Pain in the shoulder joint is a specific painful sensation caused by damage to the head of the shoulder, glenoid cavity of the scapula, cartilage, capsule, surrounding soft tissues and nearby anatomical formations. It can be acute or dull, constant or transient, aching, pulling, bursting, drilling, etc. Often aggravated by movement. May depend on weather and time of day. To determine the cause of pain, radiography, CT, MRI, ultrasound, arthroscopy, joint puncture, and laboratory tests are used. Until the diagnosis is clarified, rest, immobilization of the limb, and taking painkillers are indicated.
Pain in the joint is the result of a fall on the arm, twisting of the shoulder, a sharp jerk or blow. Occur with household, street and sports injuries. Less commonly, they form in industrial accidents, falls from a height, and traffic accidents. Swelling is noted, bruising and abrasions are possible.
A contusion of the shoulder joint develops upon impact. Pain at the time of injury is moderate, subsides fairly quickly. The edema is moderate or insignificant, the function of the limb is preserved, limited due to pain. A dislocation is formed when you fall on a straight arm or hit. There is a very sharp pain in combination with a click. The high intensity of pain persists until the moment of reduction. The shoulder joint is deformed, retraction is determined in place of the head of the shoulder. Movement is not possible.
A fracture of the head or neck of the shoulder, a detachment of a large tubercle occurs upon impact, falling on the shoulder. Intense explosive pain is typical, sometimes a bone crunch is heard. Pain does not subside over time. To avoid increased pain, the patient holds the diseased hand healthy. A pronounced edema, diffuse cyanosis is revealed, deformation, pathological mobility, crepitus are possible. Movement is severely limited.
Tears and ruptures of the rotator cuff of the shoulder are accompanied by a sharp pain radiating to the neck, forearm, hand. Depending on which muscle is affected, the pain increases when you try to lift, abduct or rotate the arm. If the movement is impossible - this indicates a complete rupture of the tendon, if possible, but sharply painful - a partial one.
Bankart injury occurs in the long-term after anterior dislocation of the shoulder, characterized by severe jerking, burning or cutting pain when trying to move the arm back, combined with a feeling of joint instability, conscious limitation of movement due to fear of re-dislocation.
Tendopathy develops with other diseases of the shoulder joint, after injuries. Initially, they are characterized by short-term pain sensations at the peak of the load. Then, aching or pulling pains begin to bother with moderate and minor exertion, at rest, at night. With calcifying tendinosis, a crunch is heard during movement.
With adhesive capsulitis, the pain syndrome appears without connection with external causes, gradually increases over 2-4 weeks, intensifies at night, in the supine position on the sore shoulder. The pains are chronic, constant, exhausting, preventing any movements, including passive ones. Pain gradually decreases and disappears within 10-14 months, along with progressive limitation of range of motion.
Acute myalgia of the deltoid muscle develops against the background of trauma, infection, significant physical activity, exogenous intoxication. Accompanied by local aching, pressing, bursting pain. The pain increases sharply with muscle tension, forcing the patient to find a comfortable position for the limb.
Arthrosis of the shoulder joint is characterized by chronic diffuse pains with predominant localization in the depth of the joint. Initially, pains are periodic, non-intense, dull, aching, pulling, appear at the beginning of movements, after a significant load. Subsequently, the pain sensations become longer, sometimes - burning, twitching, girdle. They remain at rest, occur at night, are accompanied by a crunch, combined with increasing limitation of mobility.
With arthrosis of the clavicular-acromial joint, pain is felt above the shoulder joint, in the distal part of the shoulder girdle. Pain sensations are chronic, have the same dynamics as in case of arthrosis of the shoulder joint, but are distinguished by a clear localization and a more superficial location, are aggravated by pressure on the acromial end of the clavicle, bringing the bent shoulder to the body.
Synovial chondromatosis occurs after injury or without external causes, characterized by undulating dull pain of moderate intensity, often aggravated at night. Short-term severe shooting pains and sudden restrictions of movement due to blockade of the joint by chondromic bodies are possible.
Aseptic necrosis of the head of the shoulder (Hass disease) is rare, at the initial stage it manifests itself as intermittent dull pulling or pressing pain during movement. For about a year, the duration and intensity of pain gradually increase, then pain appears at rest, the function of the limb is limited.
With arthritis of the shoulder joint, pain is diffuse, dull, pulling, occurs after an injury, against the background of an infectious or rheumatic disease. At first, the pain is weak, intermittent, aggravated in the evening, after physical exertion. Then - long, medium intensity, remaining at rest. When infected, the pain becomes sharp, jerking, shooting, pulsating, combined with symptoms of general intoxication.
Hematogenous osteomyelitis usually occurs in childhood, affects the upper parts of the humerus, manifests itself as local bursting, tearing, boring pain, which quickly increases to unbearable, is combined with symptoms of intoxication, chills, and a sharp deterioration in the general condition. In post-traumatic osteomyelitis, the clinical manifestations are similar, but develop more slowly, occur against the background of open fractures.
Acute aseptic bursitis of the shoulder joint is manifested by moderately severe arching diffuse dull pain, swelling, and slight hyperemia. During the transition to the chronic form, the pains decrease, with the development of infectious bursitis, they increase, become sharp, twitching, pulsating, deprive of night sleep, combined with an increase in edema, hyperemia, fever, signs of general intoxication.
Tendonitis is formed after tears of the rotator cuff or against the background of overloads. The patient is worried about pain when trying to move his arm to the side (damage to the supraspinatus muscle), turn the shoulder outward (inflammation of the infraspinatus or teres minor muscle), put the arm behind the back (tendonitis of the subscapularis muscle). The pains are moderate or not intense, aching or pulling.
Synovitis is a complication of injuries and other diseases of the joint, characterized by dull arching pain, gradually increasing over several days, correlated with an increase in the volume of the joint (amount of fluid). With suppuration of the effusion, the pain is acute, twitching, intense, exhausting, accompanied by violations of the general condition.
In rheumatoid arthritis, both joints are often involved. For a mild form, intermittent weak pains of a pulling or pressing nature, morning stiffness are typical. Moderate activity of the autoimmune process is manifested by periodic prolonged dull pressing, aching or bursting pain at rest and during movement, prolonged stiffness. In severe form, diffuse, undulating intense pain is observed, aggravated at night, constant stiffness, persistent synovitis, weakness, hyperthermia.
In systemic lupus erythematosus, pain in the shoulder joints is often symmetrical, although unilateral involvement is also possible. In mild cases, painful sensations are dull, local, pulling or aching, quickly disappear. In severe cases, the pain is progressive, undulating, diffuse, disrupting night sleep, combined with swelling, redness, synovitis. There are lesions of the skin, internal organs.
Rheumatism is manifested by strong, but short-term migrating pains in the shoulder and other joints that occur 1-2 weeks after an acute infectious disease. Variability is typical - pains can be pulsating, burning, baking or dull, pressing, pulling. They persist for several days, then disappear or weaken sharply.
Benign tumors (non-ossifying fibromas, osteochondromas, chondromas) are long-term, asymptomatic, characterized by intermittent, non-intense local pain, which remains at about the same level for many months or years. With an increase in neoplasia, synovitis occurs, a hard seal is felt in the joint area.
In case of malignant neoplasia, pain sensations are initially dull, indefinite, fuzzy, dim, sometimes intensifying at night. The pains progress rapidly, become diffuse, sharp, bursting, baking, twitching, cutting. Accompanied by edema, deformation, violation of the general condition. At the advanced stage, the pain is unbearable, exhausting, and is relieved only by narcotic analgesics.
Pain in the shoulder joint is often provoked by the pathology of the cervical spine. Typical "lumbago" - sudden sharp pain, which often radiates throughout the arm, from the shoulder to the fingertips. There may be mild pain spreading from the neck to the shoulder. A distinctive feature of the pain syndrome is the preservation of range of motion. Possible neurological causes of pain associated with damage to the spinal column:
Pain in the shoulder joint, shoulder girdle, upper shoulder may be due to upper plexitis (Duchenne-Erb palsy). One-sided shooting pain is observed with pressure on the supraclavicular and subclavian region, limitation of movements, and sensitivity disorders.
In diseases of the internal organs, reflected pain in the shoulder joint occurs due to the presence of myofascial trigger points. The following pathologies become the cause of pain:
Pain in the shoulder joint sometimes occurs with depression, some mental disorders. In diabetes mellitus, it has an organic basis due to the increased likelihood of developing tendonitis, capsulitis, and other minor rheumatological diseases. It can be provoked by taking anabolic steroids (due to necrosis of the clavicle and acromial process), corticosteroid drugs (due to necrosis of the head of the shoulder).
Traumatic injuries are under the jurisdiction of traumatologists, with pain of non-traumatic origin, patients turn to rheumatologists or orthopedists. Specialists collect complaints, conduct an external examination, establish the time and circumstances of the onset, the dynamics of the development of symptoms, their dependence on external circumstances. The examination may include the following methods:
In case of traumatic injury, you need to fix the hand with a splint or scarf bandage, apply a heating pad with cold water or an ice pack wrapped in a towel. In the absence of wounds of abrasions, chloroethyl can be applied to the skin. With severe pain, an analgesic may be taken. Self-repositioning attempts, massage, active limb movements are categorically contraindicated - this can aggravate the injury and complicate further treatment.
With non-traumatic pathologies, rest, an elevated position of the limb is recommended. With an exacerbation of degenerative diseases (tendinosis, arthrosis), an ointment with analgesic, anti-inflammatory and warming effects is applied to the shoulder joint. The appearance of redness, increasing swelling, severe pain, signs of general intoxication is an indication for immediate contact with a specialist.
A common measure is a protective regime, drawn up taking into account the characteristics of the disease. It may include permanent immobilization with a plaster or scarf bandage, temporary wearing of orthoses, exclusion of all or some types of load on the arm. Unjustified immobility, like unjustified overload, harms the joint, so the activity regimen should be determined by the doctor.
With dislocations, reduction is performed, with fractures with displacement - reposition. The most common non-drug methods are exercise therapy, massage, physiotherapy. In the treatment of the joint, a wide range of physiotherapeutic methods are used, including:
According to the indications, drug treatment is prescribed - NSAIDs in tablets and injections, chondroprotectors, local remedies (ointments, gels, creams, warming patches). In some cases, intra-articular administration of chondroprotectors and hormonal preparations, blockade of soft tissues with glucocorticoids is carried out. With synovitis, therapeutic punctures are performed.
Surgical interventions on the shoulder joint are performed by open and arthroscopic access, are divided into the following groups, taking into account the variant of the pathology:
Limitation of movements due to scarring of soft tissues becomes an indication for redressing, due to changes in the articular ends of the bones - for arthroplasty, arthrodesis, joint arthroplasty. In malignant tumors, surgical interventions are supplemented with chemotherapy, radiation therapy.