SHOULDER PAIN – CAUSES AND TREATMENTS

Shoulder impingement is also known as bottleneck syndrome. This is because it usually involves painful inflammation in the shoulder joint that develops due to the constricted body conditions. Tendons and bursae become trapped in the shoulder joint, causing the discomfort. People who often have to work overhead or do sports that put a lot of strain on the shoulders often suffer from this shoulder condition. Many patients notice this particularly when they try to lift their arm overhead or move it to the side. Sometimes there is already a loss of strength in the affected arm.

Shoulder impingement is often caused by the bursa in the shoulder, which becomes thickened and inflamed due to overloading. This leads to inflammation of the tendons of the rotator cuff. As the disease progresses, the tendons can even tear. In addition to overloading the shoulder, bony protrusions and calcium deposits can also lead to shoulder impingement.

A precise diagnosis is important for accurate treatment. Thanks to state-of-the-art equipment, we can offer you all the necessary devices such as an MRI at the ETHIANUM. Once the diagnosis has been made, your specialist will advise you individually. Conservative therapies with physiotherapy, anti-inflammatory medication and injections can often bring about an improvement.

If the shoulder impingement does not improve after a few weeks of treatment with conservative therapies, a shoulder arthroscopy may be considered. During this minimally invasive procedure, the inflamed bursa can be carefully loosened or removed. Tears in the tendons of the rotator cuff can also be sutured. If bony protrusions are present, the ideal acromion shape is restored. You can find out more about shoulder arthroscopy here.

The rotator cuff is made up of four tendons. The associated muscles originate on the shoulder blade and join at their tendinous insertion on the humeral head. An injury to the rotator cuff can be caused by trauma, such as a sports accident, or by degeneration, i.e. signs of wear and tear. With age, the tendons become less well supplied with blood. The tendons can become frayed, tears can form and eventually they can also rupture. These injuries are clearly visible in an MRI scan.

It is not possible to heal the tendon without surgery. Physiotherapy can alleviate the pain. However, if the expected success does not materialise, arthroscopic surgery can help to alleviate the pain permanently. The rotator cuff can be permanently repaired using the latest special suturing techniques, so-called single or double-row suturing techniques. It may also be necessary to remove the inflamed bursa and a troublesome bone spur. This allows the humeral head to be re-centred in the joint. In the case of large tendon tears, partial closure (margin convergence), muscle transfer (latissimus dorsi transfer) or debridement alone may also be indicated.

Calcific shoulder refers to a degenerative change in which calcium deposits form in a tendon or tendon insertions of the rotator cuff. The larger these calcium deposits are in the shoulder, the more severe the pain. This occurs particularly when the arm is raised sideways to over 90 degrees. It helps to visualise these calcium deposits in the shoulder. Sometimes as soft as toothpaste, sometimes as hard as chalk, they sit in your shoulder. In any case, the calcium deposits lead to a narrowing of the shoulder. This favours inflammation of the bursa. It swells or sticks together permanently. The extent and stage of calcified shoulder can be diagnosed very clearly using an ultrasound or X-ray image. MRI images help the specialist to recognise the accompanying symptoms more precisely or to define the progress of the calcific shoulder.

Anti-inflammatory injections are administered as the first step in the treatment of a calcific shoulder. These are particularly helpful against acute shoulder pain. Extracorporeal shock wave therapies can provide support. These help to break up calcium deposits. However, they do not loosen a stuck bursa, which can repeatedly cause pain in the shoulder. Depending on the individual diagnosis, arthroscopic surgery is recommended. This minimally invasive procedure involves removing and flushing out existing calcium deposits. The bursa can also be loosened or removed. And finally, damage to the tendons can be corrected immediately.

The long biceps tendon is often responsible for pain in the shoulder. This is because this long tendon attaches to the joint lip at the upper edge of the joint socket, initially running horizontally before then running downwards at a 90 degree angle and along the outside of the arm, where it merges into the muscle. It allows the arm to be bent at the elbow and moved forwards. In doing so, it is exposed to great mechanical stress. It can become inflamed, tear in parts or even tear completely. However, it is also possible that the pain is caused by instability of the tendon at its tendon anchor (SLAP lesion), in the joint or outside the joint in the bone groove.

The correct cause can be determined by a detailed examination including sonography and MRI. Depending on the findings, injections and targeted treatment of the inflammation can help. If the pain hardly changes, a minimally invasive procedure is recommended. In this procedure, the tendon can be stabilised (SLAP repair) or repositioned (tenodesis).

Frozen shoulder syndrome is a stiff shoulder. Frozen shoulder is triggered by inflammation of the capsule. As it progresses, the joint capsule of the shoulder shrinks, which is accompanied by an increasing restriction of movement. Doctors differentiate between two forms of frozen shoulder. There is the primary frozen shoulder. There is no recognisable trigger for this form. It occurs more frequently in patients with hormonal changes, hyperthyroidism or metabolic diseases such as type 1 and 2 diabetes. The secondary form is a secondary disease. For example, because the shoulder has been immobilised due to other injuries or because a tendon tear has already occurred.

A frozen shoulder goes through three phases. In the first phase, the freezing phase, the shoulder joint stiffens. This phase is usually accompanied by severe pain. A detailed clinical examination helps to establish the diagnosis. If outward rotation of the arm, lateral lifting or inward rotation is restricted and very painful, the diagnosis of frozen shoulder is obvious. The second phase is known as the plateau phase. In this phase, the pain subsides, but the shoulder stiffens and can hardly be moved. The third phase of frozen shoulder is the thawing phase. The pain subsides and the shoulder slowly regains its movement.

Treating frozen shoulder requires sensitivity for each phase of the disease. In the first phase, pain relief with muscle-relaxing or anti-inflammatory medication or injections takes centre stage. Cortisone therapy may be necessary. Later on, medication, injections and physiotherapy can be very helpful. Arthroscopic surgery is considered if the recovery process stagnates or the patient’s quality of life is severely restricted. In a minimally invasive procedure, the orthopaedic specialist will release the capsule and treat tendon tears if necessary.

Many people are familiar with a dislocated shoulder. It is painful enough when it has to be set under medication or anaesthetic. However, a repeatedly dislocated shoulder leads to an unstable shoulder in the long term. An unstable shoulder can dislocate with the slightest movement, sometimes even during sleep. This phenomenon often begins at a young age.

A distinction is made between congenital (habitual) and traumatic shoulder dislocation. Congenital shoulder dislocation is usually treated conservatively. Physiotherapy with muscle strengthening can help to stabilise the shoulder. Traumatic shoulder dislocation caused by an accident can result in damage to the joint capsule. The joint capsule can tear in or out completely and cartilage and bone can be damaged.

There are numerous treatment methods for an unstable shoulder. As part of a minimally invasive arthroscopy, the joint lip can be fixed (Bankart repair) and the capsule-ligament structure restored. In the case of more extensive damage, bony operations with restoration of the bone damage are used (Latarjet-Bristow, J-crest chip). Physiotherapeutic measures are usually taken after an operation.

Shoulder osteoarthritis can show numerous symptoms: pain, inflammation, increasing restriction of movement or even joint stiffness. These can all be signs of cartilage damage in the shoulder or shoulder osteoarthritis. Osteoarthritis of the shoulder can be caused by overloading, injuries, accidents or even bacterial infections. The treatment of shoulder osteoarthritis depends on the stage it is at. X-ray, CT and MRI images simplify the diagnosis. Based on these, treatment is determined individually. This can involve several phases and different methods.

At the ETHIANUM in Heidelberg, we offer you treatment using the Autocart method as an innovative method. This is particularly suitable for minor cartilage damage. In other words, it is particularly suitable for clients with incipient osteoarthritis or cartilage damage caused by an accident. Here, the defect is repaired by the body’s own cartilage cells.

Subsequently, the body’s own stem cell therapy, hyaluronic acid injections and physiotherapy support recovery. The use of joint prostheses can also be significantly delayed or avoided altogether. In the case of more severe cartilage damage with corresponding pain and restricted movement, partial or complete joint replacement should be considered.