Causes of shoulder pain

It should be remembered that neck pain can irradiate C5 to the deltoid region, C6, C7 and C8 to the upper edge of the scapula, and along the diaphragmatic nerve, and through C3 to the limited area in the shoulder region.

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Tears of the tendon cuff (rupture of the tendon of the supraspinatus)

The tendon of the supraspinatus, and sometimes also the adjacent muscles, subscapular and subacute, can be ruptured by a sudden thrust (for example, in a fall). A partial break is accompanied by a painful "arch syndrome". At full rupture, the shoulder retention is limited to 45-60 °, provided the blade is rotated. If the hand is passively withdrawn by more than 90 °, the deltoid muscle begins to participate in the lead, which makes it possible. Passively, the hand moves in full. Pain is felt in the top of the scapula and in the upper part of the arm. There is also palpable tenderness under the acromial process. Arthrography reveals the communication between the capsule of the shoulder joint and the subacromial bursa. Treatment: it is possible to restore the integrity of the tendon only in young people, in elderly patients this is not so successful.

Habitual dislocation of the shoulder

Usually dislocation occurs anteriorly and is the result of trauma, even minor. Such a dislocation can also cause withdrawal and external rotation (for example, when the patient is laid on the couch). The capsule of the shoulder joint is attached to the neck of the scapula, but is remote from the joint lip. Sometimes in the head of the humerus there is a posterolateral "tooth", which can be seen on the roentgenogram, taken in the position of the hand, rotated medially. Treatment: Bankart surgery (hem of the joint capsule to the joint fossa) or Putti-Piatt, in which the shortening of the subcapsular tendon is produced. Less often, dislocation occurs posteriorly, with the capsule of the joint tearing away from the back surface of the neck of the scapula, the claw of the head of the humerus is located at the top medially. Such a dislocation of the shoulder joint is caused by the withdrawal of the shoulder and its medial rotation. Treatment: pulling the tendon of the subacute muscle.

Painful "arch syndrome"

In this case, pain in the shoulder occurs when the shoulder is withdrawn in the interval 45-160 °. The causes of pain in the shoulder when leaning shoulder can be as follows.

1. Tendonitis or partial rupture of the tendon of the supraspinatus. Pain can be reproduced by pressing on a partially withdrawn hand of the patient. Treatment includes active movements in the shoulder joint; taking anti-inflammatory drugs, for example naproxen 250 mg after 8 hours inside; injection of steroids, for example triamcinolone acetonide (40 mg) and local anesthetics in a subacromial synovial bag (bursa).
2. Subacromial bursitis causes maximum pain in the shoulder when the arm is withdrawn in the interval 30-60 °. Treatment: anti-inflammatory drugs and introduction to the subacromial synovial bag of corticosteroids.
3. Calcification of the cuff of the tendon of the rotator muscle (usually referred to as the tendon of the supraspinus muscle of the scapula) can cause a painful "arch syndrome", while the pain in the shoulder can be so strong that the examination of the affected shoulder becomes impossible. Radiographic examination revealed calcification of the cuff of the rotator. Miraculous relief from pain can be obtained by injecting corticosteroids into a subacromial synovial bag.
4. A sharp blow to the area below the acromial process. Characteristic of the increase in pain in the shoulder with the withdrawal of the shoulder in the range of 60-180 °. Relief can bring NSAIDs, local injections of glucocorticoids and physiotherapy.
5. Acromoclavicular arthritis. In this case, there is pain in the shoulder when the arm is drawn in the interval 120-180 °. In case of stubborn flow, one should think about excision of the lateral part of the clavicle.

Tendonitis of the long head of the biceps brachii

The pain in the shoulder is felt in the anterior part of the shoulder joint and, as a rule, is strengthened by forced contraction of the biceps muscle. In the treatment, NSAIDs are used. Relaxation of pain also occurs after injections of glucocorticoids into the tendon, but there is a risk of rupture.

Separation of the long head of the biceps arm

Discomfort appears after lifting of gravity or strong push, thus as though "something breaks off". When the arm is bent at the elbow in the region of the biceps muscle, a globular formation occurs. With the preservation of the biceps muscle function, surgical intervention is rarely used.

Shoulder-scapular periarthritis ("frozen shoulder")

In elderly people, this disease can occur after a slight injury. Pain in the shoulder is quite strong. There is a sharp decrease in both passive and active mobility in the shoulder joint. A 90-degree hand is not possible. The treatment uses NSAIDs, intra-articular glucocorticoid injection, physiotherapy procedures aimed at activating the movements in the shoulder joint, and manipulative effects. Treatment can last 2-3 years.