The most common painful conditions of the shoulder
Written by:The shoulder is a complex articulation which has the function of joining the arm to the trunk. It consists of seven different joints (3 bones and ligaments 4), all indispensable to its correct functionality. The Dr. Erico Schiavone , specialist in Orthopaedics and Traumatology , explains the different diseases that can affect what is known in medicine as the "shoulder joint complex."
To make a proper diagnosis of shoulder pain requires some trial and a study of the patient's symptoms. In this case, the diagnostic provides 4 different tests:
- Inspection: The specialist observed the shoulder of the patient
- Palpation: specialist touches the focal points of the patient's shoulder
- Mobility: the patient performs specific movements designed to discover the source of pain
- Strength: specialist tests the strength of the patient, through flexion, abduction and external rotation of the arms
Obviously, depending on the diagnosis, the treatment will change. But what are the main diseases that affect the shoulder?
-
Conflict subacromial
It is a disorder characterized inflammation of the soft tissue occupying the subacromial space (rotator cuff, subacromial bag, CLB) as a result of compression on the bony structures that surround it (the lower surface of the acromion, humeral head, tuberosity).
SYMPTOMS
- Shoulder pain at rest, almost always at night
- Deficit joint
- Deficit shoulder strength general
Clinical tests
- Test Neer
The specialist will place behind the patient, and rotates inside of the arm with the other hand while keeping the scapula down, trying to create friction between the pre-insertional portion of the supraspinatus and the anteroinferior portion of the acromion (tip shoulder)
- Test Hawkins
Both the shoulder that the patient's elbow is flexed to 90 °, and the specialist carries a friction between the supraspinatus tendon and ligament coracoacromial, bringing down the forearm and keeping the elbow stationary.
- Yocum test
The patient, in sitting position, putting his hand on the shoulder that you are looking at raising the elbow at 90 degrees, then push resisting the specialist, which puts pressure on the elbow of the same. This creates compression between the greater tuberosity and coracoacromial ligament.
Diagnosis and Therapy
The actual diagnosis will be confirmed through test image, such as magnetic resonance or X-rays. Based on the stage of progress and severity of pain in the shoulder, the treatment includes:
- Fans, painkillers and anti-inflammatory
- Infiltration
- Cryotherapy
- Surgery
2. Rotator cuff injury
It is a lesion which involves mainly the supraspinatus tendon, and can occur as a result of a trauma or degeneration of the tendon tissue caused by wear or calcification.
SYMPTOMS
- Ache
- Difficulty in movement
- Lack of strength in the muscles involved
Clinical tests
- Test Jobe
The patient must resist the thrust exerted by the specialist, while his arms are raised to 90º and 30º flexed, hands with thumbs down and the elbow extended. This test is used to assess the supraspinatus muscle, and make sure you are actually injuries.
- External Rotation test in adduction
The patient, with raised arms and elbows bent at 90 degrees, should rotate the shoulder resisting the pressure exerted by the specialist.
- Test Patte
The patient, with shoulder 90º abducted and flexed elbow must perform a non-rotating counter-resistance carried out by the specialist behind him. Used to assess the condition of the infraspinatus muscle.
- Lift-off Test
With hand shoulder to be examined placed behind his back, the patient must push and resist the pressure made by the specialist: in the case of injury, the patient will not be able to push.
- Napoleon Test
The patient should press Allamano against the abdomen, trying to keep the elbow straight. The specialist performs a pressure on the elbow forward. The test assesses the subscapularis muscle: in the event of injury, the patient will not be able to do with his shoulder strength, tending to flex the wrist.
Diagnosis and Treatment
Diagnosis is commonly carried out with an MRI, able to display the exact point of injury to the shoulder. X-rays, however, can not show the severity of the damage to tendons, but may show its consequences. Depending on the severity of the situation, the treatment includes:
- NSAIDs, painkillers and anti-inflammatory
- Physiokinesitherapy
- Infiltration
- Surgery
3.Articolazione acromioclavicular
This disease is often linked to problems of osteoarthritis or instability following direct or indirect trauma.
SYMPTOMS
- Ache
- Functional impairment
- Deformity
clinical tests
- Cross-Arm Test
It is a maneuver indirect passive horizontal adduction the acromioclavicular joint. The specialist performs a pressure on the patient's arm, bent at 90º. IN the case of injury, it causes a painful reaction.
- Test of instability and reducibility (Piano Key)
The reduction maneuver of extreme lateral subluxation of the clavicle upwards. In case of injury, the patient will feel pain.
Diagnosis and Therapy
In both cases, the final diagnosis should be made through an analysis of the patient's medical record and an X-ray examination. Treatment involves:
- Cryotherapy
- Fans, painkillers and anti-inflammatory
- Instrumental therapy
- infiltration intraarticular
- Surgery (in severe cases)
Along 4.Capo Biceps Brachial (CLB)
THE CLB is a question often in painful shoulder. There are degenerative diseases (tendinitis, CDR etc.), instability and lesions secondary to trauma (detachment, rupture, slaplesion etc.)
Specific clinical tests
- Sign Popeye
The patient places his hands over his head and then contract your biceps. In case of rupture of the tendon is known a altered morphology of the muscles, which tend to be asymmetrical.
- Palm-Up Test
The patient puts his arms to 90º, with the forearm and lying face up, and try to resist the pressure done by the specialist who contrasts manually. If this pressure produces a sudden, it means instability of the tendon.
- Yegarson test
The patient flexes the elbow at 90 degrees and extends the forearm with the palms facing down. It must therefore make a partial rotation of the arm to bring the palms upward, while specialist opposes this push. If the patient feels pain, the tendon is damaged, or unstable
- Test shooting
The patient flexes the elbow 90º and performs rotations. If you realize a sudden, the tendon may be unstable or damaged.
Diagnosis and Treatment
The final diagnosis can be done through a careful examination of the patient's medical record, an ultrasound and an MRI. Depending on the severity of the chaos, the treatment includes:
- Cryotherapy
- Fans, painkillers and anti-inflammatory
- instrumental therapy
- Infiltration
- Surgery
5.Instabilità Gleno-humeral
The glenohumeral instability is linked to a failure capsular and ligamentous. Usually, it is a result of a traumatic injury, but also can be congenital in origin and derived from articular stress as a result of sports.
Specific clinical tests
- sulcus Test
While the patient is sitting, the specialist puts pressure on the arm by holding the distal humerus. It is useful to evaluate the lesion below the acromion
- Drawer test
The patient is sitting or lying down. The specialist stabilizes the scapula with one hand and with the other push forward and backward the humerus. Excessive mobility could be a symptom of laxity of the shoulder structures.
- Apprehension Test
The patient is seated with his arm raised and the elbow flexed at 90º. The specialist from behind executes a slow rotation and with the other hand pushes slightly the humerus forward. If the patient feels pain, the test is positive.
Diagnosis and treatment
The diagnosis will be complete after examination of the patient's medical record, an MRI with contrast and, in severe cases, a CT scan before surgery. The treatment involves:
- Cryotherapy
- Physical therapy and muscle strengthening
- Using braces and bandages during exercise
- Surgery (arthroscopic Bankart or intervention arthro-ical of Latarjet