Diagnosis

The diagnosis begins with a detailed interview and physical examination of the patient. Pain in combination with typical movement restrictions already indicate damage to the tendons of the shoulder. Depending on the affected tendon, different movements in the shoulder are restricted.

An experienced orthopedist can then use an ultrasound examination to detect inflammation, degenerative changes and tears in the tendons of the shoulder muscles. An X-ray examination can also be used to examine the bony structures of the shoulder and possible calcification in the shoulder joint. Abnormalities of the bones or calcium deposits can provide important information about the cause of the injury and degeneration of the tendons.

In most cases, these measures are sufficient to diagnose a torn tendon. To better diagnose more complicated tendon injuries, partial tears and small degenerative changes, an MRI examination can be performed. The MRI examination can be performed in addition to ultrasound and X-ray diagnostics.

Although the bony parts are difficult to depict in an MRI, the soft tissue, cartilage, tendons and muscles can be depicted. The MRI examination does not require any radiation at all and provides high-resolution three-dimensional images of the inside of the shoulder. Complete tears of tendons of the shoulder can be clearly shown, but also partial tears, thickening, degenerative inflammation and accompanying injuries can be easily detected. The MRI can also show inflammatory changes in the tendons. In particular, the long biceps tendon is often irritated and inflamed after acute injuries, degenerative changes and in cases of severe shoulder soreness.

Therapy

Injuries to the tendons of the shoulder can be treated conservatively and surgically in many ways.Some tendon tears that do not cause symptoms do not always require surgery. A tear of the long biceps tendon causes hardly any functional restrictions, which is why it does not need to be treated in many cases. Irritation of the tendons can often be reduced by sparing the tendons and using drug therapies.

Calcified deposits can also dissolve by themselves or with the help of shock wave therapy, causing the symptoms in the shoulder to subside. Complete tendon tears or partial tears can be treated and fixed. This is done by means of arthroscopy or open surgery.

Only very rarely are the pain and damage to the shoulder so severe that a shoulder prosthesis becomes necessary. If the shoulder is painful, the joint is often spared and immobilised to prevent damage, irritation and inflammation of tendons, the bursae or other structures in the shoulder. However, in order to maintain mobility in the shoulder and to perform everyday tasks again, light exercises can provide relief for the shoulder.

Initially, the shoulders can be moved back and forth in a circular motion while standing to loosen the joint and muscles. In a subsequent exercise, a kneeling position on all fours can be adopted. Then try to slowly walk with your back into a hollow back and lower your upper body to the floor with outstretched arms.

In a third exercise the stretched arms can be slowly moved backwards while standing. If you stand about 30 cm with your back in front of a wall, the stretched arms can be pressed against the wall with slowly increasing force. It is important with injuries of the shoulder that all exercises should not be performed against the pain.

Drug therapy for pain is very useful for shoulder complaints. Torn tendons in the shoulder can lead to considerable pain at night and during the day during everyday activities. In order to enable everyday life for the duration of the treatment, the pain should be treated with appropriate pain medication.

Initially, drugs from the NSAID group can be taken. These include drugs such as “Ibuprofen“, “Diclofenac” and “Indometacin”. They can be combined with each other if necessary, but the maximum dose must be observed. In addition, for very severe shoulder pain, opioids of different strengths such as “tilidine” or “morphine” can be used. The pain medication should only be taken temporarily until a causal therapy of the torn tendon is initiated.