Pain in the muscles of the arm

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

A high percentage of diagnosed diseases of the soft tissues 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 the 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 physicians: 

• The shoulder is the upper arm area, starting from the shoulder joint and ending with the elbow.
• The humeral girdle is the entire upper surface (belt) of the hands that connects them to the trunk, including the deltoid, small and large, supraspinous and subacute, round and subscapular muscles.

The shoulder joint and surrounding tissues are considered to be one of the most complex and multifunctional body structures, the variety of movements in it is realized due to the mobility of the periarticular system, including muscles. The developed muscular-ligament apparatus of the shoulder allows a person to perform rotational, circular, flexural, extensor, rotational and many other kinds of movements, however how multifunctional the system of soft tissues and tendons is, so it is vulnerable to various diseases.

Pain in the muscles of the shoulder can be the result of inflammation, damage to the periarticular tissues proper, but it can also be an accompanying background sign of the underlying disease that is not directly related to the locomotor apparatus. That is why it is so important to identify the causes of pain, timely diagnosis.

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Causes of pain in shoulder muscles

Periarticular pains in the shoulder are most often provoked by joint instability, which in turn can be caused by such factors: 

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

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

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

• Tendonitis of the muscles of the rotational cuff.
• Calcific tendonitis.
• Tendonitis of the biceps.
• Different types of tendon ruptures.

2. Common (diffuse) defeat of non-inflammatory shoulder joint capsule - capsulitis
3. Complex damage of the periarticular system - subacromial syndrome.

A detailed description of the causes of pain in the muscles of the shoulder.

• Tendonitis is an acute or chronic inflammation of the tendons surrounding the shoulder joint. Damage to the tendon inevitably leads to pain in the muscles of the shoulder due to the close anatomical relationship of these structures. Tendonitis can affect both the muscle of the rotator cuff, and the biceps, supine, subacute, subscapular muscles. In addition, there is calcifying tendonitis, in which calcifications accumulate in the tissues of the tendon.
• Inflammation of the tendon of the inner shoulder zone, flexor muscle, biceps tendinitis. Pain differs intensity, constancy, increases with the movement of the hands.
• Inflammation of the joint - bursitis. The disease is closely related to overexertion, sports injuries. In addition to the pain symptom, bursitis is manifested by swelling in the bursa zone, often the pain radiates into the hand, limiting the amount of movement.
• Frozen shoulder syndrome or retractile capsulitis. This syndrome is a reflex dystrophic defeat of the shoulder joint capsule with a parallel lesion of bone structures in the form of osteoporosis.
• Shoulder-scrotal periarthrosis is a syndrome that is still being actively studied, since its true etiology is not clear. In addition, the nature of pain with shoulder-scapular periarthrosis can range from acute, aggravated pain to aching, permanent. The pain does not subside, can be accompanied by insomnia, markedly restricts the movement of the hand.
• Myofascial pain syndrome is a typical disease of the muscular tissue in various areas of the body, but the favorite location for the MFBS is the shoulder girdle, the lower back. Myalgia accompanying strained muscles develops in clearly defined places - trigger points.
• Vertebrogenic causes of pain in the shoulder muscles are most often found in the osteochondrosis of the cervical spine, when a secondary complication develops - radiculopathy. It is believed that osteochondrosis can be one of the factors that provoke humeropathy periarthritis, periarthrosis.

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

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

Since the painful muscle symptom is often not acute, it is not always possible to identify its causes in a timely manner. More often the patient addresses to the doctor with already formed painful chronic syndrome and a set of accompanying reactions, signs that considerably complicates diagnostics of muscular pains in a humeral belt.

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Symptoms of shoulder pain

The pain sensation in the shoulder girdle can have dozens of various 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 the nociceptive, which in turn is accompanied by a number of side effects, reactions. In addition, the nociceptive nature of the symptom allows you to run a cascade of psychosomatic, psychogenic sensations, which makes it extremely difficult to quickly diagnose and manage the pain. It is believed that in 65-70% of cases, the pain develops slowly, gradually as a reflex tonic response to the systematic overstrain of the muscles of the shoulder girdle. The load on the shoulders can be either dynamic or static, in any case, the muscular hypertonus 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 the areas of the affected tendons, joints, ligaments, but can also be diffuse fibromyalgia, myofascial syndrome.

How to identify the area of damage? Painful symptom and restriction of hand movement What can become inflamed, hurt Pain with one or both hands retracted Subacromial bag damage, inflammation in the supraglossal muscle, tendon (inflammation, stretching of the tendon) Shoulders hurt when both hands are fully upward vertically Inflammation, degenerative change clavicular-acromial joint and damage to surrounding muscles. Pain during hair combs, throwing your hands behind your head, with external rotation of your hands Tendon tendon of small round or subacute muscles Painful pain with the hands behind the back Stretching or inflammation of the tendon of the scapular muscle Pain symptom when bending the arm at the elbow and lifting the goods, turning the wrist - the key in the door (shoulder suppuration) Stretching, inflammation of the biceps muscle of the shoulder girdle, tendons Pain in the arm behind the back (get the object from the back pocket). Pain with internal rotation of the shoulder Damage (stretching, inflammation) of the scapula of the shoulder All movements of the hands, turns of the head, movement of the neck cause painful sensations, movements are severely limited Inflammatory process in the capsule of the shoulder joint, in periarticular tissues.

Diagnosis of shoulder pain

Diagnosis of pain in the shoulder muscles can be accurate provided: 

• The specific localization of pain.
• Debutation of pain and diagnosis in the initial period of the syndrome.
• Absence or presence of specific signs accompanying muscle pain.

Diagnosis of pain in the shoulder muscles can include such steps: 

• Examination of the patient with a painful symptom in the shoulder.
• Determination of the symmetry of the location of the shoulder blades, arms, collarbones (with paresis, the lowering of the shoulder from the side of the lesion is clearly visible).
• Visual detection, palpatory examination of muscles for the presence of hypotrophic sites. Particularly characteristic is muscle malnutrition with prolonged neurogenic process (more than 14 days).
• Tests for determining possible pareses.
• Tests that reveal the balance and the ratio of active and passive movements.
• Test for determining the strength of resistance, the function of the large and small muscles of the chest, muscles of the shoulder girdle.
• Determination of the strength of flexor muscles and extensor muscles.
• Identification of symptoms similar to those of radicular syndrome.
• Evaluation and determination of tendon reflexes.
• Palpation of points of radicular exits, detection of signs of radicular lesion.
• Detection of diagnostically important trigger points for confirmation of fibromyalgia, MFBS (myofascial pain syndrome).

Also, X-rays of the spine (cervico-brachial, thoracic zone) can be assigned to concretize diagnostic findings, neurovisual methods - MRI, CT, ultrasound of joints, as well as dopplerography of vessels and electrophysiological examinations for the determination of muscle tone

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

Diagnostic feature	Articular pathologies	Diseases of muscle tissue (periarticular structures)
Characteristics of the pain symptom	The pain is permanent, does not subside, is slightly increased during movement	Pain develops in response to a specific movement
Zone of pain localization in the shoulder	More often diffuse, diffuse	The pain is clearly localized, has boundaries
Dependence on active or passive movements	Significant restriction on the volume of all types of traffic	Reducing the volume of active and simultaneous preservation of all types of passive movements, without changes
Presence or absence of edema	Often swelling is visible to the naked eye, an effusion is revealed	Muscle pain often provokes asymmetry of the body, also characterized by swelling in the joint area of bursitis

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Treatment of shoulder pain

General rules, which involves the treatment of pain in the shoulder muscles, are very similar to the stages and methods of treating joint disease, the musculoskeletal system ..

Treatment of muscle pain in the shoulder girdle: 

• Neutralization of all the pain-provoking factors - immobilization of the arm, shoulder, often - complete rest.
• Anti-inflammatory drugs - non-steroidal anti-inflammatory drugs (NSAIDs) in tablet form, as well as in ointments, gels. 
• Anesthesia with compresses (30% dimexide solution).
• Possible injections of corticosteroids in the affected area.
• Periarticular administration of homeopathic preparations - Traumeel, Zeel.
• Activation of trophic periarticular tissues, improvement of metabolic processes with assistance, physiotherapeutic procedures.
• Assignment of a complex containing B vitamins, trace elements.
• Massage of the muscle, including massage with the development of the joint.

As a rule, the therapy of mild muscle pains, developed as a result of muscle strain, does not last more than 3-5 days. It is quite enough reasonable rest, adjusting training exercises and sparing, warming massage. The remaining cases require complex diagnosis, often dynamic examination (monitoring the condition of the shoulder girdle in motion) and the appointment of a course of drugs that reduce the perception of pain, improve trophic muscle fibers, neutralizing inflammation.

Prevention of pain in the muscles of the shoulder

Preventative measures aimed at getting rid of pain in the shoulder girdle, first of all, depend on the cause, the revealed provoking factor. In general, the prevention of pain in the muscles of the shoulder is a system of exercises designed for athletes who actively use the shoulder girdle. Also help to reduce the risk of developing muscle pain in the shoulder the following rules for strengthening the "corset" periarticular tissues: 

• It is necessary to ensure proper rigidity of the bed, to sleep on a small pillow.
• Daily do warm-ups of all muscles, including muscles, tendons of the shoulder.
• At the slightest painful symptoms in the shoulder, you should limit the movement of the hand from the pain and give them a small rest.
• If a person fulfills monotonous, rhythmic movements with his hands (the painter, the operator of the conveyor line, etc.), one should regularly carry out massages of the shoulder zone, possibly using essential oils, warming and relaxing gels.
• All exercises from the complex of physiotherapy exercises should not be performed intensively and for a long time, charging should not exceed 15-20 minutes in the morning and not more than 30 minutes during the day (2-3 sessions, each for 15 minutes).

Pain in the muscles of the shoulder is a very common symptom inherent in our age of speed and hypodynamia. Unfortunately, shoulder symptoms, provoked by physical exercises do not exceed 25-30% of all cases, the basis of them is overstrain of the shoulder muscles as a result of a prolonged static posture, hypothermia and atony, muscle weakness. That is why strengthening the muscle corset, maintaining the normal state of the muscles, adherence to the regime - tone-relaxation, this is the way to avoid discomfort in the shoulder girdle.