What are those causes of shoulder pain?
Shoulder injuries can be caused by excessive over-the-top movements of the upper extremities, often due to repetitive high-volume training, such as swimming, tennis, baseball pitching, weight lifting, gymnastics, etc.; they can also be caused by various over-the-top activities in daily life, such as teachers writing boards, sanitation workers scrubbing windows, housewives cleaning rooms, or due to trauma, such as a fall, or standing on a bus in response to sudden braking pulling on the handrail. sprain, etc. In general, injuries to the glenoid labrum of the shoulder joint and instability of the shoulder joint are common in younger patients, while rotator cuff injuries tend to occur in middle-aged and older patients.
If you have shoulder pain, you should ask yourself some questions: Is your shoulder joint stiff? Is there limited movement? Does it feel like it is dislocating? Is there any weakness in the shoulder joint that affects your daily life?
If the answer to any of these questions is “yes”, you should see an orthopedic surgeon or sports medicine doctor.
What are the common injuries to the shoulder?
Soft tissue injuries (muscles, tendons, ligaments, glenoid labrum) are more likely to occur in the shoulder than bone injuries.
Instability
It can be dislocation or subluxation or a sense of instability. Dislocation can be anterior, posterior and downward dislocation. Dislocations are subdivided into locked dislocations and reducible dislocations. Shoulder dislocations are often associated with injuries to the glenoid labrum, glenoid rim, cartilage and rotator cuff. For example, anterior dislocation of the humeral head can lead to tearing of the anterior glenoid labrum, resulting in a Bankart injury; repeated anterior dislocations can lead to injury and compression of the cartilage behind the humeral head resulting in a Hill-Sachs injury. Subluxation is the deviation of the humeral head from the center of the glenohumeral joint and is often indicative of a lesion, such as a massive rotator cuff injury that can lead to a subluxation of the humeral head superiorly. Patients with instability tend to have pain and dislocation when the shoulder joint is moved to certain specific positions. This can only be detected by performing specific tests during the examination. For example, in patients with anterior instability, the additional forward stress on the humeral head in the 90ºabduction-external rotation position of the shoulder can trigger pain and a sense of dislocation. This test is called the anterior fear test and often only an experienced sports medicine physician or shoulder surgeon can make a proper physical examination and diagnosis.
What is impingement syndrome?
Impingement syndrome is a painful condition caused by impingement of the acromion and rotator cuff tissues during shoulder flexion and abduction. Impingement syndrome has very distinctive signs and occurs at a high rate in people who play or work with overhead upper extremity sports, such as volleyball players, tennis players, baseball pitchers, teachers, and car mechanics. It often requires rehabilitation and treatment under the guidance of a medical professional. Otherwise, prolonged impingement can lead to further injury such as rotator cuff damage resulting in decreased muscle strength and increased pain.
Why is the rotator cuff important?
The rotator cuff is one of the most important soft tissue structures of the shoulder joint. It is composed of four muscles and their tendons that hold the humeral head in the center of the shoulder joint and allow the shoulder to perform supination and overhead movements. A massive rotator cuff injury can lead to subluxation of the humeral head, leading to arthritis in advanced stages.
What can cause a shoulder injury to worsen?
Some people may ignore the pain and continue to play sports, work or perform daily activities that can aggravate the injury. For example, 40% of rotator cuff injuries have an enlarged rotator cuff tear, and 80% of them have symptoms due to the enlarged tear. As time goes on, many people tend to accept the symptoms of persistent pain, weakness of the limb and limited movement of the joint, thus forgoing further treatment and losing the opportunity to improve pain and function. The quality of life is much reduced, such as large rotator cuff tears with heavy nighttime pain, which seriously affects the patient’s sleep and leads to other disorders. And as the disease progresses further it leads to advanced shoulder stiffness and degeneration of the articular cartilage leading to arthritis.
What is the treatment for shoulder injury?
Early detection and treatment is the best way to avoid aggravation and complication of shoulder injuries. Conservative treatment includes physician-directed muscle strengthening exercises and ligament distraction exercises, physical therapy, NSAID therapy, seal therapy, and arthroscopic acromioplasty. The following is a list of exercises designed to strengthen the muscles around the shoulder joint and prevent injury.
I. Basic muscle strength exercises: Attach one side of a tension spring to a doorknob, pull the spring slowly toward the body, hold for 5 seconds, and repeat 5 times on each side of the limb, twice a day.
Second, the wall push-up exercises: facing the wall, hands on the wall, feet apart and shoulder width. Slowly do push-up movements, repeat 5 times, and maintain the posture for 5 seconds, practice 2 times a day.
Third, shoulder bracing exercises: sitting on a chair with armrests, hands on the armrests, feet on the ground, hand brace the armrests and slowly rise, maintain the rising posture for 5 seconds, repeat 5 times, practice 2 times a day.
Treatment with NSAIDs is effective in relieving pain and is often used in combination with physical therapy and muscle strength exercises. Sequestration is the injection of anesthetics and hormonal drugs into areas with definite pain, such as the subacromial, rostro-humeral ligament, acromioclavicular and glenohumeral joints, to relieve the pain and inflammatory response. It is a very effective way to treat shoulder disorders. It is required that the injection be done by a shoulder surgeon or sports medicine doctor in order to prevent infection and poor results. Closed treatment is very effective for frozen shoulder, subacromial impingement, supraspinatus calcific tendonitis and acromioclavicular arthritis, etc. Poor results in 1 time can be re-injected after 1 week, and if the results are poor or recurring after 3 times of use, re-injection is not recommended and surgical treatment is attempted.
Surgical treatment includes open surgery and arthroscopic surgery
Although open surgery is the gold standard for rotator cuff injury, shoulder instability and other diseases, with the progress of minimally invasive arthroscopic surgery in the last 20 years, the effect of its treatment has been equivalent to open surgery in many aspects, and has the characteristics of less damage, faster patient recovery and low incidence of complications such as infection. In foreign countries, this type of surgery can be done on an outpatient basis, and patients can even drive themselves home after a few hours of observation. In China, due to the low popularity of shoulder surgery and sports medicine, the lack of specialized doctors in this field, and the lack of related health science education, many patients with shoulder disorders do not receive formal treatment, and some even believe that such diseases cannot be cured or will get better on their own. It is true that some diseases such as frozen shoulder have a tendency to heal on their own, but treatment of such diseases can shorten the course of the disease, reduce pain and prevent complications. In contrast, many diseases such as shoulder instability and rotator cuff injury will develop further damage if left untreated. With the development of our economy and the improvement of people’s living standards, the demand for treatment of shoulder joint diseases will become higher and higher, and many large hospitals in China are beginning to pay attention to the treatment of such diseases. Therefore, if you have a shoulder pain problem, you should seek consultation from an orthopedic surgeon, preferably a sports medicine or shoulder joint specialist.