A aching shoulder is the most frequently reported problem by patients at the shoulder surgery clinic. Patients most often describe it as pain localized, among others, in the rear part of the shoulder blade or 1/3 of the proximal humerus near the attachment of the distal ("end") of the deltoid muscle. Characteristic is also the intensification of ailments in everyday activities performed with the hand above the head or during physical work, and the radiation of pain both along the limb and to the neck. The most disturbing symptom should be night pain, awakening from sleep after turning over on the sick shoulder.
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The reasons
When looking for the causes of pain, attention should be paid to the significant anatomical structure of the functional unit referred to as the shoulder, because it is in fact made up of 4 joints:
- The shoulder-shoulder joint is formed by the head of the humerus and the articular surface of the neck of the shoulder blade
- Shoulder-clavicular joint
- The sternoclavicular joint
- Scapulo-rib joint / space
In the shoulder joint, the most common causes of pain in the elderly are degenerative damage to the rotator cuff / taper, i.e. muscle tendons that enable rotation, abduction and bending of the arm by pulling the humeral head downwards and into the acetabulum, centralizing its position and allowing smooth movement.
In younger people, damage to the rotator cuff / taper is most often associated with sports and overload injuries. In addition, in this group, shoulder pain is often caused by scapular dyskinesia, i.e. pathologies originating from an abnormal scapula path, resulting in a reduced amount of space for the tendons of the rotator cuff. This disease, called the subacromial tightness syndrome, is most often treated through rehabilitation appropriately selected for the patient's needs.
In the shoulder-clavicular or sternoclavicular joints, pain is usually caused by degenerative changes, i.e. damage to the articular surfaces. The rubbing of such damaged joint surfaces against each other usually results in pain and local inflammation. Symptomatic degenerative changes in these joints occur as a result of many years of overload with physical work or sports, or as a result of an injury with dislocation of the shoulder-clavicular or sternoclavicular joint. The treatment of first choice is a single injection of a steroid drug followed by local physical therapy and rehabilitation. If there is no improvement, an operation is performed for the shoulder-clavicular joint to remove the articular surfaces that are the source of pain. This procedure is performed arthroscopically
The scapulo-rib connection is a space filled with muscles and a bursa, i.e. a thin-walled reservoir with a small amount of fluid allowing the scapula to slide smoothly along the chest wall. In the case of improper positioning and operation of the scapula (dyskinesia of the scapula, protraction of the scapula) or an incorrect anatomy of the scapula (bone growth of the scapula), this sliding may be impaired, resulting in a snapping scapula syndrome. The causes related to the position of the scapula should be treated with personalized rehabilitation, and anatomical abnormalities quite often require arthroscopic surgery involving the resection of the bone growth or the upper angle of the scapula.
The author of the text: lek. Hubert Laprus, MD
