Synonyms in a broader sense
- Shoulder Pain
- Impingement Syndrome
- Tendinosis calcarea
- Torn rotator cuff
- Biceps tendon endinitis
- AC joint arthrosis
- Shoulder arthrosis (omarthrosis)
- Supraspinatus tendon syndrome
Introduction
The majority of people experience shoulder pain at some point in their lives. This may be caused by an injury, but it can also develop within the context of certain diseases and progress slowly. In the case of acute shoulder pain, one speaks of complaints that do not last longer than six weeks.
If the pain lasts between six and twelve weeks, it is considered to be sub-acute. Chronic pain finally lasts longer than twelve weeks. Below are some causes that can lead to shoulder pain.
Pain in neck, throat and upper arm
Acute attacks of pain in the neck-shoulder area often have muscle tension as their cause. Possible triggers are draught or cold, a tense posture, incorrect sitting or lying down, as well as an unusually heavy load. Mental problems can also lead to muscle tension.
Muscle strains are rarer. The only exception is recurring pain that radiates from the neck and throat into the shoulder. They often develop due to wear and tear of the cervical spine caused by too little or wrong movement and a lot of sitting.
The intervertebral discs become flatter, the cervical spine ossifies and the small vertebral joints wear out (facet joint arthrosis). This causes pain in the neck area and leads to an increasingly stiff neck. In addition, the muscles harden, which causes additional pain all the way to the shoulder.
Draft or cold can then trigger acute pain attacks. Furthermore, these processes pave the way for later nerve root compressions. Pain in the neck and shoulder that radiates into the arm usually involves nerves that are trapped directly after they leave the spinal cord (root compression).
The nerve roots must pass through a narrow bony opening in the immediate vicinity of the respective intervertebral disc. In most cases, especially in older patients, the above-mentioned wear-related processes are responsible for entrapment. Less often, herniated discs of the cervical spine, disc protrusions of the cervical spine or whiplash of the cervical spine (e.g. car accident) are the cause.
The consequences of root compression are sensory disturbances and pain in the neck, shoulder and circumscribed areas of the arm. This may be accompanied by slight paralysis of certain muscles and possibly the weakening of reflexes. Depending on the pinched nerve root, the complaints occur in different places.
The pain usually depends on posture and is stronger at night. Pain radiating from the shoulder into the arm may cause irritation of individual nerves. In most cases this is caused by carpal tunnel syndrome.
A nerve (N. medianus) is pinched at the wrist. Repeated activities with the hand, for example writing on a computer keyboard, encourage this. The pain usually occurs at night, radiates from the hand to the shoulder and improves acutely by moving the arm.
Emotional disorders of the fingers can also occur, as well as clumsiness of the fingers in the morning. Furthermore, nerves in the nerve plexus between the cervical spine and the shoulder, in the so-called plexus cervicobrachialis, may be damaged. This can be caused by acute allergic-inflammatory processes (neuralgic shoulder amyotrophy).
Drug abuse, infections, rheumatic diseases or overuse can be triggers. The movement-independent pain usually begins suddenly, at night and on the dominant side of the arm. Hours later, they turn into a weakness of the shoulder muscles, which in the long term can manifest itself in the form of a protruding shoulder blade and slowly subsides.
Sensory disturbances are more in the background. Other reasons for damage to the nerve plexus are tumors or metastases, late damage from radiation, infections (e.g., Lyme disease) and certain sporting activities (field hockey, shooting). Other possible reasons are carrying a heavy backpack, sudden pulling up or down on the arm and incorrect positioning during an operation.A constriction of vessels and nerves in the area of the upper thoracic opening (thoracic-outlet syndrome) is also a rare cause of pain in the shoulder and arm.
There is often an additional cervical rib and the pain can be provoked by certain maneuvers. In addition, diseases of the shoulder can also cause pain in the shoulder and upper arm. These include shoulder joint arthrosis, rotator cuff tear, subacromial syndrome or biceps tendon inflammation.
In these diseases, the pain is mainly dependent on movements in the shoulder joint. Apart from this, organic diseases can also make themselves felt through pain in the shoulder-neck area. In the first place, the heart attack is mentioned as an absolute emergency.
Only about one third of all cases are characterized by typical pain in the left arm, and often the pain radiates into the shoulder, neck and back. The pain is independent of movement and breathing. At the same time general weakness, anxiety, paleness, sweating, nausea and shortness of breath occur.
In addition, liver and bile duct diseases can cause pain in the right, spleen diseases in the left neck-shoulder region. Impingement syndrome The so-called impingement syndrome causes a bottleneck in the shoulder joint. This is often caused by a degenerative change in the tendon of the supraspinatus muscle, which begins to calcify due to wear and tear.
This makes it thicker and more rigid, so that it becomes trapped in the acromion during certain movements. Chronic inflammation of the tendon can also be the cause. This is also more frequently observed in young athletes who put a lot of strain on their shoulder.
Symptoms: Patients typically report pain when the arm is straddled from the body, especially between 70° and 130°. This range is also called painful arc. If the 130° are exceeded, the arm can usually be raised further without difficulty, as the scapula then turns outwards, thus clearing the acromion for the calcified or inflamed tendon.
Diagnosis: The diagnosis of impingement syndrome can be checked by MRI, CT or ultrasound. These imaging techniques can be used to detect changes in the tendon and shoulder joint, so that other possible causes of the observed symptoms can be ruled out. For example, a torn tendon or an injury in the shoulder joint capsule can be checked.
If the symptoms improve as a result of the injection of anti-inflammatory drugs into the shoulder joint, the diagnosis of impingement syndrome can be considered certain. Therapy: Therapy is usually carried out by conservative measures, i.e. a surgical intervention is not performed in most cases. Initially, anti-inflammatory drugs can be injected directly into the shoulder joint; they improve the symptoms and soothe the irritated tendon tissue.
In addition, physiotherapeutic treatment is recommended to improve and stabilize mobility in the affected shoulder joint. An alternative procedure is shock wave therapy (ESWT). In this procedure, very strong sound shock waves are generated which can be focused on the shoulder.
Due to their strong pressure, they are able to break up calcifications in the shoulder area. The small calcification particles can be better broken down and removed by the body, so that shock wave therapy can achieve good results. However, if the pain persists for more than half a year despite these measures and is therefore chronic, a surgical intervention can be considered.
This is usually performed arthroscopically, i.e. as part of a shoulder joint endoscopy. For this purpose, cameras and instruments are inserted into the joint through small skin incisions, so that the inflammatory areas can be removed under visual control. If the pain occurs after a traumatic event, it could be a shoulder contusion.
Such an event is typically a shock, blow, impact by falling or a collision, which can easily happen during sports, for example. Symptoms: A shoulder contusion manifests itself as pain at the affected area, accompanied by redness and swelling. Frequently, bruising also occurs.
Therapy: Immediately after the traumatic event, the shoulder should be immobilised and movements paused. It should also be cooled with ice. Compression and elevation (in the case of the shoulder, rather relief for the shoulder).B.
by an arm sling) are also good immediate measures. These 4 measures are also called the PECH rule. In the further course of the healing process, warming ointments can be used to support the healing process, but you should wait about 2 days. It is important not to put weight on the shoulder again until the bruise has healed completely.
