Reasons: The source of shoulder pain may be damage to the tendons of the rotator cuff, which consists of 4 small muscles (infraspinatus, supraspinatus, subscapular, polygon minor). These tendons surround the head of the humerus and are fused with the joint capsule. The supraspinatus tendon is most often damaged, for example when throwing a ball with the hand raised above the shoulder line.
But the pain can also be caused by an injury to another tendon in the shoulder area, the biceps tendon. They are easy to stretch even during such a trivial activity as reaching in the car for a handbag lying on the back seat.Tendon strains accumulate and can cause chronic shoulder pain and even tendon ruptures.
Treatment: When a rupture is complete, surgery is usually required. The most common procedures are arthroscopic. Their goal is to reconstruct damaged tendons. In the case of the biceps tendon, it is often cut, shortened and attached to the bone elsewhere. Partial injuries can be treated better and better by injecting tendons with platelet-rich plasma (PRP) under ultrasound control, not forgetting the very important role of properly conducted motor rehabilitation.
Reasons: A healthy sub-shoulder bursa resembles a glued foil bag, a sick one – a thickened bag filled with fluid. This change occurs when the rotator cuff is weakened or damaged. Then, when the arm is raised above the shoulder line, the bursa conflicts with the brachial process, and there is a painful narrowness (structures rub against each other).
Treatment: It consists in administering oral analgesic and anti-inflammatory drugs, injecting steroids directly into the bursa, one or a maximum of two times, preferably under ultrasound guidance. An important element of the treatment is rehabilitation, which restores proper mobility of the joint.
In some cases, surgical removal of the bursa is necessary. If the rotator cuff tendons are ruptured, surgery is required to reconstruct them with anchors.
Reasons: This is what is said about the thickening and stiffening of the articular capsule, which results in a significant limitation of the range of movements in the shoulder joint. Avoiding hand movements due to pain may contribute to the ‘freezing up’ of the shoulder.
Treatment: In the case of this ailment, a long rehabilitation conducted by an experienced therapist is necessary. The disease can last up to 1.5 years, so it is very important to explain to the patient what its course is, what symptoms may be disturbing.
If it is not implemented at the right time, adhesions form in the joint capsule and the subacromial space, which stiffen the joint. When this happens, they must be removed surgically.