Shoulder joint pain
Pain in the shoulder joint is a specific painful sensation caused by damage to the head of the shoulder, the articular cavity of the scapula, cartilage, capsule, surrounding soft tissues and nearby anatomical formations. It can be acute or blunt, permanent or transient, aching, pulling, bursting, drilling, etc. It often intensifies with movements. It may depend on the weather and time of day. To determine the cause of pain, radiography, CT, MRI, ultrasound, arthroscopy, joint puncture, laboratory tests are used. Until the diagnosis is clarified, rest, immobilization of the limb, taking painkillers are indicated.
Joint pain is the result of falling on the arm, shoulder dislocation, a sharp jerk or blow. Occur with household, street and sports injuries. They are formed less frequently in industrial accidents, falls from heights, road accidents. There is swelling, bruising and abrasions are possible.
Bruising of the shoulder joint develops upon impact. The pain at the time of injury is moderate, it subsides quickly enough. The swelling is moderate or insignificant, the function of the limb is preserved, limited due to pain. Dislocation is formed when falling on a straight arm or a blow. There is a very sharp pain in combination with a click. The high intensity of pain persists until the moment of reduction. The shoulder joint is deformed, a sinking is determined in place of the shoulder head. Movement is impossible.
A fracture of the head or neck of the shoulder, the detachment of a large tubercle occur when hitting, falling on the shoulder. Intense explosive pain is typical, sometimes bone crunching is heard. The pain does not weaken over time. To avoid increasing pain, the patient holds the sick hand with a healthy one. Pronounced edema, diffuse cyanosis, possible deformation, pathological mobility, crepitation are revealed. Movements are severely restricted.
Tears and tears of the rotator cuff of the shoulder are accompanied by sharp pain radiating into the neck, forearm, hand. Depending on which muscle is affected, the pain increases when trying to lift, pull or rotate the arm. If movement is impossible, this indicates a complete rupture of the tendon, if possible, but sharply painful – a partial one.
Soft tissue diseases
Damage to the Bankart occurs in the long-term period after anterior dislocations of the shoulder, characterized by severe twitching, burning or cutting pain when trying to pull the arm back in combination with a feeling of instability of the joint, conscious restriction of movements due to fear of repeated dislocation.
Tendopathies develop in other diseases of the shoulder joint, after injuries. Initially, they are characterized by short-term pain at the peak of the load. Then aching or pulling pains begin to bother with moderate and minor loads, at rest, at night. With calcifying tendinosis, a crunch is heard during movements.
With adhesive capsulitis, the pain syndrome appears without connection with external causes, gradually increases over 2-4 weeks, increases at night, in a lying position on a sore shoulder. The pain is chronic, constant, exhausting, preventing the performance of any movements, including passive ones. Pain gradually decreases and disappears within 10-14 months simultaneously with progressive limitation of the volume of movements.
Acute myalgias of the deltoid muscle develop against the background of trauma, infection, significant physical exertion, exogenous intoxication. Accompanied by local aching, pressing, bursting pain. The pain increases sharply with muscle tension, forcing the patient to find a comfortable position of the limb.
Degenerative joint lesions
Osteoarthritis of the shoulder joint is characterized by chronic diffuse pain with predominant localization in the depth of the joint. In the beginning, the pains are periodic, non-intense, dull, aching, pulling, appear at the beginning of movements, after a significant load. Subsequently, the pain sensations become more prolonged, sometimes – burning, twitching, shingling. They remain at rest, occur at night, are accompanied by a crunch, combined with an increasing restriction of mobility.
With osteoarthritis of the clavicular-acromial joint, pain is felt above the shoulder joint, in the distal part of the upper arm. The pain sensations are chronic, have the same dynamics as with arthrosis of the shoulder joint, but differ in a clear localization and a more superficial location, they increase when pressing on the acromial end of the clavicle, bringing the bent shoulder to the body.
Synovial chondromatosis occurs after injuries or without external causes, characterized by undulating dull pain of moderate intensity, often intensifying at night. There may be short-term severe shooting pains and sudden restrictions of movements due to the blockage of the joint by chondromic bodies.
Aseptic necrosis of the shoulder head (Hass disease) is rare, at the initial stage it is manifested by intermittent dull pulling or pressing pains during movements. For about a year, the duration and intensity of pain gradually increase, then pain sensations appear at rest, the function of the limb is limited.
Inflammation of solid structures
With arthritis of the shoulder joint, the pain is diffuse, dull, pulling, occurs after an injury, against the background of an infectious or rheumatic disease. At first, the pain is weak, unstable, increasing in the evening, after physical exertion. Then – long, medium intensity, remaining at rest. When infected, the pain becomes sharp, jerking, shooting, pulsating, combined with symptoms of general intoxication.
Hematogenous osteomyelitis usually occurs in childhood, affects the upper parts of the humerus, manifests itself with local bursting, tearing, drilling pain, which quickly intensifies to unbearable, combined with symptoms of intoxication, chills, a sharp deterioration in the general condition. In post-traumatic osteomyelitis, clinical manifestations are similar, but develop more slowly, occur against the background of open fractures.
Inflammatory diseases of soft tissues
Acute aseptic bursitis of the shoulder joint is manifested by moderately pronounced bursting diffuse dull pain, edema, minor hyperemia. During the transition to the chronic form, the pain decreases, with the development of infectious bursitis, it increases, becomes acute, twitching, pulsating, deprives of night sleep, combined with an increase in edema, hyperemia, an increase in body temperature, signs of general intoxication.
Tendinitis is formed after tears of the rotator cuff or against the background of overloads. The patient is concerned about pain when trying to move the arm to the side (defeat of the supraspinatus muscle), turn the shoulder outward (inflammation of the subcostal or small round muscle), bring the arm behind the back (tendinitis of the scapular muscle). Moderate or non-intense pain, aching or pulling.
Synovitis is a complication of injuries and other diseases of the joint, characterized by a dull bursting pain, gradually increasing over several days, correlating with an increase in the volume of the joint (the amount of fluid). With suppuration of effusion, the pain is acute, twitching, intense, exhausting, accompanied by disorders of the general condition.
Autoimmune pathologies
In rheumatoid arthritis, both joints are often involved in the process. For a mild form, intermittent mild pains of a pulling or pressing nature, morning stiffness are typical. Moderate activity of the autoimmune process is manifested by periodic prolonged dull pressing, aching or bursting pain sensations at rest and during movements, prolonged stiffness. In severe form, there is a diffuse wave-like intense pain, increasing at night, constant stiffness, persistent synovitis, weakness, hyperthermia.
With systemic lupus erythematosus, pain in the shoulder joints is more often symmetrical, although unilateral damage is possible. In mild cases, the painful sensations are dull, local, pulling or aching, quickly disappear. In severe cases, the pain is progressive, undulating, diffuse, disturbing night sleep, combined with edema, redness, synovitis. Lesions of the skin and internal organs are noted.
Rheumatism is manifested by severe, but short-term migrating pains in the shoulder and other joints, which occur 1-2 weeks after an acute infectious disease. Variability is typical – pains can be pulsating, burning, baking or dull, pressing, pulling. They persist for several days, then disappear or abruptly weaken.
Tumors
Benign tumors (non-ossifying fibroids, osteochondromes, chondromes) occur for a long time, with little symptoms, and are characterized by intermittent, non-intense local pain that persists at approximately the same level for many months or years. With an increase in neoplasia, synovitis occurs, a solid seal is felt in the joint area.
With malignant neoplasia, pain sensations are initially dull, indeterminate, fuzzy, dim, sometimes intensified at night. The pain progresses rapidly, becoming diffuse, sharp, bursting, baking, tugging, cutting. Accompanied by edema, deformation, violation of the general condition. At the advanced stage, the pain is unbearable, exhausting, relieved only by narcotic analgesics.
Neurological causes
Pain in the shoulder joint is often provoked by pathology of the cervical spine. Typical are “lumbago” – sudden sharp pain sensations that often radiate throughout the arm, from the shoulder to the fingertips. There may be non-intense pain spreading from the neck to the shoulder. A distinctive feature of the pain syndrome is the preservation of the volume of movements. Possible neurological causes of pain associated with spinal column injury:
osteochondrosis;
herniated disc;
spondylitis;
spondyloarthrosis;
deforming spondylosis;
spinal stenosis.
Pain in the shoulder joint, upper arm, upper shoulder may be caused by upper plexitis (Duchenne-Erb paralysis). There is unilateral shooting pain with pressure on the supra- and subclavian region, restriction of movements, sensitivity disorders.
Other reasons
In diseases of the internal organs, there are reflected pains in the shoulder joint due to the presence of myofascial trigger points. The cause of pain sensations are the following pathologies:
cardiovascular system: coronary artery disease, pericarditis;
chest organs: pneumonia, pleurisy, Mediastinal tumors, Pancostal cancer;
abdominal organs: gastric ulcer and duodenal ulcer, cholecystitis, cholangitis, hepatitis, cirrhosis, fatty hepatosis.
Pain syndrome in the shoulder joint sometimes occurs with depression, some mental disorders. In diabetes mellitus, it has an organic basis due to the increased likelihood of developing tendinitis, capsulitis, and other minor rheumatological diseases. It can be provoked by taking anabolic steroids (due to necrosis of the clavicle and acromial process), corticosteroid drugs (as a result of necrosis of the shoulder head).
Diagnostics
Traumatic injuries are managed by traumatologists, with pain of non-traumatic genesis, patients turn to rheumatologists or orthopedists. Specialists collect complaints, conduct an external examination, establish the time and circumstances of the appearance, the dynamics of the development of symptoms, their dependence on external circumstances. The examination may include the following methods:
Radiography. It is performed in one or two projections. The presence of violations is indicated by a change in the contours of the head of the shoulder and the articular cavity, a decrease in the size of the articular gap, areas of rarefaction in the thickness of bone tissue, marginal defects, osteophytes.
Ultrasound examination. When assessing the condition of the periarticular soft tissues, it detects hemorrhages, signs of inflammation, degeneration, foci of calcification. Sonography visualizes free intra-articular bodies, fluid in the joint, often allows you to determine the cause of pain syndrome.
CT and MRI. They are prescribed at the final stage of diagnostic search with unclear data from other methods, to clarify treatment tactics. They allow to determine with high accuracy the localization, prevalence and nature of pathological changes of traumatic, inflammatory, and tumor genesis.
Puncture of the joint. It is performed in the presence of signs of synovitis. The resulting liquid is sent for microbiological or cytological examination, studied using immunological methods.
Synovial membrane biopsy. It is carried out for rheumatological diseases, specific arthritis, tumor processes for subsequent histological examination.
Arthroscopy. It is carried out for visual inspection of joint elements, biopsy sampling. When determining pathology, diagnostic measures are supplemented with therapeutic ones (for example, removal of free-lying bodies).
Laboratory tests. In rheumatic pathology, specific markers of various diseases are identified. In inflammatory processes, an increase in ESR, leukocytosis with a shift to the left is confirmed. In oncological lesions, the severity of anemia, the degree of organ dysfunction and metabolic disorders are assessed.
