Muscle pain in the arm of the shoulder

One of the most common pain symptoms concerning the upper musculoskeletal system is pain in the shoulder muscles. Painful sensations can be associated with inflammation of bone tissue, joints, but more often they are directly caused by pathology of periarticular structures - ligaments, muscles, tendons.

The high percentage of diagnosed soft tissue diseases of the shoulder is explained by the specific biomechanics and anatomical structure of the shoulder joint, as well as the physiological features of the structure of tendon and muscle tissue.

It should be noted that the generally accepted concept of "shoulder" is somewhat different from the definition of this anatomical zone by doctors:

• The shoulder is the upper part of the arm, starting from the shoulder joint and ending at the elbow.
• The shoulder girdle is the entire upper surface (girdle) of the arms, connecting them to the body, including the deltoid, small and large, supraspinatus and infraspinatus, teres and subscapularis muscles.

The shoulder joint and surrounding tissues are considered to be one of the most complex and multifunctional structures of the body, the variety of range of motion in it is carried out due to the mobility of the periarticular system, including muscles. The developed muscular-ligamentous apparatus of the shoulder allows a person to perform rotational, circular, flexion, extension, rotational and many other types of movements, however, as multifunctional as the system of soft tissues and tendons is, so vulnerable it is to various diseases.

Shoulder muscle pain may be the result of inflammation, damage to the periarticular tissues themselves, but it may also be an accompanying background symptom of an underlying disease not directly related to the musculoskeletal system. That is why it is so important to identify the causes of pain and make timely diagnostics.

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Causes of Shoulder Muscle Pain

Periarticular pain in the shoulder is most often caused by joint instability, which in turn can be caused by the following factors:

• Overexertion, stretching of the ligaments of the shoulder girdle during intensive strength training.
• Damage, inflammation of the joint capsule.
• Stretching of the muscles located near the joint capsule as a result of compensatory self-correction of the joint function.
• Damage to the cartilage of the glenoid cavity, lack of support for the biceps.

In general, the causes of pain in the shoulder muscles can be divided into three nosological categories:

1. Isolation of degenerative, inflammatory or traumatic injury to muscle tendons:

• Rotator cuff tendinitis.
• Calcific tendinitis.
• Biceps tendinitis.
• Different types of tendon ruptures.

2. A widespread (diffuse) lesion of the shoulder joint capsule of a non-inflammatory nature - capsulitis
3. Complex damage to the periarticular system - subacromial syndrome.

A detailed description of the causes of shoulder muscle pain.

• Tendinitis is an acute or chronic inflammation of the tendons surrounding the shoulder joint. Tendon damage inevitably leads to pain in the shoulder muscles due to the close anatomical relationship of these structures. Tendinitis can affect both the rotator cuff muscle and the biceps, supraspinatus, infraspinatus, and subscapularis muscles. In addition, there is calcific tendinitis, in which calcifications accumulate in the tendon tissue.
• Inflammation of the tendon of the inner shoulder, the flexor muscle, biceps tendinitis. The pain is intense, constant, and increases with arm movement.
• Inflammation of the joint - bursitis. The disease is closely associated with overexertion, sports injuries. In addition to the pain symptom, bursitis is manifested by swelling in the bursa area, often the pain radiates to the arm, limiting the range of motion.
• Frozen shoulder syndrome or retractile capsulitis. This is a syndrome of reflex dystrophic damage to the capsule of the shoulder joint with parallel damage to bone structures in the form of osteoporosis.
• Shoulder-scapular periarthritis is a syndrome that is still being actively studied, since its true etiology has not been clarified. In addition, the nature of pain in shoulder-scapular periarthritis can vary from acute, increasing pain to aching, constant. The pain does not subside at rest, can be accompanied by insomnia, and significantly limits arm movement.
• Myofascial pain syndrome is a typical disease of muscle tissue in various areas of the body, but the favorite place of localization for MFPS is the shoulder girdle, lower back. Myalgia, accompanying tense muscles, develops in clearly defined places - trigger points.
• Vertebrogenic causes of pain in the shoulder muscles are most often hidden in osteochondrosis of the cervical spine, when a secondary complication develops - radiculopathy. It is believed that osteochondrosis can be one of the factors that provoke scapulohumeral periarthritis, periarthrosis.

Also, pain in the muscles of the shoulder girdle can be caused by the following syndromes and diseases:

1. Impingement syndrome.
2. Polymyalgie rheumatica – rheumatic polymyalgia.
3. Neuralgic amyotrophy, myelopathy.
4. Herniated disc of the cervical or thoracic spine.
5. Pain in the muscle tissue of the shoulder as a reflected symptom in diseases of the bronchopulmonary system, heart, diaphragm, liver.

Since the muscle pain symptom is most often not acute, it is not always possible to identify its causes in a timely manner. More often, the patient comes to the doctor with an already formed chronic pain syndrome and many accompanying reactions, signs, which significantly complicates the diagnosis of muscle pain in the shoulder girdle.

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Symptoms of Shoulder Muscle Pain

Pain in the shoulder girdle can have dozens of different causes, respectively, the symptoms of pain in the shoulder muscles can be variable depending on the etiology and pathogenetic mechanism of development. The most significant and most common pain in the shoulder is nociceptive, which in turn is accompanied by many side effects, reactions. In addition, the nociceptive nature of the symptom allows you to launch a cascade of psychosomatic, psychogenic sensations, which makes it extremely difficult to quickly diagnose and relieve pain. It is believed that in 65-70% of cases, pain develops slowly, gradually as a reflex tonic response to systematic overstrain of the muscles of the shoulder girdle. The load on the shoulders can be both dynamic and static, in any case, muscle hypertonicity is accompanied by constant aching sensations that do not subside at rest and even at night.

Symptoms of pain in the shoulder muscles can be localized in areas of damage to tendons, joints, ligaments, but can also be diffuse due to fibromyalgia, myofascial syndrome.

How to identify the area of damage? Pain symptom and limited arm movement What can become inflamed or damaged Pain when moving one or both arms back Damage to the subacromial bursa, inflammation in the supraspinatus muscle, in the tendon (inflammation, tendon strain) Shoulders hurt when fully raising both arms up vertically Inflammation, degenerative change in the acromioclavicular joint and damage to the surrounding muscles Pain when trying to comb your hair, throw your arms behind your head, with external rotation of the arms Strain of the teres minor or infraspinatus tendon Aching pain when moving your arm behind your back Strain or inflammation of the subscapularis tendon Pain symptom when bending your arm at the elbow and when lifting weights, turning your wrist - a key in the door (supination of the shoulder) Strain, inflammation of the biceps brachii, tendon Pain when moving your arm behind your back (to get an object out of your back pocket). Pain with internal rotation of the shoulder Damage (stretching, inflammation) of the subscapularis muscle of the shoulder All arm movements, head turns, neck movements cause painful sensations, movements are severely limited Inflammatory process in the capsule of the shoulder joint, in the periarticular tissues.

Diagnosis of Shoulder Muscle Pain

Diagnosis of shoulder muscle pain can be accurate provided that:

• Specific localization of pain.
• Debut of pain and diagnosis in the initial period of development of the syndrome.
• The absence or presence of specific signs accompanying muscle pain.

Diagnosis of shoulder muscle pain may include the following steps:

• Examination of a patient with pain in the shoulder.
• Determining the symmetry of the position of the shoulder blades, arms, and collarbones (in case of paresis, the lowering of the shoulder on the affected side is clearly visible).
• Visual detection, palpation examination of muscles for the presence of hypotrophic areas. Muscle hypotrophy is especially characteristic in the case of a long-term neurogenic process (more than 14 days).
• Tests to determine possible paresis.
• Tests that reveal balance and the relationship between active and passive movements.
• A test to determine the resistance force, the function of the large and small chest muscles, and the muscles of the shoulder girdle.
• Determination of the strength of flexor and extensor muscles.
• Identification of symptoms similar to those of radicular syndrome.
• Evaluation and determination of tendon reflexes.
• Palpation of root exit points, identification of signs of radicular damage.
• Identification of diagnostically important trigger points to confirm fibromyalgia, MFPS (myofascial pain syndrome).

Also, to specify the diagnostic conclusions, an X-ray of the spine (cervical-shoulder, thoracic area) may be prescribed, neurovisual methods may be used - MRI, CT, ultrasound of the joints, as well as Dopplerography of the vessels and electrophysiological examinations to determine muscle tone.

How to distinguish between joint and muscle pain in the shoulder girdle?

Diagnostic feature	Joint pathologies	Diseases of muscle tissue (periarticular structures)
Characteristics of pain symptom	The pain is constant, does not subside at rest, and slightly increases with movement.	Pain develops in response to a specific movement
Shoulder pain localization area	Most often diffuse, spread	The pain is clearly localized and has boundaries.
Dependence on active or passive movements	Significant restriction of the volume of all types of traffic	Reduction of the volume of active and simultaneous preservation of all types of passive movements without changes
Presence or absence of edema	Often the swelling is visible to the naked eye, and effusion is revealed	Muscle pain often provokes body asymmetry, and is also characterized by swelling in the joint area with bursitis

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Treatment for Shoulder Muscle Pain

The general rules that are involved in treating pain in the shoulder muscles are very similar to the stages and methods of treating diseases of the joints and musculoskeletal system.

Treatment of muscle pain in the shoulder girdle:

• Neutralization of all factors that provoke pain - immobilization of the arm, shoulder, often - complete rest.
• Anti-inflammatory drugs – non-steroidal anti-inflammatory drugs (NSAIDs) in tablet form, as well as in the form of ointments and gels.
• Pain relief using compresses (30% dimexide solution).
• Injections of corticosteroids into the affected area may be possible.
• Periarticular administration of homeopathic preparations – Traumeel, Zeel.
• Activation of trophism of periarticular tissues, improvement of metabolic processes with the help of physiotherapeutic procedures.
• Prescription of a complex containing B vitamins and microelements.
• Muscle massage, including massage with joint development.

As a rule, therapy for mild muscle pain resulting from muscle strain does not last more than 3-5 days. Reasonable rest, adjustment of training exercises and gentle, warming massage are quite sufficient. Other cases require complex diagnostics, often dynamic examination (monitoring the condition of the shoulder girdle in motion) and prescription of a course of drugs that reduce pain perception, improve muscle fiber trophism, and neutralize inflammation.

Preventing Shoulder Muscle Pain

Preventive measures aimed at getting rid of pain in the shoulder girdle, first of all, depend on the cause, the identified provoking factor. Basically, prevention of pain in the shoulder muscles is a system of exercises developed for athletes who actively use the shoulder girdle. The following rules for strengthening the "corset" of periarticular tissues also help to reduce the risk of developing muscle pain in the shoulder:

• It is necessary to ensure that the bed is properly firm and sleep on a small pillow.
• Do daily warm-ups of all muscles, including the muscles and tendons of the shoulder.
• At the slightest painful symptoms in the shoulder, you should limit the movement of the arm on the side of the pain and give them a little rest.
• If a person's job requires him to perform monotonous, rhythmic hand movements (painter, conveyor line operator, etc.), he should regularly massage the shoulder area, possibly using essential oils, warming and relaxing gels.
• All exercises from the therapeutic exercise complex should not be performed intensively and for a long time; exercise should not exceed 15-20 minutes in the morning and no more than 30 minutes during the day (2-3 approaches, 15 minutes each).

Shoulder muscle pain is a very common symptom inherent in our age of speed and physical inactivity. Unfortunately, shoulder symptoms caused by physical exercise do not exceed 25-30% of all cases, their basis is overstrain of the shoulder muscles as a result of a long static posture, hypothermia and atony, muscle weakness. That is why strengthening the muscle corset, maintaining the normal state of the muscles, following the regime - tone-relaxation, this is the way to avoid discomfort in the shoulder girdle.