It is defined as pain that is located in the shoulder region and appears with some movements of the arm.
Shoulder pain is one of the most frequent medical consultations, and it affects 25% of the population at some point in life. It is more common in people who are elderly or do heavy work.
MOST COMMON CAUSES OF SHOULDER PAIN
1. Periarticular causes (the most frequent):
· Rotator cuff tendonitis: can be related to shoulder overload (middle age, overloading professions, sports that require repetitive movement of the arm above the head such as: tennis, swimming and weightlifting), joint instability (young, hypermobile) or cuff degeneration with age (old age).
· Calcific tendinitis: is a process of unknown cause that gives rise to degenerative changes that occur as part of biological aging, in combination with movements, causing chronic inflammation with deposits of calcium and/or hydroxyapatite in the supraspinatus tendon in patients over thirty and forty years, more frequently in women than in men. The pain is of sudden onset, intense, in the anterosuperior part of the shoulder, preventing falling asleep if it is severe, it is relieved with immobilization of the arm.
· Rotator cuff tendon rupture: it can be partial or total, increasing its incidence and magnitude with age. It can occur after a trauma, generally in young people. Variable symptomatology: from asymptomatic to pain and limitation of mobility, with intense night pain being characteristic.
· Subacromyodeltoid bursitis: it is secondary to degeneration, calcification or trauma of the rotator cuff, especially of the supraspinatus tendon, to impingement of the bursa or to inflammatory processes of the glenohumeral joint. The pain is permanent (day and night), increasing with shoulder movement and radiating to the middle or upper third of the arm. Limited active and passive movements.
2. Joint causes:
· Inflammatory arthritis: rheumatoid arthritis
· Wear-and-tear arthritis: osteoarthritis. More common in older people (over 50 years of age). There are also other diseases that can cause osteoarthritis, such as Paget's disease, injuries or overuse of the shoulder due to sports or work. The entire joint is affected and causes loss of cartilage, bone damage, osteophyte formation and soft tissue inflammation Cartilage loses its ability to absorb shock and regenerate.
· Acromioclavicular arthritis: The most common symptoms are pain in the upper part of the shoulder, pain when crossing the arm in front of the body, for example to touch the other shoulder or when raising the arms above the head.
· Osteoarthritis: it is a degenerative process of the cartilage, increasing the friction between the
joint surfaces during movement.
· Risk factors: female gender, older age, obesity, diabetes, bone deformities, joint trauma, high-impact sports activities, and occupation (jobs that chronically strain the joint)
· The main symptom is pain, which worsens with physical exertion and is relieved by rest, and is usually worse at the end of the day and after long periods of immobilization. Stiffness is also common, especially after the patient wakes up, improving after the first half hour.
· Frozen shoulder (retractile or adhesive capsulitis)
· Risk factors: female gender, older age, trauma, surgery, diabetes, cardiorespiratory and cerebrovascular problems, thyroid disease, and hemiplegia.
· The characteristic symptoms are: pain (dull and continuous, predominantly at night), stiffness (greatly limiting arm movements such as combing one's hair) and decreased mobility of the arm, both active and passive.
· Dislocation/subluxation: The joint “pops out” forward, backward, or downward, completely or partially. It can occur as a result of a sports injury (football), direct trauma or a fall.
· Risk factors: male sex and age between 20 and 30 years.
· The characteristic symptoms are: visibly deformed or out of place shoulder, swelling, hematoma, very intense pain, inability to move the arm, weakness or tingling in both the arm and neck.
3. Extrinsic causes: pathologies that affect other organs and whose pain radiates to the shoulder (referred pain). Generally, in these cases the pain does not subside with immobilization.
If shoulder pain is sudden, intense, preferably in the left shoulder, and is accompanied by a tight feeling in the chest, it should be treated as a medical emergency.
Diagnosis
Most often, the diagnosis is straightforward. The doctor with the physical examination, makes sure that the pain comes only from the shoulder and with what movements it intensifies. The doctor's examination is usually sufficient for diagnosis, but sometimes it may be necessary to perform x-rays, ultrasounds or magnetic resonance imaging depending on the suspected diagnosis that the doctor has.
Treatment
At first, the joint should be kept at rest, without exertion, but it should never be immobilized with bandages or plaster casts. Medical treatment is based on three pillars: pharmacological treatment; injection with anesthetics and corticosteroids in the shoulder (infiltration); and rehabilitative treatment.
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