Shoulder pain is a condition with which, at least once in a lifetime, we have had to interface.
The shoulder is a very complex joint, made up of 3 bones: the clavicle, the humerus and the scapula, held together by a dense intertwining of tendons, ligaments, muscles, nerves and blood vessels which together allow the execution of the movements of anterior and posterior rotation, abduction (moving away from the body) and adduction (bringing the arm closer to the body).
So of all those movements thanks to which it is possible to carry out any type of daily action in the workplace, personal or sports.
Given the continuous use of this joint in all daily tasks, it is understandable that shoulder pain is as widespread as it is disabling. The pain is often caused mostly by traumatic phenomena, by degenerative processes linked to wear and age, by pathological processes of an inflammatory nature, or, much more commonly, resulting from muscle fatigue.
Shoulder pain can manifest itself in many ways, therefore it can be acute or persistent, localized only to the shoulder or extended to the neck , back, armand up to the hand, it can be accompanied by limitations in movement, reduced physical strength, bone deformities, lesions or wounds of the skin and even reduced skin sensitivity or tingling in the fingers .
And again the pain can concern only one shoulder, right or left , a hypothesis that leans in favor of a trauma, or both, a more common condition if the cause is of a systemic nature.
Let’s now explore all the causes of shoulder pain starting to investigate a problem as widespread as it is complex.
What are the most common causes of shoulder pain
It goes without saying that traumatic events are the ones most responsible for the onset of shoulder pain, often these are small events such as blows, bruises or minor impacts that have no outcome, if not a localized pain that tends to resolve in a short time, after applying ice packs to promote vasoconstriction and reduce swelling .
Sometimes, as we will see shortly, the traumas can be of considerable force, especially if they are the result of falls or accidents, such as to cause dislocations, fractures or injuries.
However, as mentioned, at the origin of a shoulder pain there can also be a pathological condition, both of an inflammatory, rheumatic or degenerative nature. We have reported here what are the most common conditions that can cause pain of this type.
Cervicobrachialgia
It is a condition that arises following a cervical hernia. There is cervical pain that radiates to involve the shoulder and upper limbs, muscle contractures in the neck , tingling in the arm and fingers, lack of strength, reduced skin sensitivity and slowed reflexes.
Depending on the level of the cervical spine affected by the herniation of the disc, the disorder will localize in specific anatomical sites, limiting the execution of certain movements from case to case.
In case of cervicobrachialgiamost often a conservative treatment is used in which during the acute phase of pain non-steroidal anti-inflammatory drugs (NSAIDs), cortisone, muscle relaxants are administered, to which the indication of a collar can be added to allow muscle relaxation (in particular way of the trapezius muscles ).
Once the acute phase of shoulder pain has been resolved, rehabilitation therapies such as postural education or osteopathy treatments are usually indicated. The use of surgery is quite rare, due to the delicacy and complexity of the cervical area of ​​the spine.
Fracture of the scapula
The scapula is a bone enveloped by the muscle masses of the shoulder, therefore its fracture can cause serious repercussions on these structures with the possibility of generating permanent disabilities.
Often due to the characteristic of being enveloped by muscles, in the event of a fracture the subject may experience a pain in the shoulder of no particular entity and notice excessive mobility of the limb, due to the interruption of relations with the collarbone.
The fracture of the scapula is generally due to a direct trauma of the shoulder, typical of a fall, be it from the stairs, from a bicycle or following a road accident.
Fracture of the clavicle
Also in this case the most responsible event of the fracture is a fall, or in any case a direct high-energy trauma.
If the fracture of the scapula is consequent to a trauma suffered at the level of the shoulder, the fracture of the clavicle is consequent to a trauma that has affected the side of the arm. Unlike what is true for the scapula, moreover, the fracture of the clavicle is immediately visible to the naked eye, since it manifests itself with a very clear deformity to which the characteristic crackling from fracture (creaking noise) and reduced mobility are added.
Fracture of the clavicleit can also affect newborns during natural birth, therefore through the vaginal canal. Although the deformity of the clavicular region can be shocking and frightening, and the pain in the shoulder is very intense and acute, generally the fracture of the clavicle has no noteworthy consequences, and healing, through the application of a brace, generally restores everything. and for all the aspect and functionality preceding the traumatic event.
Shoulder dislocation
Phenomenon that occurs when the humerus of the scapula moves away, caused by a trauma affecting the glenohumeral ligaments, responsible for the relationship between the bones.
This type of dislocation is put back in place through the execution of corrective maneuvers which, although painful, are often fundamental to the treatment, which in any case must be followed by a period of rest with the brace.
The corrective maneuver must always be performed and only after an x-ray, because if a fracture is added to the dislocation, the corrective maneuver could aggravate the situation even more.
Acromion-clavicle dislocation
This is a condition generally resulting from a fall on the back or side in which the trauma is discharged at the level of the collarbone and shoulder , stretching or injuring the conoid and trapezoid ligaments.
These ligaments have the function of holding together the clavicle and the acromion (region of the shoulder blade) and therefore of supporting the entire upper limb.
Depending on the intensity of the trauma, the dislocation can determine the appearance of a real “step” which indicates the collapse of the ligaments and the removal of the two joint heads.
Rotator cuff syndrome
This is a typical pathology that arises following phenomena of work overload of the upper limb. The rotator cuff is made up of tendons that perform the function of connecting and fixing the humerus to the scapula.
This formation undergoes wear and degeneration phenomena due to age but also linked to chronic inflammatory pathological phenomena such as osteoarthritis.
Rheumatoid arthritis
Disease of autoimmune origin which mainly affects the female sex and which establishes inflammatory and degenerative phenomena in the joints.
This pathology determines the onset of severe pain to damage all the joints of the body, bone deformities, functional impotence and lack of strength.
Periarthritis
This is an inflammatory process affecting the tendons, ligaments and soft tissues of the joint (in this case the shoulder).
This pathology causes severe pain that occurs mainly during the night, when the shoulder is subject to the pressure of the body weight lying down. The pain can also radiate to the arm and hand.
Myocardial infarction
It is a much rarer phenomenon than other causes of shoulder pain , and certainly a shoulder pain should certainly not suggest a heart attack or a heart attack.
However, pain in the left arm and shoulder is also one of the symptoms that concur in the course of a heart attack.
In this section we have tried to illustrate the most common causes of shoulder pain. Now, let’s move on to identify what are the most effective therapies to solve the problem.
How the diagnosis takes place
We have seen how the possible causes of shoulder pain can essentially be traced back to traumatic, degenerative and inflammatory phenomena.
These are all events that require careful evaluation by an orthopedic physician if the symptoms are acute, persistent or cause motor limitations.
Obviously a small contusion, unless it results in intense manifestations, should not generate any concern, usually it is sufficient to apply ice and keep the limb at rest to soothe the pain.
When the pains are persistent and are associated with tingling in the hand, limitations of movement and pain radiating to the neck , arm and back , it is necessary to undergo a specialist visit in orthopedics.
After having ascertained all the symptoms perceived by the patient, the orthopedist can prescribe more in-depth diagnostic analyzes. Based on the diagnostic suspicions formulated, a blood sample will be indicated, useful for verifying the presence of a rheumatic disease or an infection, or instrumental investigations such as ultrasound, magnetic resonance and CT scan to view the state of health and integrity of the bones and soft tissues of the shoulder.
Which are the most effective
therapies The therapies depend on the triggering cause, but generally they are of a pharmacological nature, through the administration of painkillers and anti-inflammatories, of a rehabilitative nature (physiotherapy, osteopathy) or surgical.
In case of bad falls or accidents, such as to suspect a fracture or dislocation, it is necessary to go immediately to an emergency room and undergo the most appropriate treatments, such as corrective repositioning maneuvers, casts, containment bandages or surgical interventions if there are no alternatives.
We also mentioned the possibility in which shoulder pain could be linked to a heart attack.
It is necessary to specify that a simple pain in the shoulder must certainly not make us think of a heart attack, in fact a heart attack manifests itself with very acute symptoms such as a sense of constriction and pain in the chest, shortness of breath, profuse sweating, anguish, feeling of dizziness and typical irradiation to the left arm.
When two or more of these concomitant symptoms concur, it is necessary to immediately contact 118 or go to the nearest emergency room.
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