The chronic shoulder pain is a picture of long evolution, months or years, and is characterized by pain in the shoulder and adjacent regions (lateral side of the arm, lateral side of the neck, scapular region and even the entire upper limb).
It is characterized by pain, of sudden or progressive onset, and that persists over time. It is usually of mechanical characteristics, with shoulder movements such as undressing, combing hair, picking up objects above the shoulder, fundamentally, although there may also be pain at rest and the existence of nocturnal pain is very frequent.
The location, as we have said, can be very variable. This localization can guide us in the topographic diagnosis, i.e., where does the pain really come from? It is important to emphasize that not all the pains that we perceive in the shoulder or adjacent regions, already mentioned, originate in the shoulder. Thus, there can be pain of cervical origin, of pulmonary origin, of periscapular origin (of the shoulder blade musculature).
Another frequently associated symptom is the loss of mobility of the shoulder, either because of pain or because there is a capsular problem (retraction) and it is very important to distinguish this circumstance.
In very evolved cases it can be associated with severe loss of force, and that many times is due to rupture of the tendons of the rotator cuff.
On the other hand, in other cases, the predominant associated symptom is instability or a feeling of insecurity in some movements or postures (apprehension).
The main cause is repetitive activities of the upper limb above the shoulder, either in domestic activities or in the context of sports activities. In this case, they can be fast and forced movements (tennis, paddle tennis, swimming, throwing sports) or movements with load (bodybuilding in hand-over-shoulder posture).
Always in the context of a lack of stability control of the shoulder and/or scapula due to a deficit of musculature or proprioception or both.
The main sports injuries of the shoulder in the athlete are tendinitis of the rotator cuff tendons, internal impingement syndromes, which are very specific injuries of athletes with a lot of hand-over-shoulder activity, and minor or major instabilities.
Predisposing factors can be of a general nature, such as age, poor physical condition, mainly caused by lack of adequate physical activity, smoking, diabetes, etc., or of a local nature, such as the morphology of the acromion, the inclination of the acromion, the shape of the glenoid (“cavity” in which the humeral head articulates), the condition of the labrum (fibrocartilaginous buckle that inserts into the glenoid rim and helps stabilize the shoulder) and the general condition of the patient’s tissues.
Treatments for shoulder pain
Numerous treatment options are available today:
- Prevention: maintaining a level of physical activity, mobility and musculature, both of the shoulder and shoulder girdle, appropriate for our age and our functional demand (To do sport you must always prepare well).
- The first step of treatment would be the performance of specific physical exercises to improve shoulder mobility, scapular mobility and periarticular musculature (rotator cuff and deltoid) and periscapular (cervical musculature, trapezius, serratus, latissimus dorsi, etc.).
Each patient should have an individualized treatment according to his pathology, age and functional demand.
It is very important to have an accurate diagnosis. It is not uncommon to treat a shoulder when the pathology is of the cervical spine, or pulmonary, for example.
If preventive measures and physical treatment are not sufficient, there are numerous treatment techniques:
- Corticosteroid infiltrations
- infiltrations of Plasma rich in platelets (“growth factors”)
- Extracorporeal shock waves
- Arthroscopic surgery: it should always be the last resort.
The most important thing is that the treatment is based on an accurate diagnosis, is staggered and always personalized.