Shoulder pain is the third most common problem after waist and neck pain. Shoulder pain is one of the top reasons for consulting a doctor, especially for people who work using their arms. First of all, there is the pathology that we define as impingement syndrome, which concerns the tendons of the shoulder. Frozen shoulder, calcific tendinitis caused by lime accumulation in the tendons, shoulder laxity or semi-dislocation of the shoulder, and strain pain due to the muscles around the shoulder called myofascial pain syndrome are the most common problems. Shoulder pain may also occur due to damage to the nerves of the muscles around the shoulder, and weakness and weakness in the shoulder are more prominent.
Less common causes are pain originating from structures outside the shoulder. The majority of inflammatory rheumatism affects the shoulder. Cancers of the upper lung area, liver, gallbladder, and even spleen problems can cause shoulder pain. It should not be forgotten that the causes of neck pain can often be confused with the causes of shoulder pain, as cervical disc herniations cause pain radiating to the shoulder.
What is impingement syndrome?
The most common cause of shoulder pain is impingement syndrome. Impingement syndrome occurs as a result of the tendons of the muscles that enable us to lift our arms and the sac in this area being squeezed between the bone structures that form the shoulder. It is more common in professionals who use their hands up, housewives, and athletes who do sports such as swimming and volleyball. As a result, this problem is a disease of shoulder abuse or overuse. The importance of this syndrome is that if the necessary treatment is not performed and precautions are not taken, it may result in complete rupture of the tendons.
What are the symptoms of impingement syndrome?
Complaints often occur as a result of using the shoulder and arm. Over time, the pain begins to become constant. It turns into a pain that keeps the patient awake, especially at night. It reaches a level that affects the patient's daily life activities such as dressing and undressing.
How is impingement syndrome diagnosed?
The diagnosis of impingement syndrome can only be made based on the clinical evaluation of the physician. It is placed as a result of its formation (Figure 3). Unfortunately, the biggest misconception on this subject is that this syndrome is diagnosed with magnetic resonance imaging. Magnetic resonance imaging and ultrasonography only help us understand the extent of the event.
How is impingement syndrome treated?
The most important issue in its treatment is to rest the arm and avoid forced movements. Using hands on the head should be avoided for at least 3 months, and such activities should never be done. At the beginning of the treatment, it is necessary to apply ice packs for 20 minutes 5 times a day, as well as use of painkillers and anti-rheumatic drugs. Cortisone injections into the shoulder can be very beneficial in patients who do not benefit from ice therapy and drug therapy. When pain is controlled, physical therapy and rehabilitation practices become important. At the end of this treatment program, it is important to use the shoulder correctly and continue shoulder strengthening exercises without causing compression. Surgical intervention is considered in patients who cannot get satisfactory results despite a good six-month treatment program.
What is frozen shoulder?
Frozen shoulder is a clinical condition that occurs as a result of severe restriction of arm movements as a result of narrowing of the joint capsule. It is a painting. The exact cause is unknown. It may occur spontaneously or following poorly treated disorders of the shoulder joint. It is more common in diabetic patients.
Is frozen shoulder a long-lasting disease?
Frozen shoulder is a disease that can last 2-3 years. It has three periods. The first is the painful period and can last up to 1 year. This is a period that can often be confused with other shoulder and neck problems. The second period is the period when the shoulder is completely frozen. The pain decreases, but shoulder movements are restricted to the extent that the patient cannot perform daily living activities. The third period is the resolution period.
How is frozen shoulder treated?
There are a wide variety of treatment methods. However, the most important issue in the treatment of frozen shoulder is that the patient knows that his illness will last a long time. Treatment varies for each period. In the first period, the patient struggles with pain. In the second period, stretching exercises can be performed accompanied by physical therapy.
A patient with calcific tendinitis pain Is it a disorder?
It is a pathology that causes the most severe pain in the shoulder. It is a condition caused by the precipitation of crystals on the tendon, which we can explain as lime accumulation in the soft tissue for an unknown reason. Shoulder pain begins suddenly and severely after a strenuous activity. Diagnosis is usually made with simple x-rays (Figure 5). In addition to drug therapy during periods of severe pain, ice application and injections into the calcific lesion are very important. In chronic cases, physical therapy and rehabilitation programs in which ultrasound therapy is at the forefront are applied. There is also the application of shock wave ultrasound. In very resistant cases, these calcifications may need to be removed surgically.
What should be done in case of frequent dislocation of the shoulder?
If recurrent dislocations occur in a shoulder without any trauma, these patients should strengthen the appropriate muscles according to the direction of the dislocation. They benefit greatly from physical therapy and rehabilitation programs that include Surgical intervention should be considered first in patients whose shoulder dislocated after a major trauma such as a fall and who subsequently experienced recurrent dislocations. The first problem that should be considered in young patients and athletes with shoulder pain is the tendency to dislocation, which we call instability, due to the looseness of the ligaments in the shoulder.
Is arthritis disease seen in the shoulder joint?
Since it is not a weight-bearing joint. Osteoarthritis is not as common in the shoulder joint as it is in the knee joint. If this disease, which occurs due to wear of the articular cartilage, develops, physical therapy practices become very important. It allows prosthetic applications to be performed later.
What is the importance of physical therapy and rehabilitation in shoulder pain?
As can be seen, the causes of shoulder pain are very diverse. It covers a wide range from tumors to trauma. For this reason, tumors and infections must be excluded in case of fever, night pain, weight loss, persistent pain that does not change with arm movements and does not relieve with simple painkillers. If inflammatory rheumatism affects the shoulder, it should be diagnosed very quickly. Otherwise, these diseases can immediately destroy the shoulder joint and cause disability.
In addition, After trauma, an emergency physician should be consulted. Trauma-related tendon damage, nerve damage, dislocations may occur, and significant damage to the structures around the shoulder may occur. Even in cases of cancer, infection and inflammatory rheumatic diseases that need to be diagnosed in the first place, there are physical therapy and rehabilitation practices to be performed according to the stage of the diseases. Appropriate exercises must be performed to at least maintain the movements of the joint. Apart from these diseases, the main treatment for most pathologies that cause shoulder pain is; physical therapy and rehabilitation practices. In cases requiring surgery, physical therapy and rehabilitation must be performed before and after surgery. For this reason, the first physician to consult for shoulder pain, as well as for waist and neck pain, should be a physical therapy and rehabilitation physician who is competent in this field.
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