Capsule

The capsule of the shoulder joint is flaccid and wide. This allows a relatively large radius of movement of the joint. At the foot end of the joint capsule, i.e. in the armpit area, it forms a so-called recessus when relaxed.

The recessus represents a kind of reserve fold of the capsule and serves to move the arm upwards as much as possible. Anterior shoulder pain can therefore always be caused by a disease of the shoulder capsule. In the clinical picture of the so-called “frozen shoulder” (stiff shoulder), the capsule shrinks, causing pain and restricting movement in the shoulder joint.

Frozen shoulder” can occur with or without known causes. This leads to an inflammation of the capsule, which causes pain. The inflammation automatically spares the shoulder joint to reduce the pain.

However, the relieving posture unfortunately leads relatively quickly to shrinkage of the capsule in the area of the shoulder joint and the associated loss of mobility. Women between the ages of 40 and 60 are frequently affected by this disease.

Synonyms:Bursitis of the acromion
Location of the greatest pain: Under the acromion, sometimes radiating into the upper arm.
Cause of pathology: Shoulder bottleneck syndrome (impingement syndrome) with irritation of the bursa under the acromion.
This leads to an inflammatory thickening of the bursa.
Age:Mostly older patients, but also patients with professions involving a lot of overhead activity (e.g. painter, plasterer). Especially also sportsmen and women with overhead activities like tennis, badminton etc.
Gender:Women = Men
Accident:As a rule, there is no triggering cause for an accident.
Pain type:Dull, pulling, especially in night pain.
Pain development: A so-called shoulder pass syndrome occurs when the head of the humerus rises above the ground. This causes the tendon of the rotator cuff, the so-called supraspinatus tendon, to jam under the acromion.
This leads to inflammation of the bursa (bursitis subacromialis) under the acromion.
Pain occurrence:Pain occurs especially when the arm is abducted beyond the horizontal plane. Pain at rest and pain at night are frequently reported.
External aspects:Usually, an inflammation of the bursa (bursitis subacromialis) is externally unremarkable.

In subacromial bursitis, the bursa is located between the acromioclavicular joint and the tendon of the upper bone muscle (supraspinatus muscle, an important part of the rotator cuff). This bursa is a shifting layer between muscle and bone.

If an inflammatory change occurs in this bursa (bursitis subacromialis), this sliding layer becomes sticky and the tendon of the muscle becomes thinner. As the disease progresses, the upper bone muscle usually tears (rotator cuff rupture), resulting in chronic pain that severely restricts the shoulder’s ability to move. The diagnosis of subacromial bursitis can usually be made easily.

For this purpose, detailed information about the patient’s medical history (anamnesis) and a physical examination are performed. As a rule, subacromial bursitis causes pain in the shoulder joint when the arm is moved (abducted) between 80 and 120 degrees to the side of the body. In addition, imaging examinations such as ultrasound (sonography), magnetic resonance tomography or X-rays can provide information about the extent of the bursitis.

The treatment of bursitis acromialis initially consists of avoiding further strain and protecting the shoulder joint. Physiotherapeutic exercises and pain-relieving medication can also be helpful. In many cases, an injection of cortisone into the subacromial space can relieve the symptoms.

However, if conservative measures do not bring any improvement, surgical removal of the shoulder bursa may be indicated. Shoulder pain that develops due to a narrowing between the head of the humerus (caput humeri) and the acromion is known as impingement syndrome.In this area of the shoulder, a certain tightness already exists naturally, which is why chronic irritation of the bursa and tendon attachments (usually supraspinatus tendon, rotator cuff) often occurs. Certain occupational groups such as painters or overhead sportsmen and women (e.g. tennis or volleyball players) have an increased risk of impingement syndrome.

At the beginning, shoulder pain only occurs during exertion (especially during activities with raised arm), later it can also occur at rest. The pain is usually particularly pronounced when the arm is abruptly lifted to the side or under stress. To relieve shoulder pain in impingement syndrome, therapeutic measures such as electrotherapy, ointment treatment, cold therapy, movement exercises and targeted muscle training can be used first.

Anti-inflammatory medication can also be used. If the conservative treatment options fail, the cause of the irritation of the shoulder should be treated. For this purpose, the space under the acromion can be expanded during surgery.

The inflamed (and usually thickened) bursa is removed and bony projections are removed. This is also intended to prevent progressive damage to the tendons of the rotator cuff and the possible threat of a tendon tear.

Synonyms:Rotator cuff lesion, supraspinatus tendon tear
Location of the greatest pain: Pain is mostly under the acromion, sometimes radiating into the upper arm.
PathologyCause:The rotator cuff tear is usually the result of an impingement syndrome.
Due to a shoulder bottleneck syndrome that has persisted for years, the tendon is subject to continuous wear. Sudden movements or an accident can cause the damaged tendon to tear completely. Even a non-damaged tendon can rupture over a major force caused by an accident.
Age:Increase of the disease with increasing age.
Gender:Men/Women: 2 : 1
Accident:Usually the cause is wear and tear, in rare cases an accident can be the cause of the damage.
Type of pain: pulling, stabbing
Origin of pain:Load-dependent.
In the case of large tears, partial paralysis of the arm can be simulated by the loss of function of the tendon (pseudoparalysis).
Pain occurrence:load dependent
External aspects:None

The shoulder joint is mainly stabilized by the muscles of the shoulder girdle. The rotator cuff is the name given to the four muscles that hold the humerus in the glenoid cavity of the shoulder. If a rotator cuff tear occurs, one or more muscles or tendons of this important muscle group are damaged.

Such a tear can have a traumatic (accident-related) or degenerative (wear-related) cause. For example, a fall or external force may cause dislocation of the shoulder, in some cases causing a tear in a muscle of the rotator cuff. In addition, such a tear can occur with increasing age, as there is a loss of cartilage substance and a loss of strength from the tendon attachments of the muscles.

A rotator cuff tear causes pain of varying intensity and restricts the mobility of the shoulder. Especially the lateral lifting of the arm (abduction) is no longer possible or only very painful in the case of a rotator cuff tear. There are various options for treating a torn rotator cuff.

On the one hand, the tear can be surgically sutured or closed. Afterwards, an extensive physiotherapeutic follow-up treatment over months or years is usually necessary to restore physical performance. In addition, in about one fifth of cases the shoulder pain remains after the operation.

On the other hand, a conservative (non-operative) therapy can be aimed at. For this, cortisone injections into the shoulder and non-steroidal anti-rheumatic drugs can be considered. Physiotherapeutic exercises are also used in the conservative treatment of a rotator cuff tear, if necessary with local pain elimination.

Synonyms:Biceps Tendon Endinosis
Location of the greatest pain:The greatest pain is located on the front of the poor humeral head, sometimes there is pain radiating into the upper arm up to the elbow joint.
PathologyCause:The causes of biceps tendon irritation are manifold.Most often, the cause of wear and tear is in the foreground. Many small injuries (microtraumas) lead to degeneration (wear) of the so-called biceps tendon anchor. This is the attachment of the long biceps tendon at the shoulder joint. This wear and tear causes discomfort when the biceps tendon muscle (Musculus bicipitalis humeri) is tensed, i.e. when bending in the elbow joint and external rotation of the forearm.
Age:Illness to increase with age.
Gender:Men > Women
Accident:No
Type of pain: stabbing
Pain development:Continuous due to wear and tear of the tendon.
Pain occurrence:Especially when bending in the elbow joint.
External aspects:Externally, usually inconspicuous.