- Shoulder pain: description
- Shoulder pain: causes and possible diseases
- Shoulder Pain: When should you go to the doctor?
- Shoulder pain: What is the doctor doing?
- Shoulder pain: You can do that yourself
shoulder pain can be found almost in all age groups and in both sexes. Sometimes pain in the shoulder occurs acutely, for example while exercising or after lifting a heavy load. In addition, more and more people suffer from chronic shoulder pain, for example due to joint wear. Regardless of their cause, shoulder pain can significantly affect everyday life. Read all about the causes and treatment of shoulder pain here.
Causes and possible diseases
When should you go to the doctor?
What does the doctor?
You can do that yourself
Shoulder pain: description
Shoulder pain is discomfort in the shoulder region, which sometimes radiate into the upper arm or neck. In about 85 percent of cases, the cause of shoulder pain is not in the shoulder joint itself, but in the area close to the joints (periarticular cause). For example, injury or disease-related damage to muscles, tendons, joint capsule, and / or synovial fluid can cause shoulder pain. In addition, diseases of internal organs (gallstones, heart attack, etc.) may be accompanied by shoulder pain.
Physicians distinguish between acute and chronic shoulder pain:
- Acute shoulder pain Occur suddenly, for example after an accident or fall on the shoulder or the arm. Reason is for example a Bizepssehnenriss, a dislocated shoulder or a Oberarmbruch.
- Chronic shoulder pain develop creeping and can be very persistent. They are caused, for example, by joint wear (arthrosis), disc herniation in the cervical spine, or shoulder stiffness.
Shoulder pain: causes and possible diseases
The following diseases and injuries are common causes of shoulder pain:
- Chronic muscle tension: Chronic tension in the neck and shoulder muscles is often responsible for shoulder pain. Mostly affected are people in sitting occupations who work a lot with their head and torso bent forward (for example, on the computer). People who tend to contract cramps, tension-type headaches, or depression often develop tension-related neck and shoulder pain.
- Joint wear (shoulder joint osteoarthritis, osteoarthrosis): In shoulder joint osteoarthritis, the cartilaginous layer on the articular surfaces, which ensures smooth mobility of the shoulder joint, is becoming increasingly drained. The consequences are years of increasing shoulder pain when moving the shoulder and restricted mobility. The symptoms are especially noticeable when the arm is turned outside and when the arm is raised to shoulder height (or higher). Shoulder joint osteoarthritis, for example, may be caused by age-related wear, circulatory disorders of the humeral head, rotator cuff tear, frequent shoulder bulging, or rheumatoid arthritis. If no cause for the painful joint wear and tear can be found, physicians speak of idiopathic shoulder joint arthrosis.
- Bottleneck syndrome (impingement syndrome) of the shoulder: This refers to dysfunction of the shoulder due to a narrowing between Schulterdach- and humerus: irritation, calcification or wear of the tendons and bursa, the space in the shoulder joint is too narrow, so that the head of the humerus abuts the shoulder roof and the tendon in the joint is literally pinched, The result is shoulder pain, especially during exercise.
If the arm is raised sideways or backwards (for example, to pull something out of the back pocket of the trouser), the shoulder pain can even become very strong. Mostly they are felt on the outside of the upper arm. Later, nocturnal shoulder pain can occur.
The cause of the impingement syndrome is usually long-term stress on the shoulder, for example, in athletes who exercise many overhead movements with their arms like handball players, volleyball players and swimmers ("sportsman shoulder"). Even people who often have to raise their arms while working (such as painters, aircraft mechanics) often suffer from shoulder pain due to the impingement syndrome.
- Inflammation of the shoulder bursa (subacromial bursitis): Inflammation of the shoulder epithelium can also cause shoulder pain and movement restriction of the shoulder joint. It usually develops as part of the impingement syndrome.
- Rupture of the rotator cuff (rotator cuff tear): The rotator cuff is a powerful "mantle" of muscles and tendons, which holds the humeral head in the shoulder joint pan while allowing arm movements in all directions (rotation). One or more tendons of the rotator cuff can partially or completely tear, which manifests itself in sudden shoulder pain.
The rotator cuff tear is usually the final stage of the impingement syndrome.The tendons are already pre-damaged by the narrowing in the joint before they break. An acute rupture of the rotator cuff without damage to the tendons, however, is rare and can happen in a fall on the outstretched arm.
- Dislocated shoulder joint (shoulder luxation): Following a fall on the (outstretched) arm or a slap on the shoulder, a dislocated shoulder may also be responsible for the shoulder pain and limited mobility of the shoulder and arm. The head of the humerus has jumped out of the socket of the scapula.
The first time a shoulder is thrown out, ligaments or bone structures in the joint area may be injured. As a result, shoulder dislocation can occur again and again, even at relatively low loads. In addition, there are people whose shoulder joints are generally unstable and already in everyday movements jump out of the joint socket (habitual shoulder dislocation), recognizable by sudden einschießenden shoulder pain. Whatever the reason for frequent shoulder straightening - it favors the shoulder joint arthrosis.
- Upper arm fracture and collarbone fracture: Shoulder pain and painful movement restrictions of the shoulder can also be caused by a fracture of the upper arm near the shoulder (proximal humeral fracture) or by fractured collarbone (clavicle fracture). An upper arm fracture is usually the result of a fall on the outstretched arm or elbow. A collarbone fracture can also occur after a fall on the outstretched arm or a fall on the shoulder.
- Gelenkeinblutung: A fall or slap on the shoulder or (outstretched) arm can also cause hemorrhage in the shoulder joint, especially in people with blood clotting disorders. Symptoms include shoulder pain and limited mobility of the shoulder and arm.
- Biceps tendon rupture: A biceps tendon rupture could be the result of sudden, stabbing shoulder pain on the outside of the shoulder - the rupture of one of the biceps tendons that attach the arm flexor muscle to the shoulder area. Other signs that point to a biceps tendon rupture are a protrusion above the elbow and a weakness in the arm, trying to bend it.
- Frozen shoulder: Shoulder stiffness shrinks the shoulder joint capsule with painful movement restriction ("freezing" of the shoulder). The whole thing develops creeping over several phases and lasts one to three years. In most cases, the shoulder stiffness occurs in the wake of another shoulder disease or injury such as shoulder joint arthrosis, calcar shoulder, rotator cuff tearing or shoulder dislocation (secondary shoulder stiffness). Less common is the primary shoulder stiffness of unknown cause. The disease mainly occurs in women between 40 and 60 years. Even diabetics are at an increased risk for frozen shoulders.
- Calcarea (Tendinosis calcarea): In this case, lime crystals are deposited on the tendon attachments of the rotator cuff (presumably due to reduced blood flow). The Kalkdepots cause shoulder pain during arm movements (especially overhead movements). If lime crystals also accumulate in the bursa of the shoulder joint, the shoulder pain becomes even more pronounced and the arm movements further restricted. A calcarous shoulder develops preferably between the 30th and 50th year of age.
- Polymyalgia rheumatica (PMR): This inflammatory rheumatic disease triggers muscle pain, especially in the shoulder and pelvic girdles. Characteristic are shoulder pain, which increase during exercise and are particularly pronounced in the morning. Even pain in the neck, buttocks and in the thighs are possible. Polymyalgia rheumatica occurs preferentially in the over-60s, especially women.
- Bacterial shoulder arthritis (bacterial omarthritis): It is caused by bacteria that have either passed through the blood to the joint or directly infected the joint, such as in the context of a joint puncture (removal of synovial fluid by needle). The signs of bacterial shoulder arthritis are rapidly increasing, severe shoulder pain and fever. There may also be swelling and / or redness around the shoulder joint.
- fibromyalgia: This mostly chronic pain disorder is associated with persistent pain in many parts of the body, such as shoulder pain, neck pain, back pain, and leg pain. They are often accompanied by insomnia, tiredness, depressive moods and headaches or migraine. The fibromyalgia syndrome is quite common, especially in women.
- Shoulder-arm syndrome (cervicobrachial syndrome): Shoulder and arm syndrome causes neck and shoulder pain, which can radiate into the arm, hands, fingers and back of the head. Due to the pain, the head can move only limited. The complaints come from the middle and lower cervical spine, but the exact cause can be very different.
For example, painful muscle tension in the neck (for example due to frequent desk work or mental stress), cervical disc herniation, congenital spinal deformities, vertebral fractures, bacterial infections of the spine, osteoporosis or tumors on the spine are possible.
- Herniated disc in the cervical spine: Sudden electric shock in the shoulder, upper arm and neck indicate a disc herniation in the lower cervical spine. In addition, the pain often emanate in individual fingers and strengthen when turning the head.
- Shoulder Belt Compression Syndrome (Thoracic Outlet Syndrome): The term includes various rare complaints in the shoulder area. What they all have in common is that they are triggered by a narrowing of the blood vessel nerve cord leading to the arm in the upper thoracic region. The consequences are changing shoulder pain, tingling and numbness on the outside of the shoulder.
- Carpal Tunnel Syndrome: The carpal tunnel syndrome is based on damage to the middle arm nerve (median nerve) in the area of the carpal tunnel. This is a narrow pass at the wrist, formed by the forearm and carpal bones as well as ligaments, in which the middle arm nerve as well as the flexor tendons of the fingers run.
The nerve damage triggers pain as well as numbness or tingling sensation in the first three fingers (partly also in the ring finger), which occur at first only at night and in the early morning, later also during the day. The pain can also radiate into the forearm and into the shoulder. The cause of the carpal tunnel syndrome remains unclear in most cases. The disease mainly occurs in middle-aged women.
- Neuroborreliose: Lyme disease (Lyme disease) is a bacterial arthritis. It is caused by bacteria (Borrelia burgdorferi), which are transmitted from ticks to humans. The disease can also spread to the nervous system and is called neuroborreliosis. The sufferers sometimes develop shoulder pain.
- Shingles: This painful rash is caused by the same virus as the chicken pox (Variella zoster virus). He usually pulls himself belt-shaped and one-sided on the trunk from the spine forward. In addition to severe back pain, shingles can also cause shoulder pain.
- Heart attack: With sudden onset of pain in the left shoulder and behind the sternum, a heart attack could be the cause, especially when chest tightness, dyspnoea, and agony are added. However, these symptoms may also have other causes such as chest tightness (angina pectoris) or a panic attack. An immediate visit to a doctor is recommended in any case!
- gallbladder If the shoulder pain occurs on the right and the affected person simultaneously experiences increasing and decreasing colicky pain in the upper and middle abdomen, it is probably a biliary colic. Their cause is either a gall bladder infection or a gallstone, which is in the duct between the gallbladder and small intestine. If a biliary colic is suspected, a doctor should be consulted immediately!
- Lung tumor (pancoast tumor): The pancoast tumor is a rare form of lung tumor that develops at the tip of the lung. It can also cause shoulder pain in addition to back pain.
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Shoulder Pain: When should you go to the doctor?
A doctor's visit is advisable in the following cases of shoulder pain:
- very strong shoulder pain
- persistent shoulder pain
- recurrent shoulder pain
- Shoulder pain after a fall on the shoulder or arm or after an accident
- distinct movement restriction of shoulder and arm
- Radiating pain to other parts of the body, such as the neck or arm
- Accompanying symptoms such as numbness or tingling
In the following situations should As soon as possible a doctor will be alerted:
- very strong, undulating pain in the right shoulder and upper abdomen, often accompanied by nausea and vomiting (suspected biliary colic)
- severe pain in the right shoulder and upper abdomen with fever and chills (suspected gallbladder inflammation)
- Sudden left shoulder pain and pain behind the sternum, tightness in the chest, shortness of breath, fear of dying, often dizziness and / or nausea (suspected heart attack or angina pectoris)
- sudden shoulder pain and chest pain with dyspnea (suspected pulmonary embolism)
Sitting is exhausting. How to survive the day without pain, you can see here.
Shoulder pain: What is the doctor doing?
In case of shoulder pain, the doctor will first ask the patient in detail about the history of the patient (anamnesis). It is important, for example, when and how often the pain in the shoulder occur, whether they are noticeable only when moving the arm or shoulder or even at rest and whether next to the shoulder pain more discomfort such as loss of strength in the arm or numbness in the fingers occur.
On the basis of this information and a physical examination, the doctor can usually make assumptions about the possible cause of the shoulder pain. Further investigations bring clarity:
- Orthopedic examination: An orthopedic examination is part of shoulder pain. It may, for example, give evidence of arthrosis of the shoulder joint, impingement syndrome, calculus shoulder, fibromyalgia and fractures (clavicle or upper arm fracture).
- Neurological examination: The functional and conduction state of nerve tracts are examined if a disc herniation in the cervical spine possibly causes shoulder pain.
- Blood test: If neuroborreliosis or shingles could be behind the shoulder pain, then a blood sample from the patient can be tested for antibodies to the particular causative agent of the disease. If, on the other hand, a heart attack is suspected to be the cause of shoulder pain, the cardiac enzymes are determined in the blood sample. Also coagulation disorders as a possible cause of a joint bleeding can be determined by a blood analysis.
- X-ray examination: X-rays are taken when, for example, calculus shoulder, polymyalgia rheumatica or a dislocated shoulder joint come into question as the cause of the shoulder pain.
- Ultrasound: By means of ultrasound (sonography), for example, shoulder stiffness, biceps tendon rupture, gallbladder inflammation and gallstones can be identified as the cause of shoulder pain.
- Arthrocentesis: If the doctor suspects bacterial inflammation of the shoulder joint as a reason for the shoulder pain, he will use a thin needle to take a sample of the joint fluid (joint puncture) to create a bacterial culture: If actually bacteria can be cultured from the synovial fluid, this confirms the suspicion of the doctor,
- Spinal Tap: If neuroborreliosis is the cause of shoulder pain, a sample of cerebrospinal fluid (cerebrospinal fluid) is taken from the lumbar spine using a thin needle. In the laboratory, the sample is examined for Borrelia - the causative agent of neuroborreliosis.
- MRI: MRI (Magnetic Resonance Imaging, MRI) is indicated when shoulder pain may be triggered by a shoulder impingement syndrome, joint wear, rotator cuff tear, or shoulder girdle compression syndrome.
- Computed Tomography (CT): As a cause of shoulder pain, for example, a lung tumor (pancoast tumor), a shoulder-arm syndrome or a herniated disc in the cervical spine in question, this can be clarified by computer tomography.
- Electrocardiogram (ECG): A record of cardiac electrical activity reveals whether a heart attack may have caused the shoulder pain.
- Cardiac catheterization: Cardiac catheterization is also used for shoulder pain whenever a heart attack is the cause of the pain.
- bronchoscopy: An examination of the airways using a camera mounted on a thin tube or metal tube is used to diagnose a lung tumor as a possible cause of shoulder pain.
So the doctor can treat shoulder pain
If an injury or illness is behind the shoulder pain, the doctor will treat it accordingly. For example, he will restrain a dislocated shoulder joint (shoulder dislocation) using a lever technique and then rest in a bandage for some time. Then the shoulder is slowly getting used to exercise with physiotherapy exercises.
If a causal treatment of the shoulder pain is not possible, as in the case of joint wear (osteoarthritis), at least pain relief is sought with conservative measures. Thus, patients with shoulder osteoarthritis receive anti-inflammatory and analgesic medications (for example as tablets or as injections into the shoulder joint) as well as mostly physiotherapy (physiotherapy, heat applications, etc.). In very severe cases, ie severe shoulder pain due to severe advanced osteoarthritis, an artificial shoulder joint can be used.
Shoulder pain: You can do that yourself
- In acute or suddenly deteriorating shoulder pain (such as due to bursitis, biceps tendon rupture, Rotatorensehnenriss or Kalkschulter), is generally beneficial - for example in the form of ice cold packs or moist-cool compresses - cold. In chronic shoulder pain, however, usually heat is perceived as more pleasant.
- If the shoulder pain is due to muscle tension caused by frequent desk work, you should pay attention to an ergonomically designed workplace. It prevents uneven loading of the muscles in the shoulder, neck and back and thus painful muscle tension. Important factors include the right height of the table and chair, the right distance to the keyboard and palm rest in front of the keyboard.
- For shoulder-arm syndrome, the World Health Organization (WHO) strongly recommends acupuncture.Also massages, cupping and arnica ointments can relieve the shoulder pain of those affected.
- To prevent shoulder pain due to an "athlete's shoulder", one should build up the shoulder muscles specifically and evenly and regularly stretch the muscles and ligaments in the back of the shoulder. A sports doctor or experienced trainer will show you suitable exercises.
- Stretching exercises for the back of the shoulder are also advisable in combination with physiotherapy, if someone is already suffering from an "athlete's shoulder": Moderately severe shoulder pain can often be relieved (stronger shoulder pain is operated on). To prevent new discomfort, regular exercise exercises of the shoulder are recommended.
- Stress, tension and everyday worries are often responsible for shoulder pain. Here, relaxation procedures can provide the necessary relief of the muscles, tendons, ligaments and the soul. For example, progressive muscle relaxation according to Jacobson, autogenic training and yoga are suitable.
- Such relaxation procedures are often used in combination with alternative therapies such as acupuncture, magnetic therapy or biofeedback for the treatment of chronic shoulder pain.
- The basic treatment for chronic shoulder pain includes pain and anti-inflammatory therapy. Good results can be achieved, for example, with a combination of acupuncture, neural therapy, physical therapy (such as cold therapy) and short-term protection. You will be advised by an experienced therapist.
- If the shoulder pain is due to osteoarthritis, you can do a lot with the medicinal plants against the symptoms. In acute painful joint inflammation, for example, envelopes with Arnica flowers or arnica ointment (or gel) rubs are suitable. Circulation-promoting baths with hay flowers or rosemary oil (together with eucalyptus oil) can be used as a beneficial heat therapy in times of lesser discomfort (non-activated arthritis). Also recommended for osteoarthritis-related shoulder pain is an anti-inflammatory tea from devil's claw root.
- In chronic shoulder pain (for example, due to osteoarthritis or calculus shoulder) sufferers often get used to a restraint, which shorten the shoulder muscles over time. To counteract this, the muscles should be regularly stretched. Have a sports doctor or physiotherapist perform appropriate shoulder stretching exercises.
- For chronic shoulder pain, regular measures are generally recommended to improve the mobility of the shoulder and strengthen the muscles in the shoulder area - especially on the painful areas. For example, targeted exercises for the shoulder girdle, massages, Feldenkrais or physiotherapy are suitable. Especially with osteoarthritis the shoulder should be moved regularly despite pain. Otherwise it will become progressively stiffer with time.
- For the use of pain and anti-inflammatory drugs (such as diclofenac) shoulder pain You should talk to your doctor or pharmacist: he will advise you on the selection, dosage and duration of use of a suitable preparation.