Shoulder pain and treatment methods

Shoulder Pain

Shoulder pain is a common musculoskeletal problem. Shoulder pain ranks third after low back and neck pain in the community. Shoulder pain is one of the first reasons for consulting a doctor, especially in people who work using their arms. One of the most important reasons for the frequent occurrence of shoulder pain is that the shoulder joint is the most mobile and most complex joint of the human body. Around the shoulder joint are soft tissues consisting of capsule, ligament, tendon, bursa and muscles. It is mainly the soft tissues around the joint that provide a solid structure of the joint. In this case, it causes frequent soft tissue lesions in the shoulder.

What are the causes of shoulder pain?

The most common shoulder pain is caused by the structure of the shoulder itself. Primarily, impingement syndrome involving the tendons of the shoulder and rotator cuff syndrome come.

Frozen shoulder, tendinitis (bicipital tendinitis), calcific tendinitis caused by lime accumulation in tendons, osteoarthritis (calcification), shoulder laxity or semi-dislocation of the shoulder (subluxation), straining pain due to the muscles around the shoulder called myofascial pain syndrome are the most common problems. Shoulder pain can also be seen due to damage to the nerves of the muscles around the shoulder, and weakness and weakness in the shoulder are more prominent. Most of the inflammatory rheumatic diseases affect the shoulder (rheumatoid arthritis, spondyloarthropathy, polymyalgia rheumatica). In addition, tumoral disorders and infections arising from the bones and soft tissues in the shoulder region can also cause shoulder pain.
Less common causes are pain arising from non-shoulder structures. Cancers of the upper region of the lung, liver, stomach, gall bladder, spleen problems, heart diseases can also present with shoulder pain. It should not be forgotten that the causes of shoulder pain can often be confused with the causes of neck pain, as neck hernias cause pain radiating to the shoulder.

What is impingement syndrome?

The most common cause of shoulder pain is impingement syndrome. Impingement syndrome is seen as a result of the compression of the tendons of the muscles that allow us to lift our arm and the sac in this region between the bone structures that make up the shoulder. It is more common in professions that use their hands, housewives, and athletes who do sports such as swimming and volleyball. As a result, this problem is a disease of misuse or overuse of the shoulder. The importance of this syndrome is that if the necessary treatment and precautions are not taken, it may result in complete rupture of the tendons.

Complaints often occur as a result of using the shoulder and arm. Over time, the pain begins to persist. It turns into pain that keeps the patient awake, especially at night. It comes to a level that will affect the patient’s daily life activities such as dressing and undressing.

How is the treatment of impingement syndrome carried out?

In its treatment, avoidance of forceful movements and using the hand on the head should be avoided. In the early period, cold application (ice packs) as well as painkillers and anti-rheumatic drugs are used. Injections into the shoulder (local anesthetic, steroid, ozone, mesotherapy) are important in reducing pain and regressing inflammation. Physical therapy and rehabilitation practices are extremely important in the treatment of impingement syndrome. It is tried to be taken under control with thermal modalities (hot application), electrotherapy (TENS, iontophoresis), ultrasound and high-intensity laser therapy (hiltherapy) and exercise programs accompanied by a physiotherapist. At the end of this treatment program, it is very important to use the shoulder correctly and to continue strengthening exercises without causing compression. Surgical intervention may be considered in patients who do not get satisfactory results with preventive treatment methods.

What are Rotator Sheath Tears? How is the treatment?

Rotator cuff injuries are the most common injury to the shoulder. There are two types of tears in the rotator cuff tendons, partial and full-thickness. The pathophysiology of rotator cuff tears is explained by intrinsic and extrinsic theories. Intrinsic avascularization (affecting the vascular structure), smoking, cholesterol and age-related degenerative changes are counted as intrinsic causes. Extrinsic causes are subacromial impingement, repetitive activity, acromion structure and traumas. As a result of rotator cuff injury, a series of changes may occur in the tendon, starting with tendinosis and ending with a full-thickness tear. Its frequency increases with age. In the advanced age group, some patients may be asymptomatic (asymptomatic) in full-thickness RC tears, and more than 50% of individuals aged >70 years have RC tears. Early diagnosis of rotator cuff lesions not only facilitates the treatment program, but also can reduce the negative quality of life of the patient due to pain and increasing range of motion limitation. Its treatment may include conservative (conservative treatments) and surgical treatments. Preventive treatments may include physical therapy applications, intra-articular injections (prp, hyaluronic acid, ozone) and drug treatments.

What is frozen shoulder?

Adhesive capsulitis is a common cause of shoulder pain. It develops due to synovitis and capsule contraction in the shoulder joint. Along with widespread pain and tenderness in the shoulder, it limits the movements of the shoulder joint in all planes. There is severe shoulder pain that makes it difficult to sleep, pain that makes it difficult to do daily activities, and difficulty in raising or turning the arm beyond a certain point. In advanced cases, they may have difficulty in performing daily functions such as personal cleaning and taking anything from the closet. Frozen shoulder is a disease that can last 2-3 years. It has three periods. The first is the painful period and can last up to 1 year. This is a period that can often be confused with other shoulder and neck problems. The second period is the period when the shoulder is completely frozen. The pain is reduced, but the shoulder movements are limited to the extent that the patient cannot perform activities of daily living. The third period is the dissolution period.

How is the treatment of frozen shoulder carried out?

Treatment includes physical therapy modalities, manipulation and exercise, as well as drug therapy and injections into the shoulder joint or into soft tissues. Physical therapy modalities (warm applications, electrotherapy, ultrasound, hiltherapy) reduce pain and support the healing process. Accompanied by a physiotherapist, appropriate exercise programs, studies on exercise equipment (cpm), exercises performed in water, opening the shoulder joint movements and re-using the arm in daily life are provided. Surgery can be applied in cases that do not heal with conservative treatments.

What is calcific tendinitis? How is the treatment planned?

It is a condition that causes severe pain in the shoulder. For an unknown reason, it is a condition that occurs with the precipitation of crystals on the tendon, which we can call the accumulation of lime in the soft tissue. Shoulder pain begins suddenly and severely after a strenuous activity. It is usually diagnosed with X-rays. In the period of severe pain, in addition to drug therapy, ice application and injections to the calcific lesion have a very important place. In chronic cases, physical therapy rehabilitation programs are applied, in which ultrasound therapy is at the forefront. There is also ESWT (shock wave therapy) application. In very resistant cases, surgical removal of these calcifications may be required.

What should be done if the shoulder is dislocated very often?

If recurrent dislocations occur in one shoulder without any trauma, these patients benefit greatly from physical therapy and rehabilitation programs that include strengthening the appropriate muscles according to the direction of the dislocation. The first problem that should be considered in young patients and athletes with shoulder pain is the tendency to dislocation, which we call instability due to loose ligaments in the shoulder.

What is calcification (osteoarthritis) in the shoulder joint?

Since it is not a load-bearing joint, osteoarthritis, which we call osteoarthritis, is not seen as much in the shoulder joint as the knee joint. Pain and limitation of movement can be seen with the movement of the shoulder joint. Physical therapy applications, intra-articular injections (hyaluronic acid, ozone, prp) and exercise programs can be seen in the treatment. is extremely important.

How to evaluate shoulder pain? Which examination and imaging methods can be requested?

The vast majority of shoulder pain originates from soft tissue. Magnetic resonance (MRI) imaging of the shoulder provides detailed analysis in evaluating soft tissues and bone structures in the shoulder. X-ray film (x-ray) may be requested in advanced age patients where more calcification is expected and in case of trauma. Shoulder tomography is also rarer, but may be requested especially in the evaluation of detailed bone structure. In patients who are thought to have nerve involvement, EMG examination may be required. Blood tests may be requested, especially if rheumatic disease, infection or tumoral condition is considered. Imaging related to other organ systems may be requested, especially if referred pain is considered (ultrasound, ECG, echo, lung graphy).
What is the importance of physical therapy and rehabilitation in shoulder pain?

In most of the pathologies that cause shoulder pain, the main treatment is physical therapy and rehabilitation applications. In cases that require surgery, it is possible to take a physical therapy program before and after the surgery. It is extremely important to protect the joint, avoid strenuous activities and exercise regularly in the long-term control of shoulder disorders and to prevent their recurrence.

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