Shoulder Pain

Signs of wear on the shoulder are caused by chronic overloading and imbalances in the muscles.

Activities that are performed above the head, such as painters or handball or tennis players, cause painful shoulder wear.

This mainly affects the movements in the shoulder, causing painful inflammation and swelling. With impingement syndrome (constriction syndrome) there is a narrowing between the shoulder roof and the humerus. The tendon running there and the bursa are constantly exposed to irritation, which causes inflammation.

Cracks, sticking and shrinkage of the joint capsule in the area of ​​the soft tissue can occur in the shoulder, which leads to shoulder pain.

Joint wear (arthrosis) can be another cause of shoulder pain. The osteoarthritis of the shoulder joint will be favored by overexertion (such as years of strength training), narrowing of the joint space in old age, rheumatic diseases (e.g. rheumatoid arthritis) or circulatory disorders.

Damage or tearing of the muscles or tendons of the rotator cuff (rotator cuff rupture) leads to pain and can severely restrict the mobility of the arm.

Painful inflammation of the shoulder joint (periarthritis humeroscapularis) can lead to shoulder stiffness (capsulitis adhaesiva) or the so-called "frozen shoulder" due to lack of exercise.

The so-called calcareous shoulder (calcific tendinitis) refers to the deposition of calcium crystals in the rotator tendon due to recurring minor tendon injuries or local tendon disorders. The limestone shoulder causes excruciating pain, especially at night.

Accidents, breaks and injuries in the shoulder area can also lead to severe pain symptoms. A collarbone fracture (clavicle fracture) or injuries in the area of ​​the humerus (e.g. humeral head fracture) are common. Dislocations of the shoulder joint (shoulder joint dislocations) can cause severe pain and have various causes. The shoulder often dislocates, resulting in a chronically unstable shoulder, which should be treated surgically as part of a mirror examination.

Other causes of shoulder pain are tendinitis or bursitis (subacromial bursitis). These arise primarily from mechanical overload, infections, rheumatic diseases and gout. Tension and hardening of the shoulder muscles due to incorrect posture and stress, for example due to sitting for too long, puts strain on the shoulder, back and neck and can lead to pain. In addition, shoulder pain can also come from the spine, caused by inflammation of the nerves or nerve injuries, by rheumatological diseases and also by internal diseases (e.g. heart attack, biliary colic, lung tumors, etc.).

Since the causes of shoulder pain are very different, different symptoms can also be in the foreground.

Shoulder pain (e.g. due to impingement syndrome or rotator cuff injury) often affects the mobility of the arm.

The arm can often hardly be lifted due to the pain and many everyday activities are difficult. The shoulder pain occurs particularly often when the arm is spread sideways (abduction) and is particularly severe at an angle of approximately 60 to 120 degrees, which is why doctors and therapists also speak of the "painful arc".

Nocturnal shoulder pain is also typical when you unconsciously lie on the painful side or turn there while you sleep. If the pain originates from the cervical spine, there is often radiating pain from the shoulder to the arms and hands.

With tendinitis, shoulder pain can be triggered by very different arm and shoulder movements, depending on which muscle tendon is affected.

There are many different causes of pain in the front of the shoulder. The front rotator cuff, the biceps tendon, part of the joint capsule, the shoulder corner joint (acromio-clavicular joint) and various soft-tissue structures such as bursa or tendons are located here. Alternatively, anterior shoulder pain can develop, i.e. through damage to structures that are not located directly on the front shoulder.

Firstly, front shoulder pain can result from inflammation or pinching of the joint capsule. Furthermore, there are bursa in the front area of ​​the shoulder, which ensure smooth gliding of the muscles. Inflammation of these bursitis in the corresponding area can cause anterior shoulder pain. As in the knee or hip joint, osteoarthritis (wear) can occur in the shoulder. Osteoarthritis can affect both the actual shoulder joint between the shoulder blade and the humerus (humero-glenoidal joint), as well as smaller joints such as between the clavicle and the shoulder blade (acromio-clavicular joint). In this case, the pain projects onto the front shoulder area. Such a degenerative change is always a gradual process, with the pain initially only occurring depending on the load. Degenerative changes in the soft tissues such as muscle or tendon tears can also be the cause. The biceps tendon is particularly often affected. Dislocating the shoulder joint (dislocation) can also cause anterior shoulder pain, since the most common direction of dislocation is by far down.

In the case of back shoulder pain, the pain is concentrated primarily on the back area of ​​the shoulder joint. Here, too, the pain can be caused by more distant structures and can only be passed on to the rear shoulder joint.

The cause is usually a blockage of the vertebrae of the cervical spine, more rarely the thoracic spine. The pain, which occurs immediately, radiates from the cervical spine to the back shoulder and is caused by the vertebral joints of two adjacent vertebral bodies becoming caught. This often happens due to jerky movements from sleep or an accident. The pain does not arise directly from the blockage but from a reactive tension in the muscles. In addition, there are significant restrictions on movement.

A herniated disc of the cervical spine can also cause pain in the back shoulder. Furthermore, movement disorders of the shoulder blade can be considered as the cause. This occurs due to inflammation of the tendon at the shoulder blade (enthesiopathy), malformation of the shoulder blade or also due to muscle tension.

Another cause may be a tear in the back of the rotator cuff (infraspinatus muscle and teres minor muscle). The pulling, stinging pain is load-dependent (especially with external rotation), is located under the rear shoulder roof and can radiate up to the upper arm. The crack often occurs as a result of impingement syndrome. This bottleneck syndrome, which has existed for years, leads to increasing wear on the tendons of the muscles of the rotator cuff. The previously damaged tendons can tear due to sudden movement. The tearing of an undamaged tendon due to an accident is far less common.

Lastly, a variety of injuries can occur with the bench press, especially due to incorrectly executed exercises. These range from simple sore muscles to muscle tear and can all cause pain in the back shoulder.

Normally, sleep and rest at night are expected to significantly reduce shoulder pain. However, this is often not the case, so those affected wake up after a few hours of sleep due to severe pain in the shoulder. There is no thought of falling asleep again. The pain, insomnia and exhaustion represent a great deal of suffering for those affected.

The cause of this phenomenon is the different conditions in the shoulder joint during the day and at night. During the day (while sitting / standing), the arm hangs down from the shoulder like a weight with a few kilograms of weight and thus increases the joint gap by simply “pulling it apart”. The structures can only stretch a few millimeters, but ensure that irritated and inflamed structures are relieved somewhat. When lying down at night, the joint space contracts again and the structures are closer together. So this relaxation causes a compression of soft tissues (tendons, bursa), which triggers pain and wakes those affected.

In the short term, some kind of stretching device can help prevent pain at night. One loop is placed around the wrist and another around the ankle, which are then connected with an expander rope. The pulling force on the arm simulates a hanging arm like during the day. Alternatively, the shoulder joint should be stretched at night when the affected person is awakened by pain, which should make the pain disappear temporarily. This type of first aid should only be used for a few weeks until the cause of the pain is clarified and treated.

Night pain in the shoulder is not a diagnostically very meaningful symptom and can occur in the context of several shoulder diseases. In the case of osteoarthritis, as well as with the bottleneck syndrome, as well as with the calcareous shoulder or with bursitis, the pain can occur at night.

In order to make the correct diagnosis for shoulder pain, some information from the medical history is important (anamnesis), as it gives first indications of the causes.

Known shoulder injuries, the movements with which the pain occurs, how long the symptoms persist, whether nighttime pain occurs and risk factors for increased shoulder wear (e.g. due to sports or work) must be inquired by the treating doctor.

A physical examination for shoulder pain can consist of a number of examination handles and methods that allow an assessment of the function of the muscles of the shoulder joint.

Typical clinical function tests are, for example, the Jobe test (side differences speak for a tendon tear, an irritated tendon or inflammation of the bursa), the neck grip (both hands are placed on the neck), the apron grip (you touch both hands on the back) and many more.

Scanning trigger points (stimulus points whose touch triggers pain) can provide further clues as to the causes of shoulder pain.

The mobility of the individual joints in the shoulder joint must also be checked. To rule out that the cause of the shoulder pain is a nerve trap, a neurological examination may be necessary. Imaging methods such as ultrasound (sonography), X-ray, magnetic resonance imaging (MRI, nuclear spin) or computer tomography (CT) allow further insights into the painful shoulder joint.

In some cases, however, the diagnostic methods described so far do not lead to a clear diagnosis. For example, it may be necessary to perform an arthroscopy. With this minimally invasive "keyhole technique" operation, a direct insight into the shoulder joint is possible and, if necessary, a treatment can also be carried out as part of a joint mirroring, such as sewing a tendon tear or removing inflamed tissue.

Treatment for shoulder pain is always aimed at the cause of the discomfort. The earlier treatment of shoulder pain is started, the better the chances of a cure.

The person affected can often use active exercise and muscle strengthening to help alleviate or even completely alleviate the symptoms.

Taking painkillers e.g. non-steroidal anti-inflammatory drugs (NSAIDs, e.g. Voltaren®) and cold packs can help against shoulder pain, especially in the early stages.

Physiotherapy, active muscle strengthening, chirotherapy, acupuncture, TENS treatments or the direct administration of anti-inflammatory drugs in the painful area can also be used to treat shoulder pain.

The so-called blackroll can also be used for shoulder pain.

A joint prosthesis can be used for severe signs of wear in the shoulder joint. For example, if an injury to the rotator cuff is the cause of the pain, the shoulder may need to be spared for a while to promote the healing process.

In severe cases, surgery can also be performed. The therapy of shoulder stiffness includes in particular physiotherapy treatment with the aim of making the shoulder movable again. There are also treatment options using electricity, electromagnetic waves or ultrasound to treat the painful shoulder.

There are numerous surgical techniques that can be used for certain causes of shoulder pain. With the help of an operation, for example, the shape and position of the humerus can be corrected, tendons sewn, muscles implemented, adhesions released, diseased bursa or tissue removed and much more.

For a healthy shoulder it is important to have good posture and to move the shoulder a lot and sensibly. Otherwise the joint will be incorrectly positioned and the inactive muscles will shrink.

Overloading should be avoided. Targeted muscle training can be used to prevent shoulder pain and premature wear on the shoulder joint. Muscle tension can occur, especially during permanently sedentary activities. Here relaxation exercises, regular short breaks and loosening exercises for the shoulder and neck muscles can have a preventive effect.

Drafts and cold as well as one-sided postures and movements should be avoided. The shoulder muscles and the shoulder joint should be stretched and warmed up before and after sporting activities. A healthy diet also protects the metabolism and the joints, which prevents shoulder problems. If it is known which stimuli trigger or intensify the shoulder pain, these should be avoided at all costs.

Pain and a feeling of stiffness in the shoulder should be taken seriously the first time it occurs and a doctor should be consulted.