Causes of shoulder pain

It should be remembered that pain from the neck can radiate along C5 to the deltoid muscle area, along C6, C7 and C8 to the upper edge of the scapula, and along the phrenic nerve, through C3 to a limited area in the shoulder area.

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Tendon Cuff Tears (Supraspinatus Tendon Tears)

The supraspinatus tendon, and sometimes the adjacent muscles - the subscapularis and infraspinatus - can be torn by a sudden jolt (for example, during a fall). A partial rupture is accompanied by a painful "arch syndrome". In case of a complete rupture, shoulder abduction is limited to 45-60°, provided the scapula is rotated. If the arm is passively abducted by more than 90°, the deltoid muscle begins to participate in the abduction, which makes this possible. The arm moves passively in full. Pain is felt in the apex of the scapula and in the upper part of the arm. Palpation tenderness under the acromial process is also noted. Arthrography reveals a connection between the capsule of the shoulder joint and the subacromial bursa. Treatment: the integrity of the tendon can be restored only in young people; in older patients this is not so successful.

Habitual dislocation of the shoulder

Usually, the dislocation is anterior and is the result of trauma, even minor. Such a dislocation can also be caused by abduction and external rotation (for example, when laying the patient on a couch). The capsule of the shoulder joint is attached to the neck of the scapula, but is distant from the glenoid labrum. Sometimes there is a posterolateral "tooth" in the head of the humerus, which can be seen on an X-ray taken with the arm rotated medially. Treatment: Bankart operation (the joint capsule is sutured to the surface of the glenoid fossa) or Putti-Piatt, which involves tightening and shortening the subcapsular tendon. Less common is a posterior dislocation, in which the joint capsule is torn from the posterior surface of the neck of the scapula, the tooth of the head of the humerus is located superomedially. Such a dislocation of the shoulder joint is caused by abduction of the shoulder and its medial rotation. Treatment: tightening the tendon of the infraspinatus muscle.

Painful "arch syndrome"

In this case, shoulder pain occurs when the shoulder is abducted in the range of 45-160°. The causes of shoulder pain when abducting the shoulder may be the following.

1. Tendinitis or partial rupture of the supraspinatus tendon. Pain can be reproduced by applying pressure to the patient's partially abducted arm. Treatment includes active shoulder range of motion; anti-inflammatory medications such as naproxen 250 mg orally every 8 hours; and injection of steroids such as triamcinolone acetonide (40 mg) and local anesthetics into the subacromial bursa.
2. Subacromial bursitis causes maximum shoulder pain with arm abduction in the range of 30-60°. Treatment: anti-inflammatory drugs and injection of corticosteroids into the subacromial bursa.
3. Calcification of the rotator cuff (usually the supraspinatus tendon) can cause painful "arch syndrome" and the shoulder pain can be so severe that the affected shoulder cannot be examined. X-rays show calcification of the rotator cuff. Miraculous relief from pain can be obtained with a corticosteroid injection into the subacromial bursa.
4. A sharp blow to the area below the acromial process. Typically, shoulder pain increases with shoulder abduction in the range of 60-180°. NSAIDs, local glucocorticoid injections, and physical therapy may provide relief.
5. Acromnoclavicular arthritis. In this case, pain in the shoulder occurs when the arm is abducted in the range of 120-180°. If the course is persistent, excision of the lateral part of the clavicle should be considered.

Long head biceps tendinitis

Shoulder pain is felt in the anterior part of the shoulder joint and is usually aggravated by forced contraction of the biceps muscle. NSAIDs are used in treatment. Pain relief also occurs after glucocorticoid injections into the tendon, but there is a risk of tendon rupture.

Rupture of the long head of the biceps brachii

Discomfort appears after lifting something heavy or a strong push, as if "something breaks". When bending the arm at the elbow, a spherical formation appears in the area of the biceps muscle. If the function of the biceps muscle is preserved, surgical intervention is rarely used.

Periarthritis of the shoulder ("frozen shoulder")

In older people, this disease may occur after a minor injury. Shoulder pain can be quite severe. There is a sharp decrease in both passive and active mobility in the shoulder joint. Abduction of the arm by 90° is impossible. Treatment involves NSAIDs, intra-articular administration of glucocorticoids, physiotherapy procedures aimed at activating movements in the shoulder joint, and manipulative effects. Treatment can last 2-3 years.