Shoulder periarthritis

Shoulder periarthritis is a lesion of periarticular tissues of an inflammatory nature. Consider the main causes of the disease, symptoms, methods of diagnosis. And also effective methods of treatment, prevention and general prognosis for recovery.

As a rule, people of middle and old age, both men and women, suffer from this pathology. Inflammation of the shoulder tendons and capsules of the shoulder joint is diagnosed very often. To provoke an ailment can be traumas, falls on the shoulder or arms outstretched. In some cases, even operations to remove mammary glands and diseases of internal organs lead to the development of shoulder periarthritis.

Any violations in the structure of the joint lead to periarthritis and other bone diseases. Frequent injuries lead to changes in blood vessels and impaired function of the joints, which entails the formation of calcifications that complicate the mobility of the limbs, cause pain and significantly reduce the quality of life.

[1], [2]

Causes of shoulder periarthritis

The causes of shoulder periarthritis are diverse, but they all cause inflammation of the shoulder tissues, damage to the tendons, joint and muscle capsules. Periarthritis does not cause joint destruction, unlike arthritis or arthrosis. The causes of periarthritis can be hidden inside the body or arise due to various acute diseases.

Consider the main causes of inflammation of the shoulder joint:

• Injuries and increased stress on the shoulders.
• Falls on the arm or arm stretched forward.
• Unaccustomed activity.
• The consequences of diseases of the cardiovascular system.
• Pathology of the lung and endocrine system.
• Disorders of cerebral circulation and development of connective tissue.
• Hormonal failures and diabetes.
• Condition after operations (for example, after removal of mammary glands).
• Spondylosis.
• Osteochondrosis and osteoarthrosis of cervical and shoulder segments.

Regular hypothermia, stress, nervous disorders and increased air humidity, aggravate the course of shoulder periarthritis. But most often the disease appears due to injuries, strokes and falls.

[3], [4]

Periarthritis of the shoulder joint

Periarthritis of the shoulder joint has four stages, each of which has certain signs and symptoms. The main sign that indicates the inflammatory process is pain and malaise. Precisely diagnose the disease can only the doctor, after radiographic and a number of other studies.

• Simple humerus periarthritis

This is the easiest form of the disease, the first sign - weak pain in the shoulder. Discomfort occurs when trying to raise your hand, touch the spine, or get your hand behind your back. The mobility of the joint is limited, so it is difficult to perform simple actions. But if the affected area is not disturbed, the pain recedes. To diagnose this form of periarthritis, a doctor can conduct an experiment. The patient should try to raise his arm under resistance. If during the exercise there are painful sensations, then this indicates a simple periarthritis.

• Acute periarthritis

Occurs in the case when a simple periarthritis was left without medical assistance and began to progress. The symptomatology is as follows: the mobility of the hand is limited even more, when you try to raise or move your hand to the side, there is a sharp pain that eventually grows. Discomfort is exacerbated in the morning and in the evening, possibly an increase in body temperature, and signs of an inflammatory process in blood tests.

• Chronic periarthritis of the shoulder joint

This form of inflammation indicates the progression of periarthritis. Chronic inflammation of the shoulder joint is treated long and difficult. The main signs of the chronic stage: pain in the shoulder area in the morning and in the evening, sharp lumbago with awkward movements of the shoulder, a decrease in discomfort, in comparison with the acute stage. Because of nocturnal pain, it is possible that sleep worsens. Since the internal tissues of the shoulder joint are severely depleted, rare lumbago appears. At this stage, the periarthritis itself will not pass, so urgent medical attention is required.

• Ankylosing (adhesive capsulitis) periarthritis

This form of the disease has no treatment. Since the pathological processes in the shoulder lead to complete bone splicing in the joint, which blocks any movement. Painful sensations are stupid in nature, but completely deprived of working capacity. In rare cases, any attempt to move the joint causes severe pain.

Depending on the form of periarthritis, the symptoms of the disease and the characteristics of the patient's body, appropriate treatment is selected. The sooner therapy is started, the greater the chances of maintaining the full mobility and functioning of the shoulder joint.

Symptoms of shoulder periarthritis

Symptoms of shoulder periarthritis depend on the form of the disease and the stage of its development. If the patient has a humeropathy periarthritis, the pain appears in the joint of the shoulder and persists for a long period of time. The pain that occurs when moving by hand, is also a symptom of a particular form of the disease. Let's consider the basic symptoms arising at different stages and at various forms of a periarthritis.

1. Simple periarthritis:
   • A slight discomfort and pain in the shoulder with certain movements of the hands.
   • Restrict the movement of the joint when trying to get your hand behind your back, touch the spinal cord or pull it up.
2. Acute humeral periarthritis:
   • Sudden painful sensations of a growing character, giving in the arm and neck.
   • At attempts to rotate a hand around an axis or aside there are sharp pains which amplify at night. The staggering limb is easiest to keep bent at the elbow and pressed to the chest.
   • On the front surface of the shoulder there is a small puffiness and redness of the skin.
   • A slight increase in temperature, insomnia, general ailments.
3. Chronic form of periarthritis:
   • The pain is moderate, exacerbated at night and in the morning.
   • When unsuccessful movements of the hand in the sore shoulder, severe pain occurs.
   • There is an ache in the shoulders that causes insomnia.

All the symptoms of the above-described forms of shoulder periarthritis have a growing character. For example, chronic inflammation can last from a couple of months to several years. But in 30% of patients the periarthritis without medical treatment takes more serious clinical forms:

• Dupley syndrome (frozen shoulder)

Due to degenerative changes in the rotator cuff, the limitations of any movements are clearly expressed. Such a symptomatology can last for 2-7 months, which leads to an overstrain of the tendons of the muscles. Progressive inflammatory process seizes articular bags, which leads to a decrease in the joint cavity intra-articular fluid.

• Pseudoparachy syndrome

Sharp restriction or total lack of ability to perform active movements in the shoulder. The duration of the syndrome is not more than a month, if the symptomatology lasts longer, this indicates a joint contracture. Pathology appears due to damage to the rotator cuff in which the head of the shoulder stabilizes.

• Paralytic Joint Syndrome

The patient loses the ability to perform any movements in the joint. Because of the traumatic damage of several structures of the shoulder joint, the overall course of the periarthritis is simultaneously aggravated.

• Impingement syndrome

Pain occurs in different positions of the limb and develops due to the periosteal cuff damage.

• Tunnel Syndrome

Discomfort occurs with sudden movements. Pathology develops due to external compression of the clavicle or adjacent tissues of the supraclavicular muscle.

Shoulder-shoulder periarthritis

Shoulder-shoulder periarthritis is an inflammation of the tendons of the shoulder and capsules of the shoulder joint. The peculiarity of this pathology is that the internal structures of the joint and cartilage are not damaged. It is this fact that distinguishes periarthritis from arthritis or arthrosis of the shoulder joint. According to medical statistics, every fifth person in the world suffers from shoulder-shoulder periarthritis. The disease is equally affected by both women and men.

Causes of pathology are different, these can be traumas, falls on an outstretched hand, excessive physical exertion or blows to the shoulder area. That is an unusual load on the joint or its overload lead to periarthritis. It is necessary to take into account the fact that between the cause of the inflammatory process and the appearance of the first symptomatology there passes a certain time interval, which can last 1-2 weeks.

In some cases, diseases of the internal organs lead to the development of the shoulder-shoulder periarthritis. Often, people who have had myocardial infarction begin pains in the left shoulder, which indicate the development of periarthritis. The pathology of the liver, trauma and any diseases of the cervical spine also provoke the disease.

Cervico-humeral periarthritis

Cervico-shoulder periarthritis, as a rule, occurs due to diseases of the cervical spine. The disease is accompanied by degenerative changes in intervertebral discs, pain and symptoms that can easily be mistaken for other pathogens. Periarthritis can occur on the background of cervical osteochondrosis, as a result of pinching the nerve bundle in the shoulder. In this case, treatment is not only periarthritis, but also a primary disease, that is, osteochondrosis.

Cervico-humeral periarthritis, like other forms of this pathology, is accompanied by pain syndrome and discomfort. Unpleasant sensations arise for no apparent reason and very often at night. Sharp pain gives to the neck and arm, gradually grows and gives into the spine. At the same time if you raise your hand up, the pain recedes. In especially severe cases, cyanosis appears on the hand and slight swelling. In addition, it is possible to increase the temperature, tenderness when trying to palpate the paravertebral points of the cervical spine.

[5]

Diagnosis of shoulder periarthritis

Diagnosis of shoulder periarthritis is the first thing a doctor does when complaining about pain in the shoulder area. Anamnesis is collected to determine the cause of the ailments. The main clinical picture of periarthritis is pain in the shoulder joint with the removal of the hand and local soreness in the joints of the tendons and bones. The doctor conducts an external examination of the limb, motor tests and palpation. After this, instrumental diagnostic methods follow, which allow differentiating periarthritis from a number of other pathologies of the joints and bones of the shoulder.

Let's consider step by step the whole process of diagnostics of the periarthritis of the shoulder joint:

• Initial inspection

At this stage of diagnosis, the physician draws attention to the severity of the muscular system of the shoulder girdle and shoulder-straps. Very often, with periarthritis in the suprapatrices, there is a slight muscle atrophy. When palpation of the patient's joint appears soreness.

• The next stage of the inspection is the determination of the volume of movements. The patient must make a hand, flexion, extension, rotation outward and inward, that is, active movements. If discomfort or pain occurs during exercise, this may indicate periarthritis.
• In addition, passive movements are being investigated. This is due to the fact that a sharp decrease in active movements appears in the Dypley syndrome, that is, the "frozen" shoulder.

As a rule, if the patient is referred to with a suspicion of a humeral periarthritis before the age of 40, the cause of the pathology is trauma, stretching, and strokes. If the patient is more than 40 years old, the disease occurs against the backdrop of pathological changes in the body.

• X-ray diagnostics

X-ray has an important diagnostic value. For a more accurate study of the cause of pain, three shots are taken: at rest, when the arm rotates inward or outward and when the shoulder is withdrawn. The main radiographic signs of shoulder periarthritis look like bone defects or uneven structure in the region of the head of the humerus. During the diagnosis, the doctor can apply the introduction of a contrast agent in the joint cavity. This allows you to determine the damage to the cuff, since in this case the substance penetrates beyond the joint.

• CT scan

This method of diagnosis is used for bone pathologies, found on radiography. With the help of modern technology, it is possible to visualize the image of the joint condition. The information obtained allows one to assess the degree of damage to the muscles and tendons, as well as the presence of additional formations.

• Ultrasonography

Ultrasound is one of the most informative methods. The main advantages of ultrasound are the lack of special training, painlessness, non-invasive and quick results.

• Magnetic resonance imaging

With the help of this study, you can consider the bones, ligaments, tendons, cartilage, muscles and the joint capsule of the shoulder. MRI can detect any stage of shoulder periarthritis, even those that could not be determined using the above methods.

• Arthroscopy

It is a kind of surgical intervention that allows you to determine the cause of the pathology and, if possible, eliminate it. Diagnostic arthroscopy is carried out in the event that the pain and limitation of movements in the shoulder joint have an unclear etiology.

Therapeutic arthroscopy is performed with cuff pathologies, with tendinosis, impingement syndrome. The procedure is forbidden for purulent-inflammatory diseases of the shoulder joint and limb, joint contracture and the general severe condition of the patient.

[6], [7], [8]

Treatment of humerus periarthritis

Treatment of shoulder periarthritis depends on the form of the disease and the condition of the patient. Therapy can be both conservative, that is, medicines and therapeutic exercises, and surgical intervention. The mild forms of periarthritis are treated conservatively, with the help of various drugs (tablets, injections, ointments). Let's consider the basic conservative methods of treatment of a humeral periarthritis:

Non-steroidal anti-inflammatory drugs

Since the main symptom of the disease is pain in the shoulder area, an analgesic and anti-inflammatory drugs are used to eliminate them. Typically, use drugs such as: Diclofenac, Ibuprofen, Aspirin, Voltaren and others. But the application of this remedy is possible only under medical supervision. This is because NSAIDs have pronounced side effects. Therefore, the duration of the use of such drugs should not exceed the time specified by the doctor.

To date, a number of new generation of painkillers have been isolated with minimal side effects: Celecoxib, Movalis, Nimesulide and others. But prescribers can only be prescribed by a doctor, after diagnosing and characterizing the pain.

Corticosteroids

Medicines used to reduce the inflammatory process in the shoulder. If NSAIDs do not have the proper effect, the patient is prescribed hormone anti-inflammatory drugs. Corticosteroids have many side effects, so they are used as injections and injected into the affected area of the shoulder.

So, according to medical statistics in 75% of cases of shoulder periarthritis corticosteroid drugs completely stop the disease. The therapy consists of 1-3 injections. As a medicine, use Betamethasone, Diprospan, or Flosteron.

[9], [10], [11], [12], [13]

Novocaine blockades

This method of treatment is used in the case when the above described did not give a positive result. Periarticular novocain blockade is very simple. In a painful area of the shoulder joint, a series of injections with an anesthetic are administered at regular intervals. In some cases, treatment can take place within 1-3 months. The duration of therapy is chosen individually for each patient, taking into account the degree of pain syndrome and the motor functions of the shoulder. Novokain is used as a blockade drug.

Postisomesesitic relaxation (IRP)

Today it is considered to be the most effective method of treatment of shoulder periarthritis. According to medical statistics, about 80% of patients with various forms of shoulder injury completely recover after 15 sessions of post-isisomesitric relaxation. This method of therapy is combined with massages and electrophoresis.

Treatment with ointments of periarthritis of the shoulder joint

Treatment with ointments of periarthritis of the shoulder joint is one of the simplest and accessible methods of therapy. As a rule, anabolic, warming and analgesic ointments are used. Anabolic pain relieves pain, and pain relieves muscle spasms and swelling of soft tissues. Thanks to this, the exchange-nutrient process in the joint is normalized, which protects it from dystrophy. Ointments are chosen, guided by the cause of the pain.

If the pain in the shoulder has appeared after a mild injury, then the preparation with a cooling or warming effect is suitable for treatment. The composition of warming ointments most often includes extract of red pepper and methyl salicylate. But these ointments can not be applied immediately after the injury, since the affected area must be cooled. That is, with a light shoulder periarthritis is better to use a cooling ointment, and a few days after the injury - a warming agent. Cooling ointments contain menthol, essential oils, alcohol and components that dilute blood.

The composition of drugs that will help eliminate pain in the shoulder and neck area, can include such substances:

• Diclofenac - used for pain of rheumatic nature, anesthetizes and stops the inflammatory process.
• Menthol - local irritant substance, its action relieves painful shock.
• Ibuprofen - removes inflammation and effectively anesthetizes.
• Venom snakes and bees - improve blood circulation, trigger the process of tissue regeneration, relieve pain.
• Extract of red pepper or mustard - used to improve blood circulation and accelerate metabolic processes in tissues.
• Indomethacin - eliminates pain, swelling and inflammation.
• Camphor - relieves pain.
• Methylsalicylate - eliminates pain and reduces inflammation.

Consider several effective ointments from shoulder periarthritis, which contain the above described substances:

• Diclofenac

Voltaren Emulgel is a drug with anti-inflammatory effect, produced in several pharmacological forms. To date, there are ointments, suppositories, tablets and drug solutions. For treatment of periarthritis it is best to use ointment. Diclofenac is recommended for use in attacks of gout, osteoarthritis, arthritis and to treat all forms of shoulder periarthritis. The product is gently rubbed into the affected shoulder surface 2-3 times a day.

• Indomethacin

Drug medication with anti-inflammatory action for pain relief in joints. One gram of the ointment contains about 100 mg of the active ingredient. Ointment is recommended for the treatment of shoulder, cervico-brachial and other types of periarthritis, gout, rheumatoid arthritis and other diseases of the joints and bones. The drug is effective in all pathologies that cause swelling, bruising and discoloration of the skin. Accurate, smooth movements of the ointment rubbed into the affected area until completely absorbed. Use the tool can be no more than 3 times a day.

• Cream Dolgit

The drug with the active substance ibuprofen. Helps reduce pain, reduces inflammation, muscle spasms and swelling. The active substance effectively dilutes the blood, which improves blood flow to bone and soft tissues. Ointment is rubbed on the skin until it is completely absorbed, but not more often 3-4 times a day. The course of treatment can last up to one month.

• Nase gel

Medication with active substance nimesulide. Despite its effectiveness, the agent is not recommended for inflammatory and purulent skin lesions, gastrointestinal ulcers, infectious diseases, and during pregnancy and lactation. Like all means of this action, the ointment is applied to the skin 2-3 times a day, until completely absorbed.

In addition to the ointments described above for the treatment of humerous periarthritis, you can use Bystrumgel, Ketonal gel, Gel dip relic and other drugs. But you can apply the ointment only after consulting a doctor. This will protect yourself from the side effects of medicines.

Physiotherapy exercises with shoulder periarthritis

Physiotherapy exercises with shoulder periarthritis is necessary both with a simple form of the disease, and with acute or chronic. And this is not surprising, since the ailment can be perfectly treated and prevented with the help of physiotherapy exercises. Exercises are aimed at reducing pain syndrome, increasing joint mobility, muscle strength of the cuff and elasticity of the capsule.

But physical therapy can be carried out only after consulting with the attending physician and the course of physiotherapy to minimize the pain syndrome. Let us consider an approximate complex of therapeutic physical training with shoulder periarthritis.

• Sit on a chair, put your hands on your waist and smoothly raise and reduce your elbows. Movements should not be sharp, as this can damage the inflamed shoulder joint and deliver painful sensations. For the first time, 6-8 repetitions are enough, but as the exercises are done, the number of approaches needs to be increased.
• Sit on a chair, put your palms on your waist, slowly remove and reduce your shoulders, try to make circular motions. Exercise for 1-2 minutes.
• On the opposite shoulder, put the diseased limb, press the elbow to the body. With a healthy arm, grasp the elbow and slowly pull the elbow of the sick arm upwards, creating resistance.

Therapeutic exercises with shoulder periarthritis

Therapeutic exercises with shoulder periarthritis are used both in the period of restoring the normal functioning of the limb, and to reduce painful sensations. All exercises are fairly simple and will not take long to complete.

• Raise and lower hands and shoulders alternately. Perform the exercise slowly, trying to maximize the muscles of the injured limb.
• Bend and unbend elbow joints. Thus palms can be in different positions: on a waist, on brachiums or are compressed in a fist at a level of the face.
• Clasp your hands in the lock, slowly lift them forward and up. Bend your arms in front of you, alternately to each shoulder.
• Cross your arms in the lock and pull out your palms outward, first up, then down and forward. Repeat the exercise several times.
• Relax the affected limb and slowly swing your arm along the body. Do not change the position, try to withdraw your hand, carry out circular movements, take him behind his back.

In addition to the above exercises, it is possible to perform a therapeutic gymnastic complex aimed at restoring the mobility of the shoulder joint. At the same time, gymnastics treatment should be started as soon as possible, as this will not allow the disease to progress.

Complex of exercises with shoulder periarthritis

The complex of exercises with shoulder periarthritis is aimed at reducing pain and restoring the mobility of the joint. Physiotherapy should be carried out simultaneously with taking medications. Such an integrated approach will allow achieving fast and maximum sustainable results.

Exercises can be done on their own or seek help from specialists. Physiotherapy and reflexotherapy are represented by such techniques as acupuncture, that is, acupuncture, acupuncture, electrophoresis, mud applications, vibromassage, magnetotherapy, shock wave therapy and laser therapy.

The attending physician will select an effective method of physiotherapy and a set of therapeutic exercises. This combination will allow you to quickly and safely restore the shoulder joint after an inflammatory lesion. But do not forget that inadequate treatment of shoulder periarthritis with the help of physical exercises can lead to very negative consequences: the progression of inflammation, increased pain or worsening of the conditions of the periarticular tissues.

[14], [15], [16]

Alternative means for brachial periarthritis

Alternative means for brachial periarthritis - this is all available recipes, time-tested. Such treatment will help to relieve muscle tension, improve blood supply, nutrition and mobility of the shoulder joint, and also normalizes the nervous system. For the therapy, vegetable herbs are used, from which they are prepared rubbers, ointments, compresses and baths on the shoulder area.

• Salt dressing

To prepare this product will need a saline solution. Take 100 grams of salt and 1000 ml of water, stir the salt until completely dissolved. For a bandage, a good gauze flap, folded into 6-8 layers, is required. Marl should be gently lowered into the solution for 2-3 hours. After this, a vessel with a bandage and a salt fluid is recommended to warm up and apply a hot gauze to the diseased shoulder joint. It is better to fix the bandage with a handkerchief or a towel. Duration of treatment is 14 days, compresses are recommended for all at night.

• Honey pack

On the surface of the skin, apply a thin layer of honey, neatly spreading on the area of the collarbone, forearms and shoulder blades. On top of the honey layer is covered with cellophane tape, wool scarf or handkerchief. Compress is best done at night and left until the morning.

• Compress of grass

To prepare the compress, you need to take herbs of chemist's chamomile, medicinal marshmallow and medicinal sweet clover, in a proportion of 2: 1: 2. The plants are crushed thoroughly until a uniform dry powder is obtained. Grinded herbs are diluted with hot water until a thick slurry is obtained. After that, the mixture should be spread on gauze and apply a hot compress to the painful shoulder. In order to save heat, you can use plastic wrap and woolen shawl. Remove the compress only after it has completely cooled down. The course of treatment is individual for each patient and depends on the degree of the disease. As a rule, compresses are used until the pain and inflammation are completely eliminated.

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Operation with periarthritis of the shoulder joint

Operation with periarthritis of the shoulder joint is performed only if the conservative therapy is ineffective. The procedure is called subacromial decompression and consists in removing a fragment of the scapula and ligament. This protects nearby tissues from further injury. The operation is indicated in the presence of pathological degenerative changes and the absence of a curative effect from drug therapy and a therapeutic gymnastics complex for 3 months. Surgical intervention is explained by the fact that conservative treatment can not lead to positive results in anatomical violation of the integrity of tendons, ligaments and muscles. And the operation allows to restore the continuous structure of the joint and its functions.

The main indications for surgery with periarthritis of the shoulder joint:

• Complaints of pain in the shoulder joint after a course of drug therapy and corticosteroid injections.
• Pain relapsing in the shoulder, which lasts more than 6-8 months.
• The operation is necessary for patients older than 40 years and those whose work is directly related to the active movement of the shoulder joints.
• Partial damage to tendons and dysfunction of the supraspinatus.
• Sparse damage to the tendon of the cuff.
• Tunnel Syndrome.

Contraindications to subacromial decompression:

• Persistent contracture of the joint.
• The general severe condition of the patient.
• Diseases of any localization of a purulent and inflammatory nature.
• Inability of the patient to carry out measures for the rehabilitation of shoulder periarthritis.
• No surgical intervention.

If the operation is not performed in a timely manner, the mobility of the shoulder joint will significantly worsen, down to total numbness. But even in the most severe cases, subacromial decompression yields positive results. After the operation, the patient waits for a long rehabilitation course, during which the limb movement will gradually recover. Regular exercise will restore the flexibility and mobility of the shoulder joint, minimize the risk of recurrence of periarthritis. As a rule, a full recovery after surgery occurs after 3-4 months. In 95% of cases, the operation is effective and permanently removes the shoulder periarthritis.

Prevention of shoulder periarthritis

Prevention of shoulder periarthritis is aimed at restoring the motor ability of the joint. In addition, prevention is necessary to prevent the disease. Prevention of injuries of the shoulder area, moderate physical activity, minor stresses and normal general health are the key to the absence of various pathologies of bones, joints and the body as a whole.

Rehabilitation course is carried out after the main therapy. As a rule, prevention includes: the use of medicinal and vitamin preparations, therapeutic massage and physical education, electrophoresis, paraffin baths, bath and other methods. But in any case, all the prevention of periarthritis is reduced to the timely application of medical care for any injuries of the shoulder joint.

Please note that the treatment of periarthritis is handled by an orthopedic trauma surgeon or surgeon. But in addition to these specialists, it is necessary to undergo examinations with a physiotherapist, neurologist and rheumatologist. If the disease caused irreversible violations of the shoulder joint function and surgical intervention did not help restore mobility, the patient is issued a disability group.

Prognosis of humerus periarthritis

The prognosis of shoulder periarthritis is based on the form of the disease. The most dangerous is the chronic ankylosing periarthritis. A similar pathology occurs in the absence of adequate treatment and is observed in 30-40% of patients. Without timely medical care, the tissues of the shoulder joint become denser, which leads to their stiffness. Pain syndrome can cause a shock. In addition, the progression of periarthritis leads to violations of the contracting ability of muscles and blockage of the scapula-sternal articulation. As a result, the limb is completely immobilized, it is impossible to restore its functioning.

Brachial periarthritis in the early stages is easy to treat. Therefore, at the first symptoms of painful sensations in the shoulder it is recommended to seek medical help. The treatment will not take much time, but it will allow to keep the mobility of the shoulder joint in a normal state.