If you’ve been experiencing persistent pain within your shoulders for over a week now, chances are that it could be due to an overuse injury such as a cuff tear or tendonitis. Such shoulder pain can be extremely difficult to manage and can put you in a problematic situation, especially if you’re a grown adult.
We happen to use our shoulders in routine daily tasks, which is why it is highly important that we do not take shoulder agony lightly and come up with ways to manage and improvise. Shoulder pain treatment becomes a necessary requirement if the pain has lasted for more than a week.
Frozen shoulder physiotherapy or general frozen shoulder physiotherapy should begin if you are unable to find a reliable treatment avenue. However, we understand your complications and have mentioned a number of shoulder pain treatment options you should consider if you are going through extensive shoulder pain.
Shoulder Pain Relief Exercises
Put an end to shoulder pain: do these 3 exercises every day!
Stand in front of a corner of the room and take a step back with your left leg. Raise your arms about 45 degrees and support yourself with your palms on the left and right of the wall.
Now stretch your sternum up and let yourself fall deep into the stretch for about a minute. In this position, you should feel a pull in the area of your arms and shoulders.
The second step is our special control: press with both palms of your hands against the wall with all your strength as if you wanted to push it away – your elbows are stretched.
Tense your entire shoulder girdle, let it loose again after about ten seconds and go into the stretch even more intensively. Repeat the interplay of tensing, loosening and stretching two more times.
For our second exercise, stand in front of a wall and take your left leg back a step. Extend your arms parallel upwards and support your palms on the wall. Angle both thumbs outward until they touch.
In this way you can check whether your arms are at the right distance from one another. Now only push your shoulder girdle forward towards the wall.
Go deep into the stretch for about a minute. You should feel a strong pull in your shoulders as you do this. In the second step, we integrate the intensive control again:
Build up firm pressure with your palms, let go after about ten seconds and stretch your shoulder girdle even further. Here, too, you alternate a few times between tensing, letting go again and further stretching.
Stand with your back in front of a flat, non-slip piece of furniture, such as a chair in front of a wall. Hold on to it with both hands and take your right leg about two steps forward. Your left leg stays behind for stabilization.
Now expand your rib cage far outwards. If you notice a strong pull in your shoulders, you are doing the stretch intensely. Hold this position for a minute, then slowly bend your right thigh forward – the pull in your shoulders should increase as you go.
To intensify the exercise, you also integrate the special control here again: Press the selected support, for example the chair, firmly down with your hands as if you wanted to bring your arms forward.
After ten seconds, take the strength out again and bend your right thigh further forward so that you continue to go into the stretch. Repeat the interplay of tensing and letting go a few more times, as in the previous exercises.
Shoulder Pain When Lifting Arm
Chronic shoulder pain, stiff shoulder – what helps
Shoulder pain and a stiff shoulder can be the result of wear and tear, inflammation, injury – and more. Information about causes and therapy
But this scenario is far from everything. This post gives you an overview of important causes of shoulder pain. The focus is on chronic complaints. Basically, it is also about diagnosis and therapy.
Causes: How does (chronic) shoulder pain occur?
If a patient with shoulder pain has nothing to report about an obvious shoulder injury, there are essentially two options:
Either the problem lies in the shoulder anyway. Then the point where the pain is mainly felt and the movements that trigger it can provide further clues. By far the most common causes of (chronic) shoulder pain are problems with the so-called rotator cuff. Pain in the front and side of the shoulder, which increases when the arm is raised upwards and when lying on the affected shoulder (night pain), are possible indicators. More in the section “Chronic shoulder pain – calcific shoulder, tendon tear”.
Or: A pain that can be localized at the outer end of the collarbone is an indication of damage to the shoulder joint.
That means: If it is a problem on the shoulder, it is important to find out which part is affected.
From overload to wear and tear
Shoulder pain plagues many people. The basic pattern: chronic overload and muscle imbalances. “Overhead workers”, for example painters, or “overhead athletes”, such as handball, volleyball and tennis players, are particularly affected.
But even well-established movement sequences using the shoulder, arm and hand in production or in the operating theater can lead to shoulder problems over time.
Overloading the movement system creates roughness, fibrillation and sometimes spurs at critical points. A bottleneck syndrome (English impingement) can develop.
That means: A shoulder, in which the inner sliding no longer works smoothly, is exposed to a constant state of irritation. Then it won’t be long before, in addition to pain, there may also be greater damage (or vice versa).
This mainly affects the so-called soft tissue such as tendons and bursa around the main joint of the shoulder and under the shoulder roof. Specifically, it is about tears and adhesions, shrinkage of the joint capsule, possibly a stiff shoulder.
More about this and about what rubs and tears where can be found in the sections “Anatomy of the shoulder” and: “Chronic shoulder pain: calcified shoulder, tendon tear”.
Joint wear and tear resulting in osteoarthritis occurs less frequently on the shoulder than, for example, on the knee or hip joint. Sometimes it affects the joint on the sternum, more likely the corner joint at the outer end of the collarbone: Osteoarthritis can develop here as a result of injuries such as a split shoulder or rheumatism.
If the head of the humerus is damaged, for example by a defective rotator cuff, then over time osteoarthritis (omarthrosis) is also possible in the main shoulder joint. More in the section “Chronic shoulder pain: shoulder osteoarthritis” below.
The other possibility: There is a disease outside of the shoulder in which the pain “only” radiates towards the shoulder. Most of the time, other symptoms come to the fore, for example shortness of breath or abdominal pain. The doctor will immediately rule out potentially dangerous diseases in the chest or abdominal cavity in order to get to the bottom of the causes of the shoulder pain (see below, section: “Acute pain events that radiate into the shoulder”).
First painful, then stiff shoulder: the mysterious Frozen shoulder
A frozen shoulder sometimes has a different background. “Frozen shoulder” – this is a clinical picture in which the shoulder starts to hurt for an unclear cause and then stiffens (see corresponding section “Frozen shoulder” below). Active and passive movements are clearly restricted. This also makes it difficult to get a good night’s sleep, which everyday life often suffers from. Weeks can pass before the whole thing begins to resolve itself again.
Sometimes a certain lack of movement remains, but consistent exercise makes the shoulder much more flexible again. Certain diseases sometimes coexist with a frozen shoulder. These include diabetes, lipid metabolism disorders, thyroid disorders and diseases that can lead to movement disorders or paralysis, such as Parkinson’s disease or a stroke.
Starting point cervical spine?
Tension in the neck muscles due to drafts, poor posture and misalignments of the spine are known to be often painful. Initially, the symptoms usually focus on the starting point, i.e. the neck. If things don’t go so well, they can expand and radiate over the shoulder and into the arm. Many people believe they have a shoulder problem. The actual causes, however, are usually dysfunction of the neck and back muscles. Doctors speak of pseudoradicular pain when the nerve roots (lat. Radix, derived from radicular) on the spinal canal are not affected.
If the symptoms do not improve or worsen within a few weeks, the doctor will review the findings. Depending on the evidence, different diagnoses should be considered, starting with wear and tear on the cervical spine. For example, although a herniated disc is rare there, it cannot always be ruled out. Warning signs in this direction can include sensory disturbances such as tingling or numbness and a loss of strength in the arm, hand or individual fingers. Then quick action is called for, a doctor has to check whether it is a case for the clinic.
Inflammation, nerve damage & Co.
One of the more rare triggers of shoulder pain is bacterial inflammation of the shoulder joint. Gout and rheumatic diseases, for example in the form of polymyalgia rheumatica, can also affect the shoulder (s). The inflamed vessels lead to muscle pain and stiffness.
In addition, bursitis occurs on the shoulder. It is not uncommon for muscles in the pelvic girdle to also hurt. Sometimes those affected still suffer from general symptoms such as fever, fatigue, weight loss and night sweats.
Some of those affected also have vascular inflammation in the head area, which can lead to headache in the temples, pain when chewing and visual disturbances (more on this below in the section “Chronic shoulder pain: rheumatism & Co.”).
Sometimes nerve damage to the shoulder occurs. The over-shoulder blade or suprascapular nerve, for example, supplies the shoulder bone muscles.
Constant pulling or pressure on the nerves can lead to muscle wasting in the shoulder, which limits its range of action. For example, volleyball and basketball players are more often affected.
Occasionally, a bulge (cyst) in the joint capsule or tendon sheath constricts the nerve. The symptoms are similar to the aforementioned bottleneck or impingement syndrome.
The fact that shoulder pain is due to a malignant lump in the bone or soft tissue of the shoulder or at the tip of the lung is also an exception.
Likewise, the possibility that a tumor presses a nerve, for example in the so-called arm plexus. This is the plexus of nerves for the shoulder, arm and chest; the nerve fibers run from the cervical spine under the collarbone to the armpit and further into the arm.
These nerve tracts can also be damaged in the so-called thoracic outlet syndrome. It is about obstacles in the triangle between the cervical spine, muscles, first rib and back of the collarbone.
The arm nerve plexus running along here can be cornered, for example, by bone or ligament parts. The main complaints are sensory disorders such as numbness and muscle weakness in the arm or hand, especially when moving the arm overhead or doing computer work.
The arm vessels take the same route. If a venous vessel is mainly squeezed in, symptoms such as pain, swelling, changes in the color of the skin (violet color) occur, for example.
if an arterial vessel becomes narrowed and closes (thrombosis), it can lead to a circulatory disorder in the hand. See a doctor as soon as possible in the event of signs such as feeling cold, pain, paleness or numbness in the hand!
Circulatory disorders with damage to the bones (osteonecrosis) rarely lead to shoulder pain.
Disorders of the shape of the shoulder due to the shape of the body can be associated with, among other things, visible poor posture and a tendency to dislocate (dislocate).
The section “Chronic shoulder pain: consequences of injuries” briefly deals with instability problems of the shoulder such as dislocations.
Acute painful events radiating to the shoulder
Acute chest pain caused by internal illnesses, for example a heart attack, often radiates into the left shoulder and left arm. It can, but does not have to be preceded by, repeated chest pain, which those affected often, but not necessarily, feel on the left side of the shoulder or arm.
Alert the emergency doctor or the ambulance service (emergency number 112) in the event of warning signs such as acute chest pain, tightness, shortness of breath, weakness, cold sweat, nausea.
Acute diseases of the gallbladder, such as colic, occur primarily in the right upper abdomen, but the associated abdominal pain can radiate into the right shoulder.
Shoulder pain: when to see a doctor?
If you experience shoulder pain caused by injury or spontaneously, you should see a doctor. Examples:
The shoulder can hardly be moved
It hurts with certain movements (active or passive), appears powerless or unstable
If, for example, after falling onto your outstretched arm, you have to hold it compulsively, possibly at an angle and supported by the other hand, and protrude a “corner” outward at the shoulder
The shoulder is swollen, the skin may feel very warm there, and it may also be reddened
A higher end of the collarbone in the shoulder area can be pressed down like a piano key and pops up again when you let go
The shoulder hurts considerably when lying on the affected side, sleep is disturbed
If, for example, you are no longer able to clasp your hands over your back well or not at all due to pain or a blockage (apron grip) or if you cannot place your forearms and hands (with your elbows bent) over your head on your neck / upper back.
If you experience tingling or numbness or muscle weakness in the arm (signs of neurological failure)
For all acute pain in the shoulder, also in connection with other painful joints and fever
If pain in the chest or abdomen and alarm symptoms such as shortness of breath and poor circulation occur (see also the notes on emergencies in the previous text), call a doctor immediately or call the emergency services (emergency number 112).
All about the shoulder: diagnosis and therapy
Talking to the doctor and having a thorough physical examination are the mainstays when it comes to diagnosing shoulder problems. In this way, non-orthopedic diseases can largely be ruled out. The orthopedic surgeon observes the patient’s physique carefully, also in side-by-side comparison.
It scans muscles and tendons in the neck and shoulder area, checks the muscle strength and muscle reflexes as well as the sensation of the skin. And he uses targeted movement tests to check the cervical spine, arms and shoulders. It is primarily about mobility, stability, strength, pain. The doctor also checks the vascular pulses and blood pressure on both arms.
The next step is often a sonography. With this imaging examination, for example, soft tissues such as tendons, bursae, the synovium and muscles can be clearly depicted. Techniques such as color duplex sonography or magnetic resonance imaging (MRT) can help with special questions.
X-ray procedures including computed tomography (CT), for example, show the bone structures, positional relationships and joint positions well, and therefore also fracture injuries. Arthroscopy of the shoulder allows diagnostic and therapeutic interventions.
Many therapy options on the shoulder
The treatment of shoulder pain knows conservative and operative ways. The focus of conservative therapy: protection of the shoulder (avoidance of overhead movements), anti-inflammatory pain relievers and physiotherapy (formerly: physiotherapy).
Further options are physical therapies, such as cold applications for acute pain, or heat treatment and electrotherapy for chronic complaints such as muscle tension.
Injection treatments with cortisone are on another page. They are still used, but very carefully and economically. In the case of severe pain, combinations of certain medications can help, including in individual cases an opioid preparation (opiate).
An externally applied, extracorporeal shock wave therapy can shatter stubborn calcium deposits on a calcareous shoulder, which do not loosen by themselves and cause constant discomfort. The doctor treats other underlying diseases, such as internal or neurological diseases, as specifically as possible.
The surgical treatment methods are also numerous. They include arthroscopic procedures, minimally invasive and classic open interventions.
Among other things, it is about correcting the shape and position of the humerus, implanting tendons, relocating muscles, loosening adhesions, removing diseased bursa and defective but obstructive tissue.
A shoulder joint replacement is an option, for example, in the case of complaints caused by shoulder osteoarthritis that cannot be controlled otherwise.
A puzzle: anatomy of the shoulder
The shoulder joint is extremely flexible. A look at the anatomy shows that. However, the large scope also has disadvantages.
Shoulder Pain Causes
Shoulder pain affects the quality of life
Shoulder pain occurs in both women and men of all ages. It is not uncommon for the pain to radiate into the shoulder, neck and entire arm to the fingers. Shoulder pain can occur suddenly while exercising or lifting heavy objects. Lying on your arm during the night often causes acute shoulder pain.
The majority of the supposed shoulder pain (85 percent) does not come from the shoulder joint itself. The triggering factors should therefore not only be determined close to the joints.
Shoulder pain can be triggered by damage to tendons, muscles, and joint capsules caused by illness or injuries, and by pre-existing joint wear and tear. However, diseases of the liver, gall bladder or a heart attack can also cause shoulder pain.
A distinction is made between acute and chronic pain in shoulder pain. If they suddenly appear in the shoulder after a fall or an accident, they can be caused by a dislocated shoulder, a fracture of the upper arm or an injury to the biceps tendon.
This type of pain is known as acute shoulder pain. The chronic shoulder pain is usually very persistent and develops over a long period of time.
One example of this is the wear and tear on the joints, osteoarthritis. If a herniated disc in the cervical spine region becomes symptomatic, severe discomfort can occur in the shoulder joint. A frozen shoulder is accompanied by inflammatory symptoms and is always perceived as extremely unpleasant.
Regardless of the cause of the shoulder pain, it significantly affects everyday life. Even the smallest movements are associated with pain.
Often only the orthopedic surgeon can help. Have your complaints persisted for more than a week? Do no movement exercises help? Do drugs like ibuprofen or diclofenac fail? Then you should consult our office hours.
The most common causes of shoulder pain
The most flexible joint in our body is the ball joint of the shoulder. Since it is largely stabilized by vision and muscles, a large range of motion is possible. As a result, the shoulder is prone to wear and tear and injuries. The result is shoulder pain that often needs to be treated in our orthopedic practice. But what diseases and injuries are these?
Muscle tension in the neck / shoulder area often leads to a painful restriction of movement in the cervical spine and shoulder joint. They occur particularly in people who have a sedentary job in their professional life and do not have enough exercise in their free time.
Certain problems in the chewing apparatus are grouped together as craniomandibular dysfunction (CMD). Pressers (bruxism) and grinders always complain of neck and shoulder pain.
Joint wear and tear, known as shoulder joint arthrosis, in which the cartilage layer on the joint surfaces steadily decreases, causes shoulder pain and increasingly restricted movement of the shoulder.
The impingement syndrome or bottleneck syndrome is based on an anatomical peculiarity of the bony shoulder roof. In the case of a sloping shoulder roof, there is generally little space between the shoulder roof and the ball.
Calcifications, changes in the shoulder joint and degenerative damage to the rotator cuff can cause permanent inflammatory changes. The lubricant between the cap muscle and the rotator cuff, the subacromial bursa, is permanently irritated and can cause chronic pain in the joint.
If the rotator cuff tears acutely as the muscular holding device of the shoulder ball, sudden shoulder pain occurs. If the biceps tendon tears, it is called a biceps tendon rupture.
A dislocated shoulder joint (shoulder dislocation) or a fracture of the upper arm near the shoulder area or the collarbone is also associated with shoulder pain.
Mostly falls or instability of the shoulder joints are responsible for these causes. In old age, relatively banal traumas are sufficient for an upper arm fracture.
If shoulder pain occurs as a result of a fall or blow, there is a possibility that it is a hemorrhage in the joint. People with bleeding disorders are particularly at risk here.
If lime crystals stick to the tendon attachments, one speaks of a calcareous shoulder (tendinosis calcarea, see separate description). It is just as much a cause of shoulder pain as the inflammatory rheumatic muscle disease PMR, polymyalgia rheumatica.
If the middle arm nerve in the carpal tunnel area is damaged, it is called carpal tunnel syndrome. This not only triggers pain in the forearm, but also in the shoulder. Borreliosis, which is transmitted to humans by ticks, and painful shingles are also among the pain triggers in the shoulder.
Most people know that heart attacks and biliary colic are heralded by sudden shoulder pain. But also with Pancoast tumor, a lung tumor, pain occurs not only in the back but also in the shoulder.
As can be seen, there are many causes of shoulder pain. In order to have the correct cause of the existing pain in the shoulder medically clarified and diagnosed, you should consult our orthopedic consultation.
What are the typical symptoms of shoulder pain?
Acute and chronic shoulder pain express themselves differently. The cause and the location of the origin play an essential role here. Often they are accompanied by restricted mobility. Affected people can neither spread nor lift their arm to the side.
They are also only able to perform overhead activities to a limited extent. Feelings of instability in the shoulder, rubbing noises in the shoulder joint and loss of strength in the arm are also possible. Feelings of cold, tingling and numbness can also occur in the shoulder.
Swelling, bruises and deformations in the shoulder area suggest shoulder pain. Likewise, a pinched nerve. Since pain can also radiate in the shoulder, the entire upper arm, the forearm and the cervical and thoracic spine region are often affected.
No matter whether you are moving or resting, shoulder pain can always occur. Especially when you lie on the affected shoulder, the pain that occurs disturbs your night’s sleep.
How is the diagnosis of shoulder pain made?
In most cases, the diagnosis of shoulder pain is made by the orthopedic surgeon. To do this, the person concerned must be examined in detail. Initially, your doctor will ask about the patient’s medical history and family history.
From his answers, he receives initial information about the possible causes or inherited diseases such as osteoarthritis. During the examination, the orthopedic surgeon locates the exact point of the pain and determines how mobile the shoulder is.
He also performs an optical diagnosis. The orthopedic surgeon checks the function of the muscles of the shoulder joint using special examination methods and techniques.
X-rays, ultrasound examinations or magnetic resonance imaging are performed to determine whether the bones are broken, osteoarthritis or deformed. By additionally injecting contrast media into the shoulder joint, an arthrogram can be used to determine whether there are tears or other structural changes in the muscles and tendons.
When it comes to the detection of tendon, muscle or ligament injuries and the representation of the shoulder structure, the ultrasound and magnetic resonance images are very informative. Since ultrasound uses high frequency sound waves, the body structures are shown in multidimensional, highly detailed images. A great advantage of ultrasound diagnosis is its dynamics.
The arm can be moved during the examination. This procedure provides valuable information on functional restrictions during exercise that do not occur at rest and can also be overlooked in magnetic resonance imaging.
X-rays provide better results than magnetic resonance imaging with regard to bony structures, joint wear, calcifications or tumorous changes and should therefore not be forgotten. Comprehensive diagnostics include examinations, function tests, ultrasound, x-rays and, in special cases, magnetic resonance imaging.
Blood tests and joint punctures are also used for diagnostics in our orthopedic consultation. When diagnosing rheumatoid arthritis, it is often the joint puncture that provides the decisive clue.
What therapy is used for shoulder pain?
Once the diagnosis has been made, shoulder pain can be treated with conservative or surgical treatment methods. First, in our orthopedic consultation, we use functional therapy measures to improve the pain.
Medicines that are administered orally or intra-articularly are suitable. Physiotherapy exercise is of particular importance. Acute complaints can usually be relieved with cooling measures. Chronic pain responds better to warmth.
Various clinical pictures such as impingement, calcified shoulder or shoulder osteoarthritis can be treated very effectively with extracorporeal shock wave therapy (ESWT) and can be considered as a measure to replace surgery.
What is the progression of shoulder pain like?
The course of shoulder pain depends on the triggering factors. If the shoulder joints are permanently overloaded, this leads to early, irreversible wear and tear and chronic shoulder pain.
Due to the many degrees of freedom of the shoulder joint with only moderate joint guidance, degenerative, often painful changes in the shoulder joint almost always occur in old age. Basically, the cause of your shoulder pain should be correctly identified and function should be restored as quickly as possible.
We would be happy to advise you in our consultation hours on how to get rid of your pain as quickly as possible, as gently as possible and, preferably, without an avoidable operation.
Shoulder Pain Without Injury
Shoulder pain: causes, treatment, exercises
1- Self test for your shoulder pain
2- What are the possible causes of shoulder pain?
3- Diagnosis: how does the doctor examine shoulder pain?
4- Conservative treatment of shoulder pain
5- Exercises of the shoulder for shoulder pain
6- Operations for shoulder pain: arthroscopy, cartilage therapy and endoprosthesis
Shoulder pain can affect us at any age. The complaints usually limit the free mobility of the shoulder joint significantly.
Shoulder pain can occur in isolation in the shoulder joint during certain movements. But they can also radiate from the neck into the whole arm. Also pain that starts in the wrist and radiates up to the shoulder, e.g. B. in carpal tunnel syndrome, is possible.
Posture problems, which can lead to shoulder impingements, are common sources of pain. But also trauma, overload and joint wear (shoulder arthrosis) can result in shoulder pain.
The incidence of acute and chronic shoulder pain has increased significantly in recent years. Almost one in ten people now complains of shoulder pain.
The symptoms are often excruciating, severely restrictive and long-lasting. Shoulder pain and stiffness of the shoulder joint are common symptoms, which is why patients at the Gundelfingen joint clinic present themselves.
Shoulder pain is to be taken seriously. We can treat many shoulder diseases effectively and effectively at an early stage. Physiotherapy and physical therapy are usually sufficient. If you miss the optimal treatment period, permanent restrictions can arise that make an operation necessary.
Night pains are particularly unpleasant: after injuries or inflammation of the shoulder joint, patients can often no longer lie on the diseased shoulder for weeks.
What are the possible causes of shoulder pain?
Due to the complex anatomy of the shoulder joint, shoulder pain can have many different causes: Common triggers are muscle tension, diseases of bones and joints, postural problems, muscle and ligament injuries and – fortunately, rarely – tumors and bone diseases.
But metabolic diseases such as diabetes or diseases of the thyroid gland can also promote shoulder pain.
The longer life expectancy leads to a higher rate of shoulder disease in old age. The social trend towards certain types of sport – even in older people – is causing shoulder pain more and more frequently.
Inadequate preparation of the body and the musculoskeletal system for new and demanding activities are just as much a trigger of the problems as the generally ever decreasing demands for movement in our society.
Acute or Chronic Shoulder Pain?
Pain that occurs immediately after a fall, impact or overload is called acute shoulder pain. Acute shoulder pain occurs suddenly and suddenly. Acute shoulder pain includes strains, bruises, or overstretching of shoulder tendons.
A fairly common cause are dislocations of the shoulder joint. Other triggers are tendon tears or broken bones (fractures) in the shoulder area.
On the other hand, there is chronic shoulder pain, which often lasts for months and occurs gradually. Chronic shoulder pain cannot be linked to a specific accident event: it is due to wear and tear or inflammatory changes in the shoulder.
Shoulder osteoarthritis is a typical chronic course. Not only the joint surface is affected. Inflammatory degeneration of the supraspinatus tendon, wear and tear of the biceps tendon or capsular inflammation of the shoulder joint (“frozen shoulder”) also cause chronic pain.
For the therapy of shoulder pain, it is very important to differentiate between chronic and acute pain. In the case of acute shoulder pain, structural damage is in the foreground. They can be treated by rest and rest. In the case of tears and fractures, the tendon or bone fragments must often be re-fixed.
With chronic shoulder pain or degenerative inflammation, it is often a matter of getting the painful inflammation under control and preventing a frozen shoulder. So here we treat more conservatively: with medication and with the help of physiotherapy.
In some cases, acute and chronic shoulder pain cannot be clearly separated. In the case of degenerative damaged tendons in the shoulder joint – these include e.g. B. the long biceps tendon or the supraspinatus tendon – even a relatively small trauma can lead to a tendon tear. If the tendon was not previously damaged, a blow to the elbow would often have no consequences.
A fall on the elbow can cause long-term damage to a shoulder tendon (rotator cuff) that takes time to become increasingly painful.
Often shoulder pain also appears gradually and insidiously and becomes increasingly stronger – often depending on certain movements. If the pain lasts longer than 3 months, one speaks of chronic shoulder pain.
Even in the case of structural damage due to previous degenerative damage, conservative therapy is in the foreground: It is not treated like acute but rather like chronic shoulder pain.
Shoulder pain often does not come from the shoulder itself
In the majority of all cases, shoulder pain does not result from a disease of the shoulder joint. Mostly it is shoulder-near areas such as ligaments, tendons or the muscles of the shoulder girdle that cause pain.
Often pain in the shoulder is actually pain in the cervical spine – that is, neck pain radiating into the shoulder. Referred pain in the shoulder can be pain due to nerve entrapment (radiculopathy due to a narrowing of the spinal canal) or due to a herniated disc in the cervical spine.
Shoulder pain when lying on your side
Shoulder pain at night when lying on the side is quite unspecific. But they are particularly agonizing because the sleeping position is restricted and the patient keeps waking up when turning around. Not only older people are affected: night shoulder pain can occur in all age groups.
An injury to the shoulder joint, bursitis (inflammation of the bursa), calcified shoulder or shoulder osteoarthritis as well as inflammation can trigger this excruciating night pain. So shoulder pain at night is a bad, but not a diagnostically very meaningful symptom. You should therefore be clarified by a shoulder specialist.
Shoulder pain and restricted movement of the shoulder joint are very common reasons for a doctor’s visit. Fortunately, in most cases, despite severe shoulder pain, the cause can be treated very well with conservative methods.
Acute shoulder pain from accident or trauma
In many cases, an accident (trauma) triggers shoulder problems. Mostly these are falls on the shoulder, the shoulder joint or on the elbow. However, trauma as a trigger for shoulder pain is not always easy to recognize.
Often a long time can elapse between the accidental damage to the shoulder joint and the occurrence of shoulder pain. This is especially true for rotator cuff damage. A fall on the elbow with a ruptured rotator cuff and shoulder pain can be years apart due to the resulting instability.
Fracture of the humeral head (humeral head fracture)
The fracture of the humerus head results from a fall that is caught with the hand, elbow or shoulder. A fracture in the head of the humerus can occur, especially in older people whose skeleton is weakened by osteoporosis.
The humeral head fracture is extremely painful. The patient cannot lie on the affected shoulder at night. The mobility of the shoulder joint is severely restricted.
In many cases, the humeral head fracture is treated by immobilization. If the fragments are displaced, surgery has to be carried out to repair the bone fracture. A shoulder prosthesis may be necessary in the event of a fracture involving the articular surfaces.
Shoulder dislocation (dislocated shoulder joint):
The high mobility of the shoulder joint can lead to the humours head jumping out of the joint socket under overload. The cause is always an accident or overextension. Certain sports (climbing, gymnastics) are particularly often affected.
Often, structures on the joint (glenoid labrum = joint lip) are also damaged during shoulder dislocation. This leads to the frequent repetition of this very painful dislocation after it has occurred once.
After a shoulder dislocation, it is particularly important to correct the joint as quickly as possible – if possible within a maximum of 30 minutes (repositioning). This adjustment can be done conservatively or surgically.
After the reduction, the shoulder must be immobilized for up to three weeks. Accompanying injuries to the soft tissue of the shoulder – joint cartilage, joint lip (labrum), joint capsule and rotator cuff – can only be treated surgically (arthroscopically).
Shoulder joint dislocation (AC joint disruption)
The rupture of the AC joint (acromioclavicular joint) formed by the acromion (roof of the shoulder) and clavicle (collarbone) is a widespread consequence of bicycle and skiing accidents. The fall is typically from on top of the shoulder.
This ruptures the tendons and the joint capsule of the AC joint. Shooting pain and restricted movement of the shoulder – especially when rotating the arm inward – are the result.
The instability of the AC joint is particularly painful when carrying heavy objects (e.g. shopping bags) on the drooping arm. The pain can also radiate into the neck region.
The treatment of AC joint disruption is conservative with a bandage (Gilchrist bandage) or surgically with a tendon suture, depending on the severity. Therapy depends on the severity of the injury.
Osteonecrosis of the humeral head (humeral head necrosis)
One of the possible consequences of a humerus head fracture is osteonecrosis of the upper arm bone (humerus): blood vessels within the bone are interrupted by the fracture. This leads to the death of the bone.
Osteonecrosis causes deep, dull shoulder pain. Due to the osteonecrosis in the humerus head, the bone cells are no longer nourished: the bone becomes weaker and weaker until the surface finally collapses. The necrosis can endanger the function of the shoulder joint.
Intensive early treatment of osteonecrosis can restore blood flow to the head of the humerus and save the joint surface. In osteonecrosis, shoulder pain has the function of an important early warning system.
Conservative therapies only help as an adjunct therapy. The focus is on operative therapies. Drilling the head of the humerus (core decompression or relief operation) can stimulate the formation of blood vessels. The key here is early surgery in the first stages of humeral head necrosis.
Shoulder arthrosis can be a long-term consequence of osteonecrosis in the upper arm. If the bone of the humerus head has already collapsed, only a surgical joint replacement with a partial or full prosthesis will help.
Labral lesion: tear of the joint lip at the shoulder joint
The glenoid labrum is a cartilaginous, connective tissue border around the joint socket (glenoid) of the shoulder joint. It plays a major role in guiding and centering the humerus head in the shoulder joint.
If the labarum is damaged after trauma, a fall or a shoulder dislocation (dislocation of the shoulder joint), the shoulder joint becomes unstable. Damage to the labarum (glenoid joint lip) causes shoulder pain in the armpit area. In the long run, it is not only the development of strength that is inhibited: the labarum tear can also lead to shoulder arthrosis.
Shoulder Pain Treatment Options: Painkillers
Your first line of action should be to take painkillers and other prescribed over the counter medicines such as NSAIDs to help minimize the severity of the pain you’re going through. Do be careful to not use any non-prescribed medicine for more than two pains. If the pain persists for that long, make sure you visit a registered professional. If oral medicine has no impact on pain relief, you can visit an orthopaedic doctor and have corticosteroid injections or pain relief.
Shoulder Pain Treatment Options: Cold and Heat Therapy
Alternating between cold and heat modes of therapy can be another way to alleviate your shoulder pain and alleviate the inflammation in your muscles. Apply an ice pack on your shoulder if you feel severe pain. Alternate it with routine heat packs for 20 minutes if you feel the pain still hasn’t subsided. Alternating between the two should get the job done.
An important step to treat upper arm pain is to limit your activity levels. All activities that exacerbate your pain should be limited to a certain extent. For instance you shouldn’t raise your affected arm or move it as much. Wear a sling if you can and limit the movement of the impacted shoulder.
Physiotherapy can be effective in shoulder impingement treatment. Physiotherapy will work its magic by reducing the severe pain of the condition and speed up the process of recovery. Shoulder impingement pain can often take 6 to 8 months to recover, but the process is faster with physiotherapy.
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