Shoulder Anatomy and Shoulder Pain

Shoulder anatomy consists of the collarbone, scapula and humerus and the soft tissues surrounding them. When soft tissue structures such as capsule, ligament, tendon, bursa or muscle are damaged, some pain occurs in the shoulder. Since the joint structure in the shoulder is very mobile, shoulder pain is experienced very frequently.

Shoulder pain can be caused by many reasons. While some of these may originate from the shoulder joint, some may be pain reflected in the shoulder.

A) Pains Originating from Shoulder Joint

We can examine the pain caused by overuse of the shoulder joint by dividing it into 5 groups.

Impingement syndromes
Frozen Shoulder
Shoulder Joint Arthritis
Subacromial Bursitis
Biceps Tendinitis and Tear

1.Impingement Syndromes: The rotator cuff muscles located in the shoulder have a very important place in shoulder movements. The rotatar cuff structure formed by the musculus supraspinatus, musculus infraspinatus, musculus teres minor and musculus subscapularis muscles are important formations that provide stabilization of the shoulder joint. This formation cola; It provides abduction, abduction, internal and external rotation. Impingement syndromes occur as a result of the rotatar cuff muscles not functioning properly. They are the most common types of shoulder pain. While it can affect people of all ages, shoulder pain can also be extremely persistent.

a) Rotatar Cuff Tendinitis: It is the inflammation in the tendons of the muscles located in the rotatar cuff structure. It is more common in people who throw or throw something heavy. Tendinitis progresses insidiously in these people who make sudden movements. The pain reaches such a level that over time the person cannot lie on his arm. In this disease, where all movements of the arm are restricted, the painful arch symptom is positive. It is of great benefit to consult a physician early in case of a disease that progresses rapidly.

In inflammation of the rotator cuff muscles, rest and the use of nonsteroidal anti-inflammatory drugs are very beneficial in the first place. If there is no improvement after a few weeks, the patient’s USG images are evaluated and physiotherapy treatment is provided. If this physiotherapy treatment provided with deep heaters does not work, it is necessary to apply local cortisone (steroid) injection treatment to the area. However, it should never be forgotten to not give more than two injections and to limit the time between two injections to at least 3 weeks. After completing the acute period, it will be extremely beneficial to strengthen the rotatar cuff muscles with some exercises. Subacromial decompression application can be tried in chronic cases.

b) Calcific Tendinitis: Some calcifications are seen in this tendon inflammation, which usually occurs after the 4th decade. The tendons of the rotatar cuff muscles are inflamed and more calcium stones accumulate around them. As calcifications increase, the intensity of pain will also increase. The frequency of attacks will increase and their duration will sometimes reach months.

Rest and cold compression application are beneficial in the treatment. Adding physiotherapy to advanced cases is extremely beneficial. As the event becomes chronic, controlled cortisone injection may be administered. But one must be careful. Carelessly administered cortisone may cause the rotatar cuff area to harden and the ligaments there to rupture. Since movements will be restricted, shoulder straps may be recommended to patients.

c) Subacromial Impingement Syndrome: Subacromial impingement syndrome may occur between the head of the humerus and the acromion region of the shoulder blade as a result of the weakness of the rotatar cuff muscles and calcification of the joint areas. In this syndrome, which is more common between the 2nd and 6th decades of life, there is edema, inflammation and wear in the tendons. Crunching sounds may be heard when moving the joint. Nonsteroidal anti-inflammatory drugs, physiotherapy and cortisone injection are beneficial in the treatment. In advanced cases, surgical treatment methods may be considered.
d) Rotatar Cuff Tear: Tears may occur in the rotatar cuff area as a result of excessive abduction of the shoulder, mostly in people over the age of 50. Tendinitis treatment is applied to patients whose painful arch and arm drop test are frequently positive. But it is useless to inject cortisone.

2. Frozen Shoulder: This disease, in which both passive and active movements of the shoulder are restricted, generally occurs in middle-aged women when the arm remains immobile for a long time due to pain. Restriction of passive movements distinguishes frozen shoulder from tendinitis cases. The joint capsule narrows and intra-articular adhesion conditions increase over time. The patient experiences enough pain to wake up at night and need to change position. Frozen shoulder disease; It may develop secondary to diabetes, heart attack, lung diseases, stroke, thyroid gland disorders and some traumas.

The main purpose of frozen shoulder treatment is not to immobilize the joint. Even though it is difficult, movement must be achieved with some anesthesia methods. With arthroscopy, injections can be made into the joint to tighten and renew the joint fluid and cartilage. Success can be achieved as a result of physical therapy.

3.Arthritis of the Shoulder Joint: Calcific calcifications of the shoulder joints. Although rheumatoid arthritis is more common in the hand, it can also manifest itself in the shoulder. Joint movements are restricted and crepitus is occasionally experienced in the shoulder joint. If fever is added to the disease, septic arthritis will occur. In radiological imaging methods, the joint space has narrowed and some signs of wear may be seen.

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Local injections, cold applications, painkillers and physiotherapy methods may be preferred in treatment. Treatments to drain the joint can also be tried in chronic cases.

B) Reflected Shoulder Pain

Heart and lung diseases can cause referred pain in the shoulder. It should be kept in mind that tumors affecting the shoulder joint and muscles and metastases of surrounding organ cancers (especially Pancoast tumor sitting on the lung dome) may cause pain in the shoulder.

Cervical disc hernias, thoracic outlet syndrome, polymyalgia rheumatica, fibromyalgia and many systemic diseases can also cause referred pain in the shoulder. Treatment of each should be directed at the underlying cause.

Arm Pain

Patients may face some pain due to deformation and inflammation of the joints and muscle tendons in the arm. The most common of these diseases are;

Medial Epicondylitis (Golfer’s Elbow)
Lateral Epicondylitis (Tennis Elbow)
It is Carpal Tunnel Syndrome.

Medial Epicondylitis (Golfer’s Elbow): It is a type of tendonitis that occurs as a result of inflammation of the flexor muscle groups in the front part of the elbow, which help bend the arm. It is inevitable that there will be pain and tenderness in the inflamed area. Medial epicondylitis is a disease that is mostly seen between the 2nd and 4th decades and is blamed on repetitive movements. It occurs as a result of overuse of the arms and wrists in people playing golf, tennis or baseball.

Pain in the inner part of the elbow, stiffness, weakness in the wrist, numbness-tingling in the ring and little finger, and difficulty when picking up items or shaking hands may signal that we are at risk of medial epicondylitis.

Resting the wrist and applying cold to the elbow are extremely beneficial in the treatment. Using an epicondyle band will help. The fastest treatment method is local cortisone (steroid) injection. PRP (platelet rich plasma) method, which has been useful in many tendinitis cases in recent years, can give successful results. Platelets taken from the patient’s own blood are obtained with a special system. It is appropriate to do it twice, one month apart. Although it does not have any serious side effects and does not act as quickly as cortisone, it significantly reduces recurrence in the long term.

Lateral Epicondylitis (Tennis Elbow): Unlike medial epicondylitis, it is the inflammation of the tendons located on the outside of the elbow. musculus appendage

Excessive strain on the tensor capri radialis brevis muscle with stretching and grasping movements will cause pain. This disease, which occurs due to overuse and trauma, is mostly seen in athletes who play tennis.

The main reason why patients consult a physician is that they feel pain in the lateral epicondyle. Pain begins with physical activity and spreads from the elbow to the hand.

In treatment, activity reduction, painkillers, wearing a brace, physiotherapy, cortisone injection, arthroscopic and surgical methods should be preferred depending on the situation of the case.

Carpal Tunnel Syndrome: It is a clinical condition caused by compression of the median nerve passing through the carpal tunnel area in the wrist. Median nerve; Since it is responsible for the innervation of the thumb, index finger, middle and ring finger, compression of the nerve in the carpal tunnel will cause weakness, numbness and tingling in the hand. Over time, weakness occurs in the hand muscles and it becomes impossible to button up clothes or talk on the phone.

During diagnosis, the physician will examine your hand, wrist, shoulder and neck in detail. He checks the wrists for any tenderness or swelling. It will strengthen the diagnosis by subjecting it to some nerve conduction tests.

Treatment varies depending on the severity of pain and tingling in the wrist. Painkillers and anti-inflammatory drugs can be used. If wrist rest bracelets and other treatment methods do not work, the median nerve can be relieved by surgery.