen;
meloxicam;
Celebrex.

For a mild form of the disease, this may be sufficient.

Blockades with diprospan have a good effect. They have a powerful anti-inflammatory effect and are applied to painful points near the joint.

The effectiveness of injections in the treatment of glenohumeral periarthritis can be increased by using other therapeutic measures in parallel with them - in particular, kinesiotaping, special exercises aimed at improving joint mobility, and physiotherapy.

Limiting the load on the affected joint is also an important step towards recovery.

Treatment of shoulder tendinitis

To figure out how to cure tendinitis of the shoulder joint, it is necessary to take into account the factors that provoked the development of the pathological process, as well as its form and stage of development. For example, if you have been diagnosed with tendinitis of the supraspinatus muscle of the shoulder joint, and you do not know how best to treat it, then you should turn to the causes of the disease. If it was provoked by injury, then the only correct solution would be surgical intervention, as in the case of detection of adhesions in this area. In mild forms of the pathology, you can completely resort to conservative therapy.

However, in almost all cases of shoulder tendonitis, treatment involves limiting your physical activity for a certain period of time. In this case, a special splint or bandage is used to fix the limb. To relieve pain when injured, ice is applied to the injury site.

SWT for the treatment of shoulder tendinitis

Many patients are interested in: “How to treat shoulder tendinitis without surgery?” Indeed, today such a possibility exists: an excellent restorative effect is achieved using shock wave therapy. This is a modern way to eliminate most ailments associated with dysfunction of the musculoskeletal system.

The effectiveness of this newest method is aimed at achieving the following results:

Relief and complete elimination of pain;
Crushing of calcium deposits in tendons;
Activation of metabolism;
Normalization of the blood circulation process;
Complete elimination of inflammation;
Restoring motor activity and healthy tissue.

Lasting healing results are monitored from the first sessions of shock wave therapy. Moreover, their frequency and intensity are determined individually. Also, the effectiveness of the procedure in 90% of situations is influenced by the timeliness of visiting a specialist.

At the Health Plus clinic, shock wave treatment is carried out using innovative Swiss equipment, under the guidance of experienced neurologists and physiotherapists, and at competitive prices. We also provide a 20% discount on the initial visit to a specialist.

Read more about treatment of tedinitis with UVT »

Drug treatment for shoulder tendinitis

If you have shoulder tendonitis, treatment with medication is an integral part of a speedy recovery. In this case, non-steroidal drugs are used, the action of which is aimed at relieving pain and eliminating the inflammatory process. In the normal course of the disease, experts recommend taking medications in tablet form; in case of severe injury, injections are prescribed.

The best effect can be obtained by taking Diclofenac, Ketoprofen, Meloxicam and Ibuprofen for one week. Also, to relieve discomfort, you can use special ointments with anti-inflammatory and analgesic components (Nise-gel, Voltaren, Diklak, etc.).

In severe forms, it is recommended to give injections in the area of tendons and muscles with the following drugs:

Dexamethasone;
Kenalog;
Hydrocortisone.

If there are concomitant diseases associated with infection and inflammation of the joints, or elevated blood sugar levels, they are initially treated. Otherwise, it will be impossible to get rid of the symptoms of tendinitis.

Physiotherapeutic methods

Mandatory measures to eliminate the above pathology include physiotherapeutic procedures. With their help, it is possible to normalize blood flow in the affected area, as well as enhance metabolism in damaged tissues and the surrounding area.

At the same time, electromagnetic radiation provides a special positive effect: the process of tissue restoration in the affected areas is accelerated and pain is relieved. Magnetic therapy has a similar effect on the patient, which is allowed even in severe stages of the disease.

Another effective treatment method is laser therapy. Through the use of such innovative techniques, it is possible to quickly relieve discomfort in the limb and increase metabolism.

To enhance the therapeutic effect, the patient may be prescribed phonoresis or electrophoresis, during which the following drugs are recommended:

Corticosteroids;
Anesthetics;
Analgesics;
Non-steroidal anti-inflammatory drugs;
Angioprotectors.

If the patient is indicated for shock wave treatment, then to achieve a lasting effect it is necessary to undergo 8-10 sessions over four weeks. This will eliminate swelling, as well as deal with calcium deposits and adhesions in the tendon area. Paraffin therapy and medicinal baths also allow you to get the desired anti-inflammatory result.

Treatment of shoulder tendinitis with folk remedies

To quickly achieve a healing effect for tendinitis of the shoulder joint, you can resort to treatment with folk remedies. However, such measures should only be implemented in addition to the basic procedures. Next, we will talk about the most popular home remedies for eliminating the disease. These include:

To achieve a powerful absorbent effect, it is recommended to use chopped raw potatoes. For this purpose, the finely grated mass is placed in a cloth and applied to the lesion for 3 hours;
For rubbing, use a mixture of crushed garlic and eucalyptus oil. The above components are preheated in a water bath and left to infuse for 24 hours;
A mixture of sea salt and onion juice is ideal for massage;
To ensure an anti-inflammatory effect, a small amount of turmeric should be added to your daily diet;
To relieve puffiness, it is useful to regularly consume bird cherry berries;
A particularly positive result can be obtained by rubbing the affected area with an infusion of walnut partitions (50 g of partitions are infused in 1 glass of vodka for 10 days).

Exercise therapy for shoulder tendinitis

In any situations associated with inflammatory processes in the tendon area, it is recommended to undergo a complex of exercise therapy. In this case, only small loads are allowed, which eliminates the possibility of deterioration of the patient’s condition. As a rule, the physiotherapist offers the patient a program developed individually and monitors the exercises at the initial stage.

In general, exercise therapy for shoulder tendonitis includes the following set of exercises :

Place both hands on the ends of the towel draped over the bar. Pull it with your healthy limb, carefully lifting the damaged one;
The palm of the damaged arm is placed on the biceps muscle of the healthy arm, smoothly raising the elbow upward;
Take a gymnastic stick, grasp it with both limbs, place it in front of you and perform circular movements clockwise;
Place your hands in a lock and carefully lift them, fixing them in front of you;
Make movements with the affected limb similar to a pendulum.

In case of exacerbation of the disease and deterioration of the patient’s condition, the exercises recommended for tendinitis of the shoulder joint must be temporarily suspended. If the undesirable manifestations go away, the course of exercise therapy can be repeated.

If you have completed standard activities, and the question is: “How to treat shoulder tendonitis?” remains relevant and you continue to be bothered by discomfort, stiffness and swelling, the only effective method will be surgical intervention. As a rule, in such situations, an arthroscopic puncture is performed, which does not require a long recovery period.

Shoulder pain treatment

1. Tendopathy (tendonitis) of tendons

rotator cuff (shoulder rotators)

The unique anatomy of the shoulder joint provides high mobility of the arm in all planes, including 360-degree circular movements. Knowledge of anatomy and functional features will help to understand the cause of diseases that affect the shoulder joint. In its structure, it is simple, consisting of 2 bones and a complex spherical joint. The large, rounded head of the humerus touches the small, flat glenoid cavity of the scapula. The diameter of the head is 3 times the diameter of the glenoid cavity. This discrepancy between shape and size provides a wide range of movements. The strength and stability of the shoulder joint is given by the elastic capsule and the articular lip located in the scapular cavity - cartilage, the curved edges of which extend beyond the boundaries of the bed and cover the head of the humerus.

Stability and mobility are achieved through the tendon-muscular system of the shoulder joint (rotator cuff or shoulder rotators). The main function of the rotator cuff is to center and press the large head of the humerus against the small glenoid cavity of the scapula.

The rotator cuff contains tendons from several muscles.

1. Supraspinatus muscle.

2. Infraspinatus muscle.

3. Teres minor muscle.

4. Subscapularis muscle.

All of them carry out movements in the shoulder joint (flexion, extension, abduction, rotation).

Tendopathy is a degenerative tendon. Tendinitis is inflammation of the tendons. With rotator cuff tendinitis, the ligaments of all the above muscles are affected almost simultaneously or sequentially. Options are possible with different pathological processes occurring in different tendons.

Causes:

There are several groups of people at risk:

· Athletes who constantly strain and injure the shoulder joint (tennis players, swimmers, water polo players, etc.).

· Workers whose professions involve constant tension with their arms raised above their heads.

· People who are forced to wear plaster casts for a long time, limiting movement in the shoulder joint.

· Patients with cervical osteochondrosis.

· Women over 50 years old.

· Persons with diseases of the endocrine system (diabetes mellitus, thyroiditis).

· Patients with poor posture.

Forms of pathology and clinical picture

There are several variants of pathology. They are divided according to the principle of localization and the nature of the processes.

Based on localization, there are general (covers the entire ligamentous apparatus of the rotator cuff) and local tendinitis (separate groups of ligaments are affected).

Depending on the nature of the disease, there are several options.

· Post-traumatic. Classic inflammation of the tendons is associated with their damage (microtears of altered tendons under loads, which subsequently “heal” poorly).

· Classic inflammatory variant. Characterized by common tendon inflammation.

· Calcifying variant. Inflammation occurs

in those tendons that have undergone calcification (deposition of calcium salts). Most often it occurs after prolonged immobilization and in old age.

In form, all the types of inflammation described above can be acute or chronic. It all depends on the duration of the inflammatory process.

The clinical picture of the disease is dominated by pain in the shoulder joint. It is associated with hand movements in any plane. At rest, it lasts much longer than other shoulder pathologies.

When palpating the shoulder, tendon nodules and pain are detected. During the calcification process, every movement is accompanied by crunching and creaking.

Diagnosis and prognosis

Diagnosis of the disease consists of a combination of the clinical picture and data from laboratory and instrumental research methods.

MRI examination is the main diagnostic method that allows us to clarify the nature and extent of the pathology.

The presence of pain during movements in the shoulder joint with simultaneous signs of inflammation (determined by a general blood test) are factors for tendonitis. The characteristics of pain during various movements make it possible to suspect the nature of the damage to certain tendons.

2. Subacromial bursitis.

Subacromial bursitis is a particular manifestation

inflammation of the periarticular bursa located under the acromion (the process of the scapula above the shoulder joint). It occurs most often in young and active people. Most often, it affects male athletes (volleyball players, water polo players, basketball players) and workers whose professions involve a constant forced position of tense arms above the head.

Causes and pathogenesis

Subacromial bursitis in 99% of cases has previous causes:

· injuries;

· loads.

Very rarely (no more than 1% of all patients with bursitis) the disease occurs for no reason.

More often, damage can be the result of injury or prolonged physical activity. The latter lead to disruption of the blood supply to the bag. As a result, they lose their barrier function and their permeability increases.

Clinical picture and diagnosis of the disease

The leading symptom of the pathology is pain when trying to raise the arm above shoulder level. There is no weakness in the muscles surrounding the joint. In the lowered position of the arms, the person does not experience any pain.

In the absence of treatment and as the pathology develops (with severe inflammation), pain can develop when moving the arms to the sides of the body below shoulder level. Only advanced inflammation can lead to redness of the skin over the shoulder joint.

Diagnosis of subacromial bursitis consists of a clinical picture, examination and a number of laboratory and instrumental research methods.

Upon examination, it should be noted that the range of motion in the shoulder joint is limited precisely because of the pain factor. To do this, a so-called Nir test is performed. Why measure the amplitude of active movements in a sore joint? After this, lidocaine is injected into the subacromial bursa (in the absence of allergies, of course). After a few minutes, repeat the amplitude measurement. She meets the standards. Which is proven by the fact that the limitation of range of motion is associated only with the pain factor.

Of the general clinical laboratory tests, a complete blood count is important. It allows you to identify the inflammatory process (increased number of leukocytes and accelerated ESR). It can also be used to judge the effectiveness of treatment.

Among instrumental methods, MRI has an advantage. It allows us to identify not only the expansion of the cavity of the bag and the presence of effusion (inflammatory contents) in it, but also the condition of the tendon-capsular apparatus of the shoulder joint. This will allow us to determine treatment tactics.

3. Biceps tendonitis

(biceps brachii)

The hand is the most important organ of the human body.

Therefore, any pathology is not only a medical, but also a social problem. One of the most common pathologies is tendonitis of the biceps brachii tendon.

Causes

The causes of tendinitis are inflammation of the tendon. It can develop as a result of the following conditions:

shoulder injuries;

· sprain due to forced position of the arms or loads;

· impingement syndrome (incarceration of the tendon between the head of the humerus and the process of the scapula).

Among the patients, athletes predominate - swimmers, tennis players, athletes (shot throwers, discus throwers and javelin throwers). The disease is also common among manual workers, which involves constant straining of the arms when lifting them above shoulder level.

The last reason is most often characteristic of men aged 40 to 50 years. This is primarily due to the fact that this age group still remains highly active. At the same time, the elasticity of the tendons and the amount of synovial fluid in the subacromial bursa are already reduced. In addition, they often (if there has been inflammation of the joint in the past) already have bone growths in the acromion area.

Clinical picture

Tendonitis is characterized by pain along the front of the shoulder. They spread along the biceps muscle up to the elbow bend.

Pain occurs when lifting heavy objects and bending the arm at the elbow joint. They also prevent you from raising your arms above shoulder level. The character is dominated by aching pain, which has a clear connection with movement. The pain goes away with rest.

With instability of the biceps tendons, active movements of the arm are often accompanied by clicking sounds in the shoulder area. They are felt by the patient himself, but can be heard by others.

If left untreated, long-term tendinitis often leads to rupture of the biceps tendon. This is a direct path to disability and surgery. A sure sign of a tendon rupture is a displacement of the biceps towards the elbow. This is very clearly visible when you try to tension it. Many people feel a click just before the rupture.

Diagnostics

Making a diagnosis requires a thorough history taking, examination and a series of instrumental studies. The pathology has very nonspecific symptoms, and therefore requires differentiation from a number of other lesions of the shoulder joint.

The following are widely used as instrumental methods.

· Radiography. It allows you to detect the presence of fractures of the process of the scapula or even the humerus itself. Since they are undoubted signs of the traumatic nature of tendinitis. If the x-ray shows various bone growths, then this is most likely a long-term disease.

· MRI. Non-invasive and harmless method. It allows you to see the condition of the tendons themselves and the underlying tissues.

· Arthroscopy. It is carried out through a small puncture into the joint cavity. The method allows not only to accurately diagnose the nature of the pathology, but also to carry out treatment.

It is important to take into account the fact that without timely contact with a specialist, tendinitis almost always leads to disability.

4. Impingement syndrome of the shoulder joint

Impingement syndrome is a condition in which the rotator cuff tendons and biceps tendon are pinched between the acromion and the humerus (its head).

The rotator cuff is a complex of tendons of several muscles that provide strength and rotation to the shoulder joint.

· Supraspinatus muscle.

· Infraspinatus muscle.

· Round muscle.

· Subscapularis muscle.

When raising the arm above the head, the space between the head of the humerus and the acromion process decreases by almost 2 times. Normally, even with strong contraction, infringement does not occur.

Causes

The syndrome develops in the presence of a number of preceding factors.

1. Constantly raising the arm above the head and straining it.

2. Traumatization of the shoulder joint.

Both processes trigger a chronic inflammatory process in the subacromial space. As a result, the growth of bone growths (osteophytes) is stimulated. Over time, they narrow the subacromial space. In addition, osteophytes disrupt the smoothness of the space between the joint and the process. All this creates conditions for tendon pinching in the subacromial space.

Clinical picture of the syndrome

The syndrome is accompanied by pain in the shoulder area. At first, they look like slight discomfort when raising your arms above head level. Later, real pain syndrome develops. Aching pain. They occur when you raise your arms to the level of the shoulder girdle.

Without treatment, bursitis of the subcaromial bursa quickly joins the syndrome. The pain becomes constant with any movement of the arms. Of course, when it rises to shoulder level and above, they become stronger.

Diagnostics

The presence of pain is a nonspecific sign. But its combination with the results of a number of instrumental methods allows you to accurately determine the diagnosis and treatment tactics.

Therefore, the gold standard for diagnosing the syndrome is a combination of several methods:

· survey;

· collection of data on the development of the disease and the presence of risk factors (age, professional and sports activities);

X-ray and MRI of the joint.

The syndrome is characterized by a connection with movement. Infringement occurs precisely at the moment of raising the arm above the level of the shoulder girdle.

X-rays show a narrowing of the subacromal space and the presence of osteophytic growths.

MRI allows you to visualize structural changes in muscles, ligaments and tendons.

5. Adhesive capsulitis

The disease is a slowly progressive growth of fibrous (a type of connective) tissue in the joint cavity. Traditionally, the pathology refers to the shoulder joint, so its name is omitted in the designation of the disease.

Mostly women suffer from it. They account for about 80% of cases of the disease. With equal frequency, pathology can occur in both the left and right shoulder joints.

Etiology and pathogenesis

For reasons of development, adhesive capsulitis can be of two types.

· Primary. Occurs in a completely healthy joint. The causes of the pathology are not known.

· Secondary. The disease develops against the background of a number of diseases:

diabetes;
myocardial infarction;
stroke;
surgical interventions on heart vessels;
thyroid disease;
malignant processes.

The leading factor in the development of the disease is the formation of collagen threads from which fibrous tissue is gradually formed. It gradually fills the joint cavity, which leads to its reduction. This leads to a decrease in the range of motion of the arm in the shoulder joint.

Clinical picture

The clinical picture of the disease is characterized by clearly defined phases. Signs of pathology are individual for each patient.

1. Initial phase. Lasts from 1 week to 1 year (the reasons for this variation in the primary disease are unknown). Most often, the period does not exceed 3-4 months. During this period, there is a gradual increase in pain in the affected joint. They are not associated with movements in the “sick” hand. Often occur at night (especially after lying for a long time on the side of the affected joint).

2. Stiffness phase. Duration is up to 1 year. But most often the period ranges from 4-6 months. The phase is characterized by a gradual decrease in pain with a simultaneous increase in stiffness in the affected joint. In the final stage, there is almost complete immobilization of the shoulder joint.

3. Resolution phase. The duration of this period is about 1 year. But it strongly depends on the first phase. The longer the pain period lasts, the longer the recovery takes.

The total duration of the disease is from 2.5 to 3 years. In the end, in the absence of treatment, 99 out of 100 patients remain with partial limitation in movements. The recovery period without intervention is extended to 4 years. Accordingly, the risk of lifelong disability increases.

Diagnostics

To diagnose a disease, its symptoms, examination and some diagnostic methods are of key importance.

When interviewed, the patient can quite clearly say (with an accuracy of 2-4 weeks) about periods of pain and stiffness in the affected joint. If a patient first approaches in the last phase of the disease, he most often talks about pain in the joint, which then gave way to stiffness.

Upon examination, you can see a simultaneous decrease in the amplitudes of active and passive movements in the shoulder. Moreover, during the second phase the patient does not experience pain at all when attempting passive movement. They are significantly limited

At the very beginning of the second phase, thinning of the deltoid muscle over the affected joint becomes noticeable. Outwardly, this looks like a smoothing of the shoulder relief.

Among the diagnostic methods, ultrasound and magnetic resonance imaging may be valuable. They are non-invasive and allow detection of thickening of the joint capsule, intra-articular and periarticular changes.

6. Arthrosis of the acromioclavicular joint

Arthrosis of the acromioclavicular joint is a degenerative disease of the joint of the same name. It lasts for a long time. The period from the onset of processes in the joint to the first signs can be measured in years.

Causes

In the risk group, older people who from a young age were involved in traumatic sports (for the shoulder joint) worked for a long time in those professions that required prolonged tension with their arms raised high.

The second most important reason is previous injury to the joint itself or its ligaments. Moreover, degenerative processes develop years after the injury.

To a lesser extent, arthrosis can be caused by injuries to the humerus, which lead to improper redistribution of loads on the arm muscles. Various congenital abnormalities of the spine and chest can also lead to the disease.

Pathogenesis of the disease

It all starts with gradually developing degenerative processes in the acromioclavicular joint. The process looks schematically as follows.

1. Thinning of the articular cartilage of the joint due to wear and tear.

2. Damage to cartilage surfaces. As a result, they lose their smoothness. Friction of articular surfaces

3. The beginning of the development of osteophytes along the edges of the joint and in places of cartilage ruptures.

4. Loss of the joint's functional activity.

Clinical picture

The first two stages of the development of the process proceed almost unnoticed. Rarely, some patients may experience unpleasant (even pain) sensations when pressing on the area of the acromial clavicular joint.

As the process progresses, occasional swelling in the joint area and pain when moving the arms and torso occur. Painful palpation is felt by all patients.

Diagnosis and prognosis

For the diagnosis of pathology, radiography of the acromial clavicular joint area is crucial. It allows you to identify narrowing of the joint space. This is a sure sign of arthrosis.

The prognosis for the development of pathology depends on the time the patient goes to the doctor. Reverse development of the process is impossible. But it is quite possible to slow it down (in some cases even stop it indefinitely). Therefore, the sooner the patient contacts a specialist and the better he follows all his recommendations and prescriptions, the greater his chances of maintaining the mobility of the acromial clavicular joint.

Omarthrosis is a chronic degenerative disease of the shoulder joint. It is characterized by the gradual destruction of cartilaginous plates and articular surfaces of bones. At the same time, osteophytes develop. And the joint itself gradually loses its functional activity.

The disease most often affects people over 50-55 years of age. According to statistics, up to 60 years of age, pathology occurs in 10% of men and 7% of women. After 70 years, both sexes suffer from this disease in approximately the same ratio - 7 out of 10. Among them, joint deformation in the final stage of the disease occurs in almost 60-70% of cases.

Causes

The causes of arthrosis of the shoulder joint are similar to other degenerative pathologies of the joints.

· Excessively strong and prolonged load on the joint. This is typical for painters, plasterers, and weightlifters.

· Congenital anomalies of the joint and humerus. The former lead to early wear of cartilage due to a low safety margin. Abnormalities of the humerus (and the arm in general) cause improper load distribution. As a result, the joint experiences excessive tension even during normal movements. This also leads to early wear.

· Metabolic disorders in the joint cavity. On the one hand, this leads to defects in cartilage tissue due to the low rate of its restoration. On the other hand, metabolic disorders cause the deposition of calcium salts. They themselves lead to damage to the articular cartilage.

There is evidence that arthrosis can be familial. This is based on the pattern that people whose parents suffered from arthrosis are more likely than others to acquire this disease with age.

Not the least of the reasons is previous shoulder injuries. This is especially true for dislocations and sprains. Typically, exposure to grass in youth increases the risk of arthrosis in old age by 50%.

Course of the disease and its clinical picture

Arthrosis occurs in several stages. Each has its own characteristic clinic.

1. First stage or degree. The processes of degeneration of cartilage tissue are minimal. Pain usually occurs in the evening and at night. They are moderate, often aching and constant in nature. The amplitude of habitual movements is preserved. They rarely cause pain. Therefore, patients whose daily activities and occupation do not involve stress on the shoulder joint have virtually no complaints. They attribute evening and night pain to “arm fatigue” or “a reaction to changing weather.” Accordingly, they do not go to the doctor.

2. Second stage. Changes in the joints lead to constant pain. They arise in response to habitual movements. At this stage, most begin to see doctors for the first time. The range of motion in the shoulder joint is reduced due to pain.

3. Third stage. At this stage, pain with the slightest movement is very pronounced. But most of all the patient is worried about stiffness in his hands. It can reach such a state that only their rocking becomes possible. The protrusions of the humerus are visible in the area of the joint.

The last stage is not typical for everyone. Most often, it is reached by those patients who did not seek medical help or ignored medical recommendations.

The disease often develops on both sides. A unilateral process predominates in patients who suffered a shoulder injury in their youth.

Diagnostics

The diagnosis depends on the stage of the disease at which the patient consulted a doctor. To identify pathology at the first stage, it is important not only to question the patient, detail his complaints, but also instrumental studies. Such as radiography and tomography of the joint. The first method allows you to notice a narrowing of the joint space. But it begins to develop at the end of the first stage. Therefore, tomography is considered the ideal method for this period, since it allows you to visualize the condition of the cartilage.

When a patient calls for a second

stage, questioning, examining the patient and performing a simple test are important. The patient's complaints are not specific, but their connection with movement and gradual intensification towards the end of the day speaks in favor of degenerative processes. The test consists of asking the patient to place his hands behind his back and clasp his palms. A healthy person will do this without problems. But this will be difficult for the patient. And when the process is severe, it is simply impossible to become.

Radiography at the second stage will only confirm the diagnosis and clarify the extent of damage to the joint.

The third stage leaves no doubt at the first contact between the doctor and the patient.

8. Dislocation of the acromioclavicular joint

Dislocation of the acromioclavicular joint occurs in people leading an active lifestyle or participating in contact sports. From the point of view of anatomy, under the dislocation of the clavicular

thoracic joint implies a complete or partial rupture of its ligaments.

Causes and clinic

Dislocation develops in the following situations.

· Falling on an outstretched arm.

· A blow to the area of half the chest and the corresponding shoulder. This typically occurs in contact sports. This is hockey, rugby, wrestling, etc.

Clinical manifestations of a dislocation are associated with pain in the shoulder area (sometimes the patient may even indicate the projection of the joint). In this case, the corresponding limb is sharply weakened.

Diagnostics

When examining the victim, a change in the relief of the affected shoulder is visible. When you press on the corresponding collarbone, it “sinks” freely. This is called the "piano key" symptom.

9. Shoulder dislocation

Shoulder dislocation is one of the most common traumatic pathologies of the shoulder joint. In terms of frequency of occurrence, it is second only to a fracture of the humerus.

Causes

Develops as a result of injury. For example, when falling or hitting any surface.

There are primary and habitual (occurring more than once) dislocations. Primary dislocation is associated only with injuries sufficient to cause the joint to sprain, rupture its capsule, and expose the head of the humerus.

Secondary dislocation also occurs with injuries. But for its development there is no longer a need for such a strong traumatic factor. In addition, more than 75% of all habitual dislocations have a congenital predisposition. Most often this is weakness of the ligamentous apparatus or elongation of the connective tissue fibers of the tendon. The latter is typical for individuals with connective tissue dysplasia and for patients with congenital syndromes (Morphan's syndrome is the most common).

Clinical picture and diagnosis

The clinical picture is dominated by two main signs:

· Pain in the shoulder area. It is constant and intensifies when you try to move your hand. This is especially true for primary dislocation. With habitual pathology, pain often occurs when trying to move the arm.

· Restrictions on hand movement. Active movements in the shoulder joint are often completely impossible. Passive movements are greatly limited.

The presence of these signs makes it possible to suspect a joint dislocation with a high degree of probability. Radiography makes it possible to clarify its nature and exclude traumatic bone injuries.

For injuries and other diseases of the shoulder, PRP therapy in Moscow can be effective

Preventive measures

If you want to eliminate the possibility of tendonitis, you should perform sports exercises only after warming up the tendons and muscles and stretching. In another situation, the occurrence of microcracks and foci of inflammation is an inevitable process.

Also, to prevent the development of the disease, you should adhere to the following recommendations:

Avoid monotonous shoulder movements;
Monitor any disruptions in the metabolic system and hormonal imbalances;
Perform physical therapy exercises regularly if you have already been diagnosed with foci of inflammation in the shoulder joint;
Take a course of treatment for osteochondrosis;
Eliminate the possibility of hypothermia;
Maintain a balanced diet.

Representatives of professional sports activities should periodically visit a specialist in order to undergo the necessary examinations.

Is it possible to cure shoulder tendinitis?

The risk group includes persons exposed to regular and increased physical activity (construction workers, athletes, etc.). If the patient applies in a timely manner, experts give a 90% prognosis for the complete restoration of the functions of his shoulder joint. Moreover, in the acute form, the treatment period can reach 14 days; in the case of a chronic disease, the procedure may be delayed, which is a consequence of the presence of calcifications.

The period of complete recovery can reach 4-6 months.