Shoulder pain – causes, diagnosis, treatment. The most common diseases of the shoulder

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Shoulder pain is quite common. It can be continuous or sudden. It occurs under the influence of overload and strain on the shoulder joint during everyday activities and during sports. The causes of shoulder pain should be sought in many diseases of the osteoarticular system. Find out what shoulder pain is and how to deal with it.

Shoulder pain – characteristics of the shoulder joint

The shoulder in the human movement system is a bone structure, connected to each other by joints. This is the fulcrum for the muscles of the upper limbs. The shoulder, which is made up of several joints, has the greatest range of motion of any joint in the body.

The shoulder consists of the following elements:

1. shoulder joint – it is a joint that consists of the head of the humerus and the acetabulum of the scapula;
2. shoulder-clavicular joint – it is the joint that connects the collarbone with the shoulder process of the scapula. Importantly, these two structures are not in contact with each other, and are connected by a cartilage disc. This connection is surrounded by an articular capsule, additionally reinforced with shoulder-clavicular ligaments. The clavicle-clavicular ligament is primarily responsible for the stabilization of the clavicle;
3. sternoclavicular joint – it is the joint that connects the sternum with the collarbone. The elements that make up this joint are the articular cavities on the surface of the sternum and the articular surface of the sternal end of the clavicle. Both these structures do not match anatomically, so they are connected by the articular disc;
4. scapulo-thoracic joint – it is a joint that consists of sliding soft tissues between the chest wall and the scapula. Characteristic for this joint is that it does not have articular surfaces and articular cartilage. This joint plays a very important role in the musculoskeletal system because it is responsible for the range of abduction and flexion motion in the shoulder joint;
5. sub-neck pond – also known as the barge space. This is the space between the head of the humerus and the shoulder process of the scapula. Like the scapulo-thoracic joint, the subcapular joint lacks articular cartilage and articular surfaces;
6. soft tissues – trapezius muscle, deltoid muscle, subcapsular muscle and triceps, i.e. the triceps muscle.

The shoulder joint is one of the most extensive joints in the human body. It consists of: the humerus, scapula, collarbone and sternum, which are surrounded by ligaments, muscles, tendons and bursae. This arrangement guarantees shoulder stabilization and freedom of movement. A very important part of the shoulder joint are the rotators located around the shoulder-scapular joint.

If you want to learn more about the anatomy of the shoulder joint, read on: Shoulder joint – everything you need to know about it

Shoulder pain – the most common accompanying symptoms

Shoulder pain is not a disease, but a symptom of an illness or injury. Although this is a symptom, this condition may be accompanied by other additional symptoms. Shoulder pain can be triggered by various factors, it is important to pay attention to any accompanying symptoms. Shoulder pain can often be accompanied by symptoms such as:

1. pain tenderness and limitation of the range of shoulder mobility – there is also a complete blockage of the shoulder;
2. muscle weakness;
3. clearly audible cracks and shoulder crunches during movement;
4. neurological complaints in the form of shoulder pain radiating to: hand and neck, elbow and wrist;
5. shoulder pain;
6. shoulder pain when moving your arm up or down.

The above symptoms are one of the signals that the patient’s condition requires in-depth diagnostics to determine what is the cause of shoulder pain.

How is the shoulder joint constructed and what is worth knowing about it? Read: Shoulder joint – its structure and injuries

Shoulder pain – causes

Due to the structure and location, shoulder injuries are very common, especially for people who practice sports that involve the upper limbs. Shoulder pain is therefore considered to be a common phenomenon.

The most common causes of shoulder pain are:

1. overloads;
2. repetitive micro-stresses and injuries of the surrounding soft tissues;
3. shoulder plexus injury;
4. polymyositis / dermatomyositis;
5. repetitive micro-overloads and injuries of the surrounding soft tissues (mainly the rotator cuff);
6. degenerative changes that increase with age;
7. inflammatory rheumatic diseases: rheumatoid arthritis, rheumatic polymyalgia;
8. psoriatic arthritis;
9. gout;
10. ankylosing spondylitis;
11. infectious arthritis;
12. myocardial infarction;
13. lung tumor;
14. pneumothorax.

Ailments and injuries that are the direct cause of shoulder pain will be described in the following paragraphs, and include:

1. sub-brachial isthmus syndrome (also called sub-brachial tightness syndrome);
2. damage to the rotator cuff;
3. damage to the tendon of the long head of the biceps;
4. frozen shoulder;
5. inflammatory diseases of the joints;
6. painful shoulder syndrome.

The sore shoulder can be treated with Poplar overload liner, which warms up and reduces pain.

What can cause shoulder girdle pain? Check: Pain in the shoulder girdle

Shoulder pain – syndrome of the shoulder gap

Nipple syndrome is one of the most commonly recognized causes of shoulder pain. This ailment is usually the result of an injury, as a result of which soft structures block the mobility of the shoulder joint and it cannot function properly.

Injuries most often occur as a result of raising hands high above the head, which is why the syndrome is diagnosed in swimmers, volleyball players and tennis players. It is also a common cause of shoulder pain for construction workers, electricians and painters.

The sub-shoulder space is located under the shoulder process. The arm structures move with the help of bursae located in the sub-shoulder space. Often, as a result of inflammation of the bursa or bone growths, there is a syndrome of tightness in the subacromial space. This hinders the smooth entry of the humerus under the shoulder process, and consequently causes severe pain when lifting the upper limb in the range of 60–110 ° (the so-called painful arch).

The primary symptom of the subacromial tightness syndrome is, of course, shoulder pain. It usually occurs in the upper and lateral parts of the arm and increases significantly with and after the upward movement of the arm. If the disease is advanced, pain occurs even while resting. There are other symptoms that can be seen in the case of sub-brachial tightness. These include: tenderness in the front and side of the shoulder, feeling stiff, reduced strength, and limited range of motion in the joint.

If you’d like to learn more about the shoulder gap syndrome, read on: Shoulder isthmus syndrome

Shoulder pain – damage to the rotator cuff

The rotator cuff consists of four muscles and their tendons surrounding the shoulder-scapular joint. This structure is overloaded or even broken during repetitive activities with hands above the head (e.g. when washing windows or playing basketball).

Damage to the rotator cuff can occur with a sudden jerk. This problem most often affects people over 40, but it also applies to young people who play sports. Most often, however, damage occurs gradually and is related to the natural process of weakening the fibers that make up the tendon. It can be estimated that over 30% of people over the age of 65 may have damaged tendons, and in most cases there are no symptoms that could indicate such damage.

A symptom of damage to the rotator cuff is shoulder pain when lifting your arm or placing your hand on your back. Pain occurs in the anterior and lateral area of ​​the shoulder. Other characteristic symptoms of a rotator cuff tear are:

1. severe pain felt deep in the shoulder area;
2. worsening pain when sleeping on the side where the injury occurs;
3. muscle weakness;
4. reduction of the range of mobility in terms of external rotation, abduction and flexion;
5. difficulties in performing everyday activities that require lifting hands, e.g. brushing or fastening a bra;
6. audible crackling noises when moving the shoulder;
7. possible symptoms of inflammation, such as redness, swelling or warmth in the joint area;
8. inability to put your hands on your neck or head.

What should you know about the rotator cuff and its causes and symptoms? Check: Rotator cuff

Shoulder pain – damage to the tendon of the long head of the biceps

The tendon of the long head of the biceps runs vertically at the front of the shoulder. The muscle is damaged as a result of mechanical injuries and inflammatory diseases of the joints. The patient feels pain in the front of the arm when making movements with the elbow bent.

This tendon is most often damaged suddenly during physical activity. The biceps muscle is responsible for many activities, such as bending the shoulder joint, raising the arms forward, and bending the forearms. Therefore, damage to the tendon adversely affects the patient’s comfort and the performance of daily activities.

It should be noted that damage to the tendon of the long head of the biceps in middle-aged and elderly people is most often caused by developing degenerative changes. In addition, this ailment primarily affects men. If the damage occurs in young people, it is usually a rupture of the biceps brachial muscle.

Many people suffer injuries, but tendon damage occurs mainly when a warm-up is not performed before training, anabolic agents are used that cause a significant growth of muscle tissue and the shoulder is exposed to numerous micro-overloads.

A tendon rupture usually affects its musculo-tendon part. The most characteristic symptom of a tendon rupture is shoulder pain accompanied by a tearing sensation. Diagnosing a tendon injury is relatively easy as the muscle contracts and a palpable thickening is formed. Additionally, the strength of the forearm is significantly weakened.

What is enthesopathy and how does it relate to overloading the tendons in the muscles? Read: Entezopathy

Shoulder pain – frozen shoulder

A frozen shoulder (i.e., joint capsulitis) is caused by damage to the rotator cuff and may be a symptom of a heart attack. The patient experiences stiffness of the joints and pain which prevent abduction and rotation in the shoulder joint.

In the case of a frozen shoulder, there is a significant limitation of mobility in the shoulder joint, which is also accompanied by increasing pain. A patient can be diagnosed with primary frozen shoulder syndrome when no causative factors, such as previous surgery or sudden trauma, are identified.

During imaging diagnostics, it can be noticed that the frozen shoulder is synovial inflammation and fibrosis of the joint capsule. Collagen tissue appears in the shoulder that looks like a scar. This new tissue is very vascularized and innervated, which explains the severe soreness and stiffness of the shoulder.

Frozen shoulder is a condition that typically affects women between the ages of 40 and 60. It is very often related to immunological, biochemical and hormonal disorders at that age. Studies that have been conducted so far indicate that frozen shoulder may be associated with diabetes, thyroid dysfunction or increased blood fat levels.

Frozen shoulder is a condition that can be divided into phases. The freezing phase lasts 1 to 8 weeks and is associated with limited movement, shoulder stiffness and pain. In the freezing phase, which can last up to 16 months, shoulder stiffness progresses, pain at rest decreases, and there are problems with daily activities. The final stage is the defrost phase, which lasts from 12 to 14 weeks. During this period, the mobility of the joint gradually returns to normal functionality. Often, however, there are cases of incomplete recovery, and the discomfort returns in the other shoulder.

Which diseases are the most painful? Check: The five most painful diseases

Shoulder pain – inflammatory joint diseases

Inflammation of the shoulder joint is one of the symptoms of diseases such as rheumatoid arthritis, psoriatic arthritis and gout. These diseases cause the synovial membrane that fills the shoulder to overgrow and build up fluid inside. Shoulder pain is one of several symptoms, it is easy to recognize these conditions.

Shoulder joint inflammation is a varied disease that can affect bone components, cartilage, bursae, ligaments, tendons, synovium, or joint capsule. The disease may be chronic, acute or subacute.

Possible causes of inflammatory disease of the shoulder joint are:

1. microbial infections as a result of open wounds or in the course of infectious diseases such as syphilis, gonorrhea, tuberculosis or Lyme disease;
2. injuries, microtraumas and overloads;
3. autoimmune reactions;
4. connective tissue diseases such as rheumatoid arthritis or juvenile idiopathic arthritis;
5. other inflammatory diseases such as Crohn’s disease, ulcerative colitis and gout.

Inflammation of the shoulder joint causes severe pain that worsens as the disease progresses. In addition, there is joint sensitivity to touch, swelling and warming of the joint, reddening of the skin or impairment of joint functionality. The patient may also complain of a general malaise, including fatigue, muscle pain, fever or lack of appetite.

Is vaccination with AstraZeneca safe in inflammatory diseases of the joints? Check: AstraZenecę vaccinations safe in inflammatory diseases of the joints? The Polish Society of Rheumatologists responds

Shoulder pain – what can my doctor help?

Shoulder diseases are diagnosed by a doctor: orthopedist and rheumatologist. An orthopedic doctor treats shoulder pain caused by a mechanical injury. If shoulder pain is accompanied by other symptoms: swelling and stiffness of the joint, pain in other joints or general symptoms (feeling crushed, low-grade fever or fever, unjustified weight loss, malaise), consult a rheumatologist.

What ailments can be reported to a rheumatologist? Check: Rheumatologist – what he does and when to visit him

Shoulder pain – diagnosis

Shoulder pain is examined by X-ray (especially after an injury) or ultrasound (which is very helpful in visualizing the soft tissues around the joint) and by magnetic resonance imaging. To confirm the inflammatory disease of the joints, laboratory tests should be performed: ESR, CRP, morphology, RF, aCCP, uric acid.

Do you know what a rheumatic profile is and when should it be performed? Check: Rheumatic profile, i.e. what tests will help detect rheumatic diseases

Shoulder pain – treatment

The most effective treatment for shoulder pain caused by mechanical trauma is rehabilitation and physiotherapy. Avoid activities that aggravate symptoms, apply cold compresses and exercise according to the therapist’s recommendations. To make cold compresses, order Visiomed KINECARE VM-GB6 compresses for the neck, neck and shoulder, with a characteristic shape that fits the upper parts of the body.

An additional method of treatment is to inject a corticosteroid blockade into the shoulder joint. The patient is given oral painkillers and anti-inflammatory drugs. In extremely severe discomfort, shoulder pain is treated with surgery. Arthritis is treated by a rheumatologist.

Which pain reliever should I choose? Check: Anti-inflammatory drugs – which ones to choose for your ailment?