Shoulder pain is common in all age groups, but why does the shoulder joint hurt? To clarify this issue, let’s first understand the main structural features of the shoulder joint. It is the most mobile three-dimensional joint in the human body. It consists of a humeral head, a sucker for the humeral head (glenoid) and the muscles and tendons surrounding them (rotator cuff) and the joint capsule.
The main structures that stabilize the shoulder joint are the glenoid, rotator cuff and the long head tendon of the biceps femoris tendon, which are also the most vulnerable structures. Injuries are mainly caused by repeated “overhead” movements and direct impacts, which cause “shoulder joint sports injuries”. Now we will introduce you to the common shoulder disorders and recognize the cause of your shoulder pain.
Shoulder impingement syndrome is the most common cause of shoulder pain and is the first cause of shoulder pain. There are several gaps in the outer upper part of the shoulder, and no contact occurs between the tissues around the gaps during normal motion.
When the gaps are narrowed in the pathological state, an impingement occurs between the structures, resulting in a symptom of injury to the bursa and supraspinatus tendon in them, known as subacromial impingement syndrome. It is caused by compression of the rotator cuff by the acromion after upper arm supination.
The main manifestations are shoulder pain, pain at night, waking up in pain and disturbing sleep; difficulty in pointing out a clear painful area; and difficulty in raising the arm over the head.
The rotator cuff is composed of the tendons of the supraspinatus, infraspinatus, subscapularis and teres minor muscles, which wrap around the humeral head and play a role in lifting and rotating the shoulder joint.
The acromion is the anterior edge of the scapula. It is above the head of the humerus and when the arm is raised, the acromion passes over or hits the surface of the rotator cuff. This causes pain and limited motion in the shoulder joint.
The pain may be caused by bursitis or tendonitis of the rotator cuff itself, or it may be caused by a partial rotator cuff tear.
Risk factors and prevention
Impingement of the acromion is more common in young athletes and middle-aged adults. Swimmers who do a lot of lifting, baseball and tennis, as well as construction workers and painters are particularly susceptible to injury. Pain can occur spontaneously from minor trauma or without obvious triggers.
Symptoms The beginning of the symptoms may be mild. Early on, patients do not come to seek medical attention. Pain with activity may be present at the beginning of the disease. The pain may radiate from the shoulder to the forearm and worsen when lifting or holding an object, and athletes may experience pain when throwing or playing tennis. As the pain progresses, nocturnal pain may develop. Strength or range of motion in the upper extremity may be reduced. It may not be possible to put the hands behind the back and make movements to fasten and unfasten buttons.
In severe cases the loss of motion may cause frozen shoulder. In acute bursitis, there may be significant tenderness in the shoulder. There is restriction of motion and pain in all directions of the shoulder joint.
Diagnosis of impingement of the shoulder relies on symptoms and signs. Patients need to be radiographed. Supraspinatus outlet position can sometimes be seen as a small bone spur at the anterior border of the acromion. MRI can reveal an effusion or bursitis. In some cases a partial tear of the rotator cuff can be found. An impingement injection test of the acromion can clarify the diagnosis
Choosing a treatment
With conservative treatment, the doctor will advise the patient to rest and avoid supination exercises. Some oral NSAIDs may also be prescribed. Some stretching contact may also be helpful in patients with frozen shoulder. Many patients are effective with cortisone and narcotic localization therapy. Acupuncture and tui-na in Chinese medicine can also be effective in relieving pain, and your doctor may also recommend some physical therapy. Physical therapy can last from a few weeks to several months. Many patients gradually improve and regain function.
Surgical treatment
When conservative treatment fails to relieve pain, the doctor may recommend surgery. The goal of surgical treatment is to remove the impingement and create a larger space for the rotator cuff. This allows the humeral head to move freely in the subacromial space and lift the upper arm without pain. The most common procedures are subacromial decompression and anterior capsuloplasty. This can be accomplished by arthroscopic surgery versus open surgery.
Shoulder arthroscopy technique: During the arthroscopic procedure, 2-3 puncture holes are made. Each hole is about 5 mm. Through these holes, a fiber optic camera system can be used to examine the shoulder joint, and small delicate instruments can be used to perform surgical operations within the shoulder joint. In rare cases, an arthroscopically assisted shoulder dissection can be performed: a small incision can be made in the anterior aspect of the shoulder joint so that the acromion and rotator cuff can be visualized under direct vision.
Most patients with impingement of the acromion have some bone removed from the anterior border of the acromion and some bursal tissue attached.
The surgeon may also treat some concomitant conditions such as acromioclavicular arthritis, biceps tendonitis or a partial rotator cuff tear along with the acromion impingement.
After surgery the shoulder joint is temporarily immobilized with a splint, which promotes early healing. As soon as you feel no more pain you can remove the immobilization and start to exercise and use the shoulder joint. Your doctor will provide a rehabilitation program based on your needs and findings from the surgery. This includes exercises to restore range of motion and strength to the shoulder joint. It usually takes 2-4 months to obtain complete pain relief.
The second cause of shoulder pain is, rotator cuff injury: The rotator cuff is a group of four tendon tissues that stabilize the shoulder joint. It can be caused by acute trauma, chronic strain causing a tear in the rotator cuff tissue producing shoulder pain.
Rotator cuff tears are a common cause of shoulder pain and mobility impairment in adults. The rotator cuff is composed of four muscles and their accessory tendons. They form the rotator cuff that wraps around the head of the humerus. These four muscles are the supraspinatus, infraspinatus, subscapularis and teres minor, which start at the scapula and together form a tendinous unit that then ends at the greater tuberosity of the humerus. The rotator cuff serves to lift and rotate the upper arm and stabilize the humeral head within the shoulder joint. Most tears occur in the supraspinatus, but other muscles have also been involved.
Risk factors and prevention
Rotator cuff tears are very common in patients over 40 years of age. It can also be caused by acute trauma and regular overhead movements. Example.
Painters who do a lot of overhead movements, warehouse workers on shelves or construction workers.
Athletes like swimmers, baseball pitchers and tennis players.
Rotator cuff tears can also be accompanied by other injuries to the shoulder, such as fractures or dislocations.
Rotator cuff tear symptoms can be acute or progressive in onset. Acute pain usually occurs after an acute trauma, such as an overhead movement or a fall (e.g., pulling, falling, impact). Progressive injuries are more common and can be caused by repetitive overhead motion or wear or degeneration of the tendon, and the patient will feel pain radiating from the shoulder all the way to the arm. The pain is mild at first and only occurs during overhead movements.
This condition can be started with medications such as aspirin that are available without a prescription. Over time, the patient may experience rest pain, or constant shoulder pain, especially with overhead movements, and weakness; a ringing sound can be heard in the joint when the shoulder is moved; joint mobility can be limited; pain at night, especially when the patient cannot sleep on the affected side; can be aggravated or triggered by a cause; often occurs in the dominant shoulder (left shoulder in people who are used to using the left hand, right shoulder in people who are used to using the right hand). Right shoulder). Other symptoms include stiffness and limited movement of the shoulder joint. Patients may have difficulty combing their hair and lacing behind their backs.
In tears that occur after an injury, there is a sudden onset of pain, and acute weakness in the shoulder.
The diagnosis of a rotator cuff tear relies on the patient’s symptoms, the physician’s examination, x-rays, and MRI. the physician will examine the patient’s shoulder to see if the pain is significant or if there is a deformity in that area. He or she will also examine the movement and strength of the shoulder joint in different directions. The doctor will also check for shoulder instability and acromioclavicular joint lesions.
The doctor will also examine your neck to rule out pain from cervical nerve entrapment and other osteoarthritis and rheumatoid arthritis.
Other signs of rotator cuff tears are.
1. Atrophy and shrinkage of the shoulder muscles
2. Pain when lifting the arm
3. Pain when lowering from a full supination
4. Weakness in lifting and rotating the upper arm
5.Bone sounds or popping when the shoulder is moved to a certain angle
X-rays in patients with rotator cuff tears are usually normal or have only small bone spurs. Therefore, doctors often perform tests like ultrasound or magnetic resonance imaging. These tests can better visualize the tendons of the rotator cuff.
MRI is usually able to identify a full tear from a partial tear. It can show if the tear is within the tendon or if it is coming off the bone.
In some cases a shoulder arthrography also has diagnostic value.
Treatment options
Once the diagnosis of a rotator cuff tear is clear, your orthopedic surgeon will recommend an effective treatment that will reduce pain and improve shoulder function.
Treatment options include
1. Conservative treatment.
Rest and restriction of overhead motion
Suspension with a sling
Anti-inflammatory and pain medication
Steroid hormone closure therapy
Exercise strengthening and physical therapy
This often takes several weeks or months to restore strength and movement to the shoulder joint.
2. Surgical treatment.
If non-surgical treatment does not reduce symptoms, your doctor may recommend surgery. Indications for surgery include acute rotator cuff tears and pain, dominant arms in people who exercise regularly, or athletes and workers who need to perform overhead activities.
The type of surgery is determined by the size, shape and location of the rotator cuff tear. Partial tears require only revision and debridement. A full tear requires sutures on both sides of the tendon. If the rotator cuff is torn from the stop of the greater tuberosity of the humerus, then he will need to be sutured directly to the bone.
Many surgical repairs can be treated on an outpatient basis and can be done the same day and sent home the same day.
During surgery the surgeon will remove some of the bone from the front of the acromion, which can cause the acromion to impingement leading to a tear. Other conditions such as acromioclavicular arthritis or biceps tendonitis can also be treated.
In general, there are three surgical approaches
1. Arthroscopic repair
A fiber optic lens with many small instruments is inserted into the joint through several small incisions. This lens is connected to a television monitor and the surgeon operates through the television.
2. Arthroscopically assisted small incision repair
New techniques and instruments allow the surgeon to repair 4-6cm total tears through small incisions.
3. Incisional repair
Generally, incision repair is performed when a large complex rotator cuff tear requires tendon transposition surgery. In some severe cases with severe arthritis, shoulder replacement is an option.
Your doctor will choose the best treatment for you.
After surgery, the shoulder joint will need to be immobilized to promote healing of the rotator cuff tear. The duration of immobilization depends on the severity of the tear. Your doctor will give you a training program to restore movement and strength to the shoulder. It starts with passive activities. Then there are active and resistance exercises. Your doctor will recommend some physical therapy. The entire rehabilitation period lasts several months.
New Developments
The main new advances in the treatment of rotator cuff tears are the new arthroscopic techniques and minimally invasive small incision techniques. This allows for less trauma and faster recovery. Many techniques use absorbable anchor screws. These screws can be absorbed after the tear has healed.
Arthritis of the shoulder joint
Many people think of the shoulder joint as a simple joint, however the shoulder joint is actually made up of two joints in the shoulder. One is attached to the acromion at the distal end of the clavicle. This is called the acromioclavicular joint. Then there is the humeral glenoid joint which is formed by the head of the humerus and the scapular glenoid. Both of these joints can produce arthritis.
In order to be able to treat a patient effectively, the doctor needs to know which joint is involved and what kind of arthritis it is. Three main types of arthritis are common in the shoulder.
Osteoarthritis, wear and tear arthritis, which is a degeneration that destroys the previously smooth cartilage surfaces of the joint. It usually occurs in people over 50 years of age, mostly in the acromioclavicular joint.
Rheumatoid arthritis is a systemic disease that affects the joints. It can occur at any age and affects multiple joints throughout the body.
Post-traumatic arthritis occurs after trauma to the shoulder joint, such as fractures and dislocations, or after rotator cuff injuries.
Signs and Symptoms
The most common symptom of shoulder arthritis is pain that worsens with activity and gets progressively worse. If the humeral glenoid joint is affected the pain is mainly in the back of the shoulder and worsens with weather changes. In acromioclavicular arthritis, the pain is mainly in the anterior part of the shoulder. In the case of rheumatoid arthritis where both joints are involved, the pain can occur in the entire shoulder.
Restriction of movement is another symptom. Patients may have difficulty combing their hair and holding things on a shelf. There may also be clicking and popping or interlocking when moving the shoulder joint.
When the symptoms worsen, any slight movement of the shoulder joint produces pain, and the pain becomes increasingly pronounced at night or even difficult to sleep.
Physical examination and x-rays can help with the diagnosis.
During the physical examination the doctor needs to find: the degree of muscle atrophy tenderness range of passive or active movement signs of muscle ligament and tendon damage other joint conditions (suggestive of rheumatoid arthritis) bone rubbing sounds during joint movement
Pressure pain in the involved joint X-rays show joint space narrowing, bone changes and bone spur formation. If local sealing of the joint site temporarily relieves pain, the diagnosis can be clarified.
As with other areas of arthritis, conservative treatment can be started with
Rest to avoid activities that cause pain; you need to change the way you do things or move your arm.
Take the NSAID aspirin or isobuprofen to reduce inflammation.
Apply ice 2-3 times a day for 20 minutes to reduce pain and inflammation.
If rheumatoid arthritis is indicated it can be treated with some controlled medications such as methotrexate or hormone injections.
Dietary supplements of glucosamine and chondroitin sulfate may also be helpful.
If conservative treatment does not work, surgery may be considered. As with all surgery, there are risks and complications associated with surgery. Your doctor will try to minimize these risks.
Brachial pelvis arthritis can be treated with a total or hemi-shoulder replacement. Arthritis of the acromioclavicular joint can be treated with a distal clavicle resection and shaping, after which the acromioclavicular area is filled with scarring. Surgical treatment is very effective in reducing pain and restoring range of motion.
Are there any other diseases that cause “shoulder pain”? The answer is yes.
(1) Bankart or Kim injury: This is a torn edge of the DD glenoid (the aforementioned “sucker”), another structure that keeps the shoulder joint stable.
This is a torn edge of the DD glenoid (the “sucker” mentioned earlier), another structure that maintains shoulder stability. This is caused by anterior or posterior dislocation of the shoulder joint. This tear is associated with pain, interlocking and a tendency to dislocate the shoulder joint and a perceived inability to control the movement of the joint.
(2) SLAP injury: A tear of the long head of the biceps tendon above the glenoid where it attaches to the bone. It occurs mainly during throwing and other strenuous sports. It manifests as pain and weakness in lifting objects.
(3) Biceps longus tendinitis: The biceps tendon is the tendonous tissue that connects the biceps to the bone. It is a common cause of shoulder joint pain. It is caused by inflammation of the tendon and tendon sheath due to trauma, repeated friction, and overuse. It is particularly common in the elderly and in athletes who use their upper extremities more (swimming, rowing, throwing, golf, weightlifting, etc.).
(4) “Frozen shoulder”: Frozen shoulder is also known as “frozen shoulder” and “frozen shoulder”. It is called “Frozen Shoulder”. We often hear the word “frozen shoulder” around us. Is there that much “frozen shoulder” happening? For a long time, there is a general lack of specialized “joint” doctors in China, and there is little understanding of the causes and pathological mechanisms of “shoulder pain”, resulting in “frozen shoulder”. “Shoulder pain can be *diagnosed*, and even the general public can “confirm” the diagnosis, becoming a “scapegoat” for many other shoulder pains. There is even a clear treatment for DD “climbing the wall”! The effect can be imagined. In fact, the clinical incidence of frozen shoulder is not high, accounting for only 10-15% of shoulder pain. “In addition to pain, the mobility of the joint is significantly reduced, especially the “external rotation” mobility is significantly limited, and you cannot comb your hair. Some studies have suggested that this is an adhesive capsulitis or an inflammation and contracture of the rostro-humeral ligament. The difference between this and other diseases is that “frozen shoulder” may improve and heal on its own (self-limiting), usually in about 2-3 years.
These diseases are common clinical causes of shoulder pain. For a clear diagnosis and standardized treatment, it is necessary to go to a major hospital and see a specialized joint surgeon, because arthroscopic surgery is developing rapidly and only specialists in major hospitals have the opportunity to receive specialized training in these latest techniques, while some primary hospitals are not yet capable of minimally invasive arthroscopic surgery.
These specialists will collect a detailed medical history, perform a detailed local examination, and may also take special body radiographs or MRI (magnetic resonance imaging) scans to make a clinical diagnosis and treatment plan after comprehensive analysis. Mild ones of these diseases can achieve good results with simple treatments, such as local injection of drugs, physiotherapy, and rehabilitation training.
For those with definite structural lesions or those for which systematic conservative treatment is ineffective, prompt surgical treatment is required. For example, acromion spur, Bankart or Kim injury, SLAP injury, recurrent shoulder dislocation, severe frozen shoulder, etc. All of these can be treated surgically using minimally invasive arthroscopic techniques. Bone spurs can be removed, sutures can be placed to repair and fix the damaged structures, and stiff joints can be loosened. After surgery, joint rehabilitation is performed gradually to achieve ideal joint function and improve the quality of life and movement.