Shoulder pain is the third most common problem after waist and neck pain. Pain caused by the shoulder's own structures is most commonly seen. Impingement syndrome involving the tendons of the shoulder, frozen shoulder, calcific tendinitis caused by calcium accumulation in the tendons, shoulder laxity or semi-dislocations of the shoulder, and strain pain due to the muscles around the shoulder 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 part of the lung, 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 hernias cause pain radiating to the shoulder.
Painful conditions of the shoulder
Impression Syndrome
strong>The most common cause of shoulder pain is impingement syndrome. Impingement syndrome occurs when the tendons of the muscles that enable us to lift and rotate our arm get stuck between the bone structures that make up 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.
The diagnosis of impingement syndrome is made by examination and confirmed by MRI or Ultrasonography.
Treatment of impingement syndrome
Treatment is planned according to the stage of impingement syndrome and the age of the patient. The most important issue in treatment is to avoid strenuous 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, ice packs can be applied for 20 minutes 5 times a day, as well as painkillers and anti-rheumatic medications. In physical therapy, superficial and deep heaters and low-frequency electrical currents can be used to control pain. &nbs p;
Ozone injections into the shoulder joint, called local ozone, can also be used successfully with 1 or 2 applications per week.
Recently, PRP (platelet-rich plasma) applications using the patient's blood provide the opportunity to treat shoulder impingement syndrome quite easily. With this treatment, it is possible to both relieve pain and repair damaged tissues.
Cortisone injections can also be used to relieve the patient quickly in patients with acute pain and severe edema.
Sometimes, shoulder pain may occur due to long-lasting shoulder pain. Trigger points may also be seen in the surrounding muscles. In these cases, treatment of trigger points must also be added.
No matter what treatment is used to relieve pain, exercise therapy must be added. The shoulder joint is a joint supported by surrounding muscles and ligaments. For this reason, having the surrounding ligaments of appropriate length and strong muscles stabilizes the joint, reducing pain and ensuring proper function, preventing recurrences of pain. The point that needs to be taken into consideration is to perform the exercises without increasing the compression.
Surgical intervention may be considered in patients who cannot get satisfactory results despite a good six-month treatment program.
Frozen shoulder
Fracture, dislocation. It is a clinical picture that is quite painful and presents with limitation of further movement after the thickening and shrinking of the capsule surrounding the shoulder joint, especially in cases where the pain cannot be well controlled and movement cannot be started early, after painful conditions of the shoulder such as surgery, impingement syndrome. Sometimes it can also be seen after conditions such as stroke or heart attack. It is a condition that is more common in diabetics, kidney patients and the elderly.
A dynamic treatment process should be started immediately to prevent frozen shoulder from developing in painful cases of the shoulder. All treatment methods mentioned in impingement syndrome are also valid for frozen shoulder. However, since hard and painful stretches to open the shoulder have the risk of further increasing the limitation of the shoulder, care should be taken when stretching during exercise.
Calcific Tendonitis
It causes the most severe pain in the shoulder. It is a pathology that causes For an unknown reason It is a condition caused by the precipitation of crystals on the tendon, which we can explain as lime accumulation in the soft tissue. Shoulder pain begins suddenly and severely after a strenuous activity. Diagnosis is usually made with simple x-rays. 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.
Very frequent dislocation of the shoulder
If recurrent dislocations occur in a shoulder without any trauma, these patients should turn to the direction of the dislocation. They benefit greatly from physical therapy and rehabilitation programs that include strengthening the appropriate muscles. 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.
Shoulder arthritis
It is a weight-bearing joint. Since there is no osteoarthritis, arthritis is not as common in the shoulder joint as it is in the knee joint. Calcification may occur in advanced stages of impingement syndrome, especially in those with an underlying inflammatory rheumatic disease such as Rheumatoid Arthritis, those who have had a traumatic fracture or dislocation of the shoulder. The treatment methods we mentioned before are also valid for arthritis, but exercise and shoulder protection techniques must be applied. In advanced patients where the pain cannot be controlled, surgical prosthesis applications can be performed.
As can be seen, the causes of shoulder pain are very diverse. Apart from the diseases we have mentioned, many diseases such as tumors, infections, inflammatory rheumatic diseases, and conditions related to bone circulation disorder can cause shoulder pain. Organ problems such as heart attack, lung infections, stomach problems can also manifest themselves with shoulder pain. Sometimes neck problems such as arthritis and hernia manifest themselves with shoulder pain. may want. 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. Since shoulder problems develop more frequently and rapidly in patients with diabetes, circulatory disorders, and kidney failure, it is recommended that these diseases be kept under control.
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