Priorities must be ranked when choosing any of the methods in both the diagnosis and treatment of shoulder diseases. This is called ALGORITHM. General principle in treatment; is to reconsider the accuracy of the patient's diagnosis and to be absolutely sure of it. Hippocrates, who is considered the father of medicine, should never forget the principle of "The patient should not be harmed first while treating the patient" when deciding on treatment. Treatments should be chosen by taking the socio-economic status of the patient into consideration. Treatment results should be closely observed and the reasons for failure should be emphasized. Here, everything is re-examined, from the patient's failure to fully comply with the doctor's recommendations, the inadequacy of the recommended treatment, the presence of another disease in the patient, the drugs used not being reported to the doctor, the side effects of the drugs, their adverse interactions, the progressive and destructive nature of the disease, and even the incorrect diagnosis. should be passed. According to contemporary medical principles, various evaluation criteria are used at each stage of the disease. Various survey forms are filled out for problems related to daily life and parameters reflecting adaptation to it. Thus, the course of the disease can be carefully monitored in patients. MEDICATION TREATMENT Various medications are used for shoulder pain. We can list these drugs as follows. Painkillers, anti-inflammatory rheumatic drugs, and muscle relaxants are in the first place. Starting and stopping these, adjusting doses, and monitoring side effects are matters that must be under the supervision of a physician. Indiscriminate use of drugs is extremely wrong. There are various ways to administer medication to patients. Medicines can be used orally, as a suppository or as an injection into the hip, or they can be applied externally or even by local injection into the joint. Local injections occupy an important place in the treatment of shoulder pain. They need to be done in the right place, in the right amount and at the right intervals. Cortisone, cartilage regenerators and local anesthetics are used as local injections into the shoulder joint. If the injection into the shoulder is entered from the front part, if the joint is entered from the outer side of the shoulder, this time it is made into the tendon or into a small sac in the shoulder. It is more common to perform intratendinous surgery. g This method is generally preferred in extra-articular rheumatism. PHYSICAL THERAPY One of the most effective treatment methods in the treatment of patients with shoulder pain is "physical therapy" applications. Which physical therapy method is preferred may vary depending on the stages of the disease. In the acute phase; While pain-relieving currents and cold applications are preferred, in later periods, applications called deep heaters that can affect deep areas are at the forefront. Deep heaters include applications such as shortwave diathermy or radar and ultrasound. Great results can be obtained with ultrasound applications in shoulder problems where adhesions occur. In addition, some rehabilitation tools are used to mobilize the shoulder joint. These are rehabilitation tools such as shoulder wheel, climbing ladder, roller lift. SURGICAL INTERVENTION When non-surgical treatment options are exhausted for those suffering from shoulder pain, surgical interventions for the shoulder come to the fore. Patients who are decided to undergo surgery should be given detailed information about the operation to be performed. Patients with high postoperative expectations may be disappointed when they encounter results that fall short of their expectations. To avoid such situations, it is essential to have pre-operative interviews that will clearly reveal the problem. In order to consolidate the results obtained from the operation, further information should be given in the following periods after the surgery. Daily life becomes easier if exercises are performed that gradually increase the range of motion. A maximum of 1 year should be waited to decide on the adequacy of the results obtained from non-surgical treatments. Sometimes this period is shorter and an operation decision can be made after 3 months. The main reasons for early decision to have surgery are as follows. The fact that people with shoulder problems are relatively young and in a profession that uses active arm strength makes it easier to decide on surgery. In addition, people who do not have any general health problems, strictly follow the doctor's recommendations and willingly do the exercises that need to be done after the operation can be invited to surgery earlier. Positive and sufficient results can sometimes be obtained from arthroscopic interventions, also called closed or bloodless surgery, before surgery. This process During this period, the shoulder joint can be seen in detail and the diagnosis is confirmed. Minor surgical interventions performed at the same time can easily solve primary problems. In open operations where a joint will be performed, operations such as cutting the problematic area, freeing a stuck tendon, repairing a torn part, and relieving an adherent area can be performed. Rarely, it may be possible to replace the shoulder joint with an artificial joint. When deciding which of these to do, factors such as the patient's condition, age, and stage of the disease will come to the fore. Undoubtedly, surgery is the last option. ALTERNATIVE TREATMENTS For those with shoulder problems, yoga, in short, relaxing the whole body, can provide significant benefits in neck and shoulder pain. It should not be forgotten that these treatment methods can only yield results when applied for a long time. Those with shoulder pain can benefit from light sports, especially swimming. In addition to the sea, the sun is also useful for shoulder problems. On the other hand, hot springs and healing muds also have curative properties for shoulder diseases. However, those who undergo treatment should not be in the acute phase of the disease. In order for the spa to provide effective and permanent results, it must be done seasonally and in sufficient numbers. The ideal number is 21 baths, but for those with limited time, this can be compressed into two weeks, once a day in the first week and twice a day in the second week. Patient Schools "Patient Schools" are places where patients are informed about everything related to their illness. It should not be forgotten that not knowing even a small detail about the disease will further increase existing problems. It is clear that the physician's relationship with the patient alone during the examination will not be sufficient. For this, patient schools where more time will be allocated to patients are required. In these courses; 4 lessons are given once a week. Lesson 1: Causes of shoulder pain, anatomy of the shoulder, diagnostic methods in shoulder diseases. Lesson 2: Treatment methods in shoulder diseases, daily life problems and solutions. Lesson 3: Shoulder exercises. Lesson 4: Summarizing what has been explained, holding a symbolic exam and issuing participation certificates. Exercise brochures or CDs for patients who cannot attend subsequent exercise classes i can be given. Of course, it is better for patients to come to these exercises regularly. In this way, patients experiencing the same problem will be able to influence each other positively. The team spirit and motivation provided accelerate the speed of recovery. At later intervals, those who attended the courses should be called again to refresh the information and reinforce the exercises.
Read: 0
