The shoulder is formed by a set of joints , which with the participation of muscles and tendons allow a wide range of mobility to the arm. Traumatology specialists state that this great mobility can lead to different pathologies, such as tendon instability or impingement, which cause shoulder pain. This pain can be continuous , or appear alone with the movement; can be transient , or prolonged over time, leading the patient to a specialized consultation for diagnosis and treatment.
What Causes Shoulder Pain
Most shoulder problems derive from the soft parts (muscles, tendons and ligaments), rather than from the bones. Most pathologies can be grouped into three broad categories:
- Tendonitis : tendons are the cordonal elements that connect muscles to bone. Most tendinitis results after prolonged overloading processes over time. This tendonitis may present as acute tendonitis (overuse), chronic tendonitis (repetitive overload or degenerative disease) or tendon rupture (acute injury).- Bursitis : inflammation of the bursae, fluid-filled sacs located around the joints, in order to reduce the friction caused by the movements of the shoulder and that is usually related to tendinitis. Inflammation of several of the elements of the shoulder can lead to stiffness of the same, which is known as frozen shoulder .
- Instability : may lead to dislocation of some of the shoulder joints. These repetitive luxations may be complete or partial causing pain and shoulder failure.
- Artitis : There are several types of arthritis, but the most frequent is the one derived from the overloads and tendinous ruptures that condition a situation of inflammation, stiffness and shoulder pain. Patients often avoid mobilizing the shoulder to avoid pain. This conditions with time a rigidity of the soft parts of the shoulder, and a stiffness of the same.
How to diagnose the causes of shoulder pain
The first step is a clinical history : it is necessary to determine the duration of symptoms, the characteristics of the symptoms, the relationship with physical activity and the treatment performed.
A physical examination is then performed. Simple radiology allows the study of bone anatomy. Other studies, such as CT, ultrasound, MRI are requested based on diagnostic suspicion following medical history and exploration. Arthroscopy can sometimes be used to complete the diagnosis. Arthroscopy is a surgical procedure that allows examination of the joint by the use of an illuminated optical system introduced through a small approach.
Treatment for shoulder pain
Treatment begins with a change in physical activity , rest, and physical therapies that help maintain shoulder strength and flexibility. Medication is prescribed to reduce pain and inflammation. Surgery may sometimes be necessary, but this happens in a minority of cases. Problems of post-traumatic instability and cuff tears require surgical treatment.
What is rotator cuff tear
This is one of the most common causes of shoulder pain and dysfunction. The rotator cuff consists of four muscles and their tendons that, coming from the scapula, form a "cuff" that surrounds the head of the humerus. They collaborate in the elevation and rotation of the arm, and help stabilize the head of the humerus inside the joint. The majority of ruptures occur in the supraspinatus
Symptoms of rotator cuff tear and its diagnosis
They may appear abruptly (after a fall or release) or gradual (overuse of the cuff in repetitive movements of the arm above the head). The patient refers to pain in the shoulder, irradiated to the arm. At first it is a pain that appears with movement and is relieved with painkillers. Over time, it may appear at rest, making nighttime sleep difficult. Pain is associated with mobility limitation (to raise the arm, to comb, to fasten the bra from the back). After a clinical history and an exploration that establishes the diagnostic suspicion, the confirmation comes after the Rx study and, mainly, MRI or ultrasound.
How to treat rotator cuff tear
In many cases, non-surgical treatment can relieve pain and improve function. Treatment options include change in physical activity, relative rest, anti-inflammatory and analgesic medication, infiltration with steroids, and physical therapies that help maintain shoulder strength and flexibility.
Surgery may be necessary, depending on the size, type and location of the lesion.
Exercises After Shoulder Surgery
After shoulder surgery, it is sometimes necessary to use a sling for a few days or weeks.
Likewise, it is advisable to carry out a series of exercises as soon as the surgeon allows to begin the mobilization of the shoulder. The rehabilitation program will depend on the findings during surgery and includes joint mobilization and muscle strengthening exercises.