Shoulder pain is a specific discomfort that indicates the presence of a pathological process in the bone and surrounding soft tissues. In some cases, pain is caused by diseases and injuries of the cervical spine, nerve trunks of the upper limb or distant organs. According to its characteristics, the pain varies from dull, non-intense, short-term to acute, severe, constant. Often there is a connection with movements. Diagnosis is carried out on the basis of a survey, examination data, the results of radiography, CT, ultrasound and other studies. Until the diagnosis is clarified, rest is indicated, sometimes it is possible to take analgesics.
Most often in the clinical practice of traumatologists there are bruises of the shoulder. Injuries occur during a fall or impact, are manifested by moderate pain at the time of injury, decreasing over time. Swelling (usually slight), bruising is possible. The function of the limb is preserved, the degree of limitation of movements depends on the severity of the injury.
Soft tissue hematomas of the shoulder are rare, usually formed in people who are overweight or have large muscle mass. The reason is a direct blow, compression of the damaged area. Initially, the symptoms are as if bruised. Then the pain does not subside, but intensifies, becomes pressing, bursting. Edema spreads to surrounding tissues. In the center of the damage zone, the tissues are first dense, tense, then fluctuation appears.
A rupture of the biceps tendon is formed with a sharp muscle tension, it can be complete or partial. Accompanied by a sharp sharp pain, sometimes a crack or crunch, a change in the contours of the biceps muscle (retraction in the upper and protrusion in the lower part of the shoulder, or vice versa). The pain intensifies when you try to raise or bend your arm, turn your hand palm up. Palpation is painful, muscle strength is significantly reduced.
A fracture of the diaphysis of the shoulder develops with a blow, fall, twisting of the arm, manifested by explosive unbearable pain. Then the pain subsides a little, but remains very intense, sharply increases when trying to active and passive movements, so the patient keeps the diseased hand healthy. The shoulder is edematous, deformed, pathological mobility, crepitus are determined.
Myositis of the biceps and triceps develops after a significant load against the background of detraining, with constant overstrain, infectious and parasitic diseases, intoxications, and some autoimmune pathologies. They are manifested by diffuse aching pain along the anterior or posterior surface of the shoulder. There is an increase in pain during palpation, tension of the affected muscle. The muscle is compacted, sometimes there is a slight edema, local hyperthermia.
With the manifestation of tendonitis of the biceps of the shoulder, the pain is usually not intense, it appears only on palpation of the upper parts of the shoulder (especially the zone of the intertubercular groove), flexion of the forearm, rotation of the hand. Overload and additional traumatization provoke aggravation of symptoms, development of acute humeroscapular periarthritis.
Shoulder-shoulder periarthritis is characterized by a sudden increase in pain. The pain covers the shoulder joint, begins to give to the neck and forearm, deprives sleep. Painful sensations are so intense that the patient avoids any movements, holds his hand, pressing it to his chest. General weakness, subfebrile condition are possible.
Purulent skin lesions of the shoulder include deep pyoderma - boils and carbuncles. They are manifested by local pain, which quickly intensifies, becomes sharp, twitching, pulsating, bursting, depriving a night's sleep. In the affected area, a dense focus of crimson color is revealed, subsequently a limited cavity with purulent contents is formed. After opening the focus, the pain quickly decreases, a gradually healing sore is formed.
Soft tissue abscess occurs when an infection spreads from a focus of pyoderma, wounds, abrasions, sometimes it is formed as a result of lymphogenous or hematogenous penetration of microorganisms from distant purulent foci. It is manifested by rapidly increasing pain, swelling, hyperemia, general hyperthermia. Within a few days, the pain becomes extremely intense, throbbing, twitching, disturbing at night. A dense, sharply painful formation is formed on the shoulder, then a focus of fluctuation appears.
Post-injection abscess develops more often in children, due to vaccinations, but can also be detected in adults who received intramuscular injections in the shoulder. The beginning of the formation of the focus often goes unnoticed due to the physiological local reaction to the administration of the drug. In contrast to the normal reaction, pain in an abscess is not aching, but bursting, does not decrease, but intensifies, is accompanied by an increase in edema, local hyperthermia. With the formation of a purulent focus, the clinic, as with a normal abscess.
Shoulder phlegmon develops for the same reasons as an abscess, but is not limited to the capsule, but spreads throughout the entire segment. It is characterized by diffuse increasing pain. The pain is pressing, bursting, throbbing, twitching, for several days reaches the degree of unbearable, intensifies with any movement. Palpation is sharply painful. There is a pronounced widespread edema, purple color of the limb, fever, weakness, weakness, severe intoxication.
With erysipelas, the appearance of pain is preceded by a bright general symptomatology - fever, intoxication, sometimes convulsions and delirium. After a few hours or the next day, moderate pain, itching, a feeling of fullness, swelling, and erythema appear in the shoulder area. Due to the involvement of the lymph nodes, the pain may spread to the axilla. The further course depends on the form of pathology. Possible complication of erysipelas with phlegmon or abscess with the development of appropriate symptoms.
Periostitis of the humerus is detected after injuries (bruises, fractures). The pathological focus is often formed along the outer or inner surface of the shoulder, in areas where the bone is closer to the skin. With aseptic periostitis, the pain is moderate, with purulent - intense, twitching, combined with fever, significant swelling, hyperemia. With a serous process, the pains are bursting, sometimes accompanied by deformation of the segment due to the formation of a "bag" with a large amount of fluid.
The shoulder is a favorite localization of the focus of hematogenous osteomyelitis in children. Initially, there is a sharp increase in temperature, weakness, intoxication, chills. On the second day, very intense jerking, boring, bursting pains join. The pain syndrome is so pronounced that the movements of the limb become impossible. To avoid explosions of pain, the patient freezes in bed.
Less commonly, hematogenous osteomyelitis of the shoulder occurs with a blurred clinical picture. Similar, but less pronounced symptoms are observed in other forms of shoulder osteomyelitis - postoperative, post-traumatic. Manifestations occur against the background of an open fracture, during the healing of a postoperative wound. Pain increases more slowly than with hematogenous osteomyelitis, does not reach such intensity.
Degenerative lesions of the tendon-ligamentous apparatus of the shoulder usually develop as a result of acute inflammatory processes. With chronic tendinitis, tendinosis of the biceps muscle is formed, periostitis - humeroscapular periarthrosis. Acute pains in the upper third of the shoulder become moderate, aching, pulling. With sudden movements, short-term shooting pain is possible. Over time, there is a restriction of movement. Sometimes calcifications are felt in the thickness of the tendons.
In children, bone cysts may form in the humerus. A solitary cyst is usually detected in boys, manifested by mild short-term pain in the upper part of the shoulder. Pain persists for a long time, but due to the slight severity of the symptom, patients rarely seek help and come to the attention of doctors only after the formation of a pathological fracture.
Girls have aneurysmal bone cysts with more pronounced symptoms. Severe arching pains in the shoulder appear after an injury, accompanied by swelling, dilatation of the saphenous veins. Movement is limited. The pain syndrome persists for several months, then gradually decreases and disappears. During the recovery period, pathological fractures are possible.
The most common benign tumors of the humerus are osteoma and osteochondroma, less common are chondroma and osteoid osteoma. The pains are vague, indistinct, of slight intensity (with the exception of osteoid osteoma), without significant progression, sometimes they bother for several years. Rapid growth, compression of the nerve trunks provoke an increase in pain. With osteoid osteoma, pain is sharp, which contributes to its early detection.
Among malignant neoplasias of the shoulder, osteogenic sarcoma prevails. The pain is dull at first, non-localized, quickly passing. It grows rapidly, becomes constant, exhausting. At the same time, pastosity of tissues, expansion of local veins, contractures appear, general symptoms join. In the later stages, the pain is unbearable, only narcotic analgesics bring temporary relief.
Pain in the shoulder is often provoked by compression of the nerve trunks in injuries and diseases of the spine, shoulder girdle, shoulder joint. Possible neurological causes of shoulder pain include:
Characteristic features of pain of neurological origin are shooting or burning in nature, spreading along the neck, shoulder girdle, forearm, often combined with sensory disturbances. In some pathologies, trophic disorders occur due to simultaneous compression of the vessels.
Sometimes pain in the shoulder is the result of diseases of the internal organs, lymphatic and blood vessels, the germination of nerve trunks by malignant tumors. Pain syndrome can occur with the following pathologies:
With pathologies of the heart, pain radiates to the left shoulder. In Takayasu's disease, both hands are involved, soreness is combined with weakness of the limbs, circulatory disorders, but the symptoms are often more pronounced on the left. With Pancoast cancer, the pains are neurological in nature, complemented by paresthesias, muscle weakness.
In case of traumatic injuries, degenerative and inflammatory diseases, purulent lesions of the bone, the examination is carried out by an orthopedic traumatologist. For other pathologies, an examination by a surgeon, neurologist, and other specialists is required. The survey plan includes:
For neurological causes of pain, an examination by a neurologist is indicated, X-rays of the spine, electrophysiological techniques can be prescribed. Suspicion of Pancoast cancer is an indication for X-ray of the chest and spinal column. With myocardial infarction, angina pectoris, an ECG is performed, with lymphedema, studies of the lymphatic system are performed.
The hand needs to be provided with rest with the help of a scarf bandage. In case of a fracture, it is necessary to apply a splint from the shoulder girdle to the hand, give the victim an anesthetic. To reduce swelling, you can put an ice pack wrapped in a towel or a heating pad with cold water on your shoulder. It is categorically contraindicated to set fragments on your own, this can lead to additional traumatization of soft tissues, nerve damage.
With symptoms of degenerative or inflammatory diseases, gels and ointments with analgesic and anti-inflammatory effects help. Any purulent process is a reason for an immediate visit to a doctor, self-treatment in such cases is ineffective, can cause deterioration and spread of infection.
In the vast majority of cases, fractures of the humerus are treated surgically; at the initial stage, it is possible to apply skeletal traction to hold the fragments in the correct position and prevent complications. Skeletal traction followed by immobilization with a plaster cast as the main method of treatment is used for concomitant trauma, the presence of contraindications to the operation.
Conservative techniques in combination with restriction of motor activity are indicated for inflammatory and degenerative lesions of the tendons and ligaments, include:
The listed methods are supplemented with massage, physiotherapy exercises, taping, manual therapy. Patients are referred for sanatorium treatment. In purulent processes, antibiotic therapy and physiotherapy are prescribed.
Operations on the shoulder are performed for injuries, purulent lesions, tumor processes. Depending on the nature of the pathology, the following are produced:
In the postoperative period, complex rehabilitation measures are carried out, including exercise therapy, massage, and physiotherapy. In case of neoplasia, patients are prescribed chemotherapy, radiation therapy, according to indications.