Shoulder-Arm Pain

*Shoulder Anatomy and Shoulder Pain

The anatomy of the shoulder consists of the collarbone, scapula and arm bone in its structure and the soft tissues surrounding them. When soft tissues such as capsule, ligament, tendon, bursa or muscle are damaged, some pain is seen in the shoulder. Since the joint structure in the shoulder is quite mobile, shoulder pain is very common.

Shoulder pain can be caused by many reasons. Some of these may originate from the shoulder joint, while others may be pain radiating to the shoulder.

*A) Pain Caused by Shoulder Joint: We can examine the pain caused by overuse of the shoulder joint by dividing it into 5 groups.

-Impingement syndromes

-Dull Shoulder

-Shoulder Joint Arthritis

-Subacromial Bursitis

– Biceps Tendinitis and Tear

*1. Impingement Syndromes: The rotator cuff muscles in the shoulder have a very important place in shoulder movements. The rotatar cuff structure formed by the supraspinatus, infraspinatus, teres minor and subscapularis muscles are important formations that provide stabilization of the shoulder joint. This formation is cola; abduction, abduction, internal and external rotation. Impingement syndromes are caused by the inability of the rotatar cuff muscles to function. These are the most common types of shoulder pain. As it can affect people of all ages, shoulder pain can also be extremely stubborn.

*a) Rotatar Cuff Tendinitis: It is inflammation in the tendons of the muscles in the rotatar cuff structure. It is mostly seen in people who throw or throw something heavy. Tendinitis progresses insidiously in these people who make sudden movements. The pain comes to such a level that over time, the person cannot lie on his arm over time. In this disease, in which all movements of the arm are restricted, the painful curve symptom is positive.

In the inflammation of the rotatar cuff muscles, rest and the use of nonsteroidal anti-inflammatory drugs are very beneficial in the first place. If there is no improvement after a few weeks, the patient is provided with physiotherapy treatment. If this physiotherapy treatment provided with deep heaters does not work, local cortisone (Steroid) injection treatment should be applied to the area. However, it should be remembered not to make more than two injections and to limit the time between two injections to at least 3 weeks. After completing the acute period, it will be extremely beneficial to strengthen the rotatar cuff muscles with some exercises. Subacromial decompression can be tried in chronic cases.

*b) Calcific Tendinitis: Some calcifications are seen in this tendon inflammation, which is usually seen after the 4th decade. The tendons of the rotatar cuff muscles are inflamed and more calcium stones accumulate around it. As calcifications increase, the severity of pain will also increase. The frequency of attacks will increase and their duration will sometimes take months.

Rest and cold compression application are beneficial in treatment. Adding physiotherapy to advanced cases is extremely beneficial. As the event becomes chronic, controlled cortisone injection can be made. But be careful. Careless use of cortisone can cause the rotatar cuff area to become rigid and the ligaments there to break. Shoulder straps may be recommended to patients as movements will be restricted.

*c) Subacromial Impingement Syndrome: Subacromial impingement syndrome may occur between the head of the humerus and the acromion region of the scapula, as a result of weakness of the rotatar cuff muscles and calcification of the joint areas. In this syndrome, which is more common between the 2nd and 6th decades of life, there is edema, inflammation and wear in the tendons. Crepitation sounds may be heard when moving the joint. Nonsteroidal anti-inflammatory drugs, physiotherapy, cortisone injections are beneficial in the treatment. In advanced cases, surgical treatment methods may be considered.

*d) Rotatar Cuff Tear: As a result of excessive abduction of the shoulder, mostly in people over 50 years of age, tears may occur in the rotatar cuff region. Tendinitis treatment is applied in patients whose painful arc and arm drop test are frequently positive.

*2.Frozen Shoulder: This disease, in which both passive and active movements of the shoulder are restricted, usually occurs in middle-aged women when the arm is immobilized for a long time due to pain. Restriction of passive movements also distinguishes frozen shoulder from tendinitis cases. The joint capsule narrows and intra-articular adhesions increase over time. The patient experiences pain enough to wake up at night and need to change position. Frozen shoulder disease; It may develop secondary to diabetes, heart attack, lung diseases, stroke, thyroid gland disorders and some traumas.

The main purpose of frozen shoulder treatment is not to immobilize the joint. Although it is difficult, movement should be provided with some anesthesia methods. With the application of arthroscopy, intra-articular stretching and joint fluid-cartilage regeneration injections can be made.

*3. Shoulder Joint Arthritis: Calcific calcification of the shoulder joints.Although rheumatoid arthritis is more like the hand, it can also manifest itself in the shoulder. Joint movements are restricted and crepitation is taken in the shoulder joint from time to time. If fever is added to the disease, a septic arthritis picture will occur. In radiological imaging methods, the joint space is narrowed and some signs of wear may be seen.

Local injections, cold applications, painkillers and physiotherapy methods can be preferred for treatment. Treatments aimed at emptying the joint can also be tried in chronic cases.

*B) Reflected Shoulder Pain: Heart and lung diseases can cause reflected pain in the shoulder. It should be kept in mind that tumors involving the shoulder joint and muscles, metastases of surrounding organ cancers may cause pain in the shoulder.

Neck hernias, thoracic outlet syndrome, polymyalgia rheumatica, fibromyalgia and many systemic diseases can also cause reflected pain in the shoulder. Treatment for each should be directed towards the underlying cause.

*Arm Pain

Patients may face some pain in the deformation and inflammation of the joint and muscle tendons in the arm. The most common of these diseases are;

• Medial Epicondylitis ( Golfer’s Elbow)

• Lateral Epicondylitis (Tennis Elbow)

• It is Carpal Tunnel Syndrome.

*Medial Epicondylitis (Golfer’s Elbow): It is a type of tendinitis that occurs as a result of inflammation of the flexor muscle groups in the anterior part of the elbow, helping to bend the arm. Pain and tenderness in the inflamed area is inevitable. Medial epicondylitis is a disease that is mostly seen between the 2nd and 4th decades and is blamed for repetitive movements. It occurs as a result of overuse of the arms and wrists in people playing golf, tennis or baseball.

Pain on the inside of the elbow, stiffness, wrist weakness, numbness and tingling in the ring and little finger, difficulty while picking up items or shaking hands may indicate that we are at risk of medial epicondylitis.

Resting the wrist and applying cold to the elbow are extremely beneficial in the treatment. Using an epicondyle tape will work. The fastest treatment method is local cortisone (Steroid) injection. PRP (platelet rich plasma = platelet rich plasma) method, which has been useful in many tendinitis cases in recent years, can give successful results.

*Lateral Epicondylitis (Tennis Elbow): Unlike medial epicondylitis, it is the inflammation of the tendons on the outside of the elbow. Excessive strain of the extensor capri radialis brevis muscle with stretching and gripping movements will cause pain. This disease, which is caused by overuse and trauma, is mostly seen in tennis players.

The main reason for patients to refer to the physician is pain in the lateral epicondyle. The pain begins with physical activity and spreads from the elbow to the hand.

In treatment, activity reduction, painkillers, wearing brace, physiotherapy, cortisone injection, arthroscopic and surgical methods should be preferred according to the condition of the case.

*Carpal Tunnel Syndrome: It is a clinical picture caused by compression of the median nerve passing through the carpal tunnel area in the wrist. median nerve; Since it is responsible for the innervation of the thumb, index finger, middle and ring finger, compression of the nerve in the carpal tunnel will cause weakness, numbness and tingling in the hand. Weakness occurs in the hand muscles over time and the clothes buttons cannot be fastened.

Treatment varies according to the severity of pain and tingling in the wrist. Pain relievers and anti-inflammatory drugs can be used. If rest wristbands and other treatment methods do not work, the median nerve is relieved by surgical method.