Shoulder pain is one of the conditions frequently encountered in clinical practice. There can be many causes of shoulder pain. Shoulder pain may arise from shoulder joint structures, cervical spine problems (calcification, hernia) or the muscles around the shoulder. Therefore, attention should be paid to the differential diagnosis of shoulder pain.
Pain due to tendon compression in the shoulder, as it is known in medicine (impingement syndrome), which we will talk about today, is the most common cause of shoulder pain. Here the problem is in the shoulder joint itself. The most important complaint in this syndrome is shoulder pain. Although the pain may occur in different patterns, it is felt especially in the shoulder joint and arm. Another important complaint is the limitation of movement in the shoulder joint. This restriction of movement is evident in the movement of turning the shoulder inward and throwing the arm from the waist to the back, and in the movement of lifting from the front and side. Generally, the last 20-30 degrees of movements are limited and painful. Pain can last for days, weeks or even months if left untreated. Pain that wakes you up at night is typical.
The diagnosis of this syndrome can actually be made by clinical examination. However, MRI examination is usually required to distinguish similar conditions that cause shoulder pain. In patients who cannot undergo MRI, diagnosis can also be made with the help of x-ray and ultrasound. Although it is easy to diagnose this syndrome, its treatment may not always be easy and may take a long time. There may be many causes of impingement syndrome. Therefore, if there is a reason that causes this condition, the treatment should first be aimed at removing it.
The primary factor that causes this disorder is inappropriate overuse of the shoulder. It is especially common in our country, especially in meticulous and diligent housewives. Home activities such as cleaning windows, excessive knitting, etc. may trigger the event. It is also common in people who do some sports. It is more common in people who do sports by lifting their shoulders up, such as swimmers and volleyball players. Part of the impingement syndrome is caused by the structurally narrow shoulder joint. Although this condition does not cause symptoms at an early age, over time the tendon begins to compress due to deterioration of posture, hunching of the back and forward of the shoulders. Sometimes a clear cause cannot be identified.
Whatever the reason, the treatment principles for compression syndrome do not change. First, the arm is partially heated. should be taken to rest. This rest does not mean giving a shoulder strap as some clinicians do. Because using a shoulder strap for a long time may cause the development of frozen shoulder. Activities that involve lifting the shoulder and arm above the head should be restricted for up to 3 months. This also includes the night. For example, it is also undesirable to sleep with your arms wrapped around the pillow so that your arms are above head level. Shoulder injection treatments are generally successful. In very painful cases, a mixture of cortisone and local anesthetic can be applied to the shoulder to relieve the pain as soon as possible. This injection must be performed with ultrasound imaging. Otherwise, it will be 50% ineffective. In cases where the pain is mild or other treatments have failed, PRP (Platelet rich plasma) injection is the most appropriate option. PRP is extremely effective, especially if there are small tears in the tendon. It is generally applied 2 times with an interval of 1 month. Another treatment alternative is physical therapy. Generally, 15 sessions of application will be sufficient. But some cases may not respond to physical therapy. Physical therapy and other injection treatments should be supported with exercise, especially after the pain subsides, and the weak muscles of the shoulder should be strengthened. One of the important points here is not to do exercises that raise the shoulder up, which may increase tendon compression. Excessive straining of the shoulder in this direction may cause tendon ruptures and the development of frozen shoulder. If there is a hunchback that causes the shoulders to come forward, it must be corrected. Otherwise, the complaints will recur and become chronic after a while.
If the complaints do not improve despite all treatments, surgical intervention is required. Surgical intervention is performed arthroscopically with a closed system and must be followed by physical therapy. Otherwise, the success rate of surgical intervention decreases significantly.
In short, shoulder tendon compression is the most common cause of shoulder pain and is treated with shoulder rest, physical therapy and exercise, cortisone or PRP injections in the shoulder. If not treated properly, frozen shoulder can lead to tears in the tendons. Surgery is not the first option and should be applied in cases that do not respond to other treatments.
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