Where does shoulder pain come from?
The most common source is the rotator cuff tendons and subacromial bursa, which are pinched when raising the arm. In second place are changes in the joint capsule and arthrosis of the acromial clavicular joint. In people with sedentary work, pain often comes from the cervical spine: then it intensifies when turning the head and is accompanied by numbness in the fingers. Referred pain from internal organs is usually independent of hand movements, and this is an important distinguishing feature.
- Tendonitis and rotator cuff impingement
- Partial or complete tear of the cuff
- Adhesive capsulitis - frozen shoulder
- Arthrosis of the acromioclavicular joint
- Subdeltoid bursitis
- Cervical radiculopathy
- Instability and recurrent shoulder dislocation
How to understand the source of pain
Pay attention to what makes the pain worse. If it appears when raising the arm to the sides in a certain range and subsides above, it is more likely about the tendons. If the arm does not rise either on its own or with the help of a doctor, capsulitis is likely. Pain when turning and tilting the head with a shooting in the arm indicates the neck. Constant pain, independent of movement, requires the exclusion of diseases of the internal organs.
- Pain when raising the arm to the sides - cuff
- Restriction of both active and passive movements - capsulitis
- Pain at the top of the shoulder when moving the arm to the opposite shoulder - acromioclavicular joint
- Shooting in the arm when moving the neck - radiculopathy
- Pain without connection with movements - we are looking for internal causes
Surveys
They start with clinical tests, which largely determine the diagnosis. Ultrasound of the shoulder is an accessible and informative method for assessing the tendons, bursa and effusion, allowing you to see tears and calcifications. X-rays are needed after injury and if arthrosis or calcium deposits are suspected. MRI of the shoulder is prescribed for suspected cuff tears and before surgery, and MRI of the cervical spine is prescribed for numbness and weakness of the arm. If pain is accompanied by chest symptoms, be sure to do an ECG.
- Functional tests of the cuff and capsule
- Ultrasound of the shoulder joint
- X-ray of the shoulder in two projections
- Shoulder MRI
- MRI of the cervical spine for numbness
- ECG if a cardiac cause is suspected
What you can do yourself
In the first days, reduce the load, but do not immobilize your arm completely: prolonged use of a scarf leads to stiffness. Sleep on your healthy side with a pillow under your sore arm. Organize your workspace so that you don’t have to hold your hands above shoulder level for long periods of time. Gentle exercises for pendulum movements and stretching are performed in a painless volume. If the pain does not decrease within 2-3 weeks or interferes with sleep, you need to see a doctor.
- Reduce the load, but continue to move your arm
- Do not wear a headscarf for more than a few days
- Comfortable sleeping position with a pillow at hand
- Pendulum exercises and gentle stretching
- Breaks from work with raised hands
- Cold in the first days after injury, later - warmth
Treatment
Reason determines tactics. For tendonitis and impingement, the basis is rehabilitation: exercises to strengthen the cuff and muscles of the scapula, posture correction, physiotherapy. Anti-inflammatory drugs are used in a short course to facilitate exercise. For calcific tendinitis, shock wave therapy is used. A glucocorticoid blockade can dramatically reduce pain, but it is prescribed by a doctor and is not repeated frequently. Complete cuff tears in active people and persistent shoulder instability are indications for arthroscopic surgery.
- Exercises for the rotator cuff and scapula muscles
- Correction of posture and ergonomics
- Physiotherapy: magnetotherapy, laser, ultrasound
- Anti-inflammatory drugs as prescribed by a doctor
- Shock wave therapy for calcifications
- Blockade for severe pain
- Arthroscopy for cuff tears and instability