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When putting a jacket on hurts
Most patients notice the problem when performing minor day-to-day movements, such as reaching for the seat belt, turning the window handle, or getting a glass from the closet. The shoulder feels jammed and painful. The pain sometimes shoots and radiates to the upper arm, or even down to the wrist in extreme cases. Overhead movements are painful, and sometimes impossible.
This is caused by the nerve compression syndrome, or impingement in medical terms. The cause is heavy load, such as continuous overhead work or sports such as tennis, badminton, or intensive dumbbell workout.
Early healing is possible with physiotherapy, anti-inflammatory medication (ibuprofen or diclofenac), or injections into the subacromial space. The above-mentioned activities need to be avoided. Without treatment, however, the pain increases with time, and is also present at night. It is hardly possible to lie down on the affected shoulder. The inflammation is already in the chronic stage and spreads to the muscle cuff. The arm can be lifted sideways only with great difficulty. Some patients report arm weakness. The first tears in the rotator cuff often appear in this phase.
A surgery is often indicated at this stage. Patients who prefer to avoid a surgery or cannot have it done for health reasons may be offered X-ray irradiation, shockwave treatment, or special training.
Chronic irritation causes calcium deposits
Calcific tendinitis is a specific form of impingement. Calcium deposits form in the tendon due to constant irritation of shoulder muscles. This happens in the middle of the joint. The deposits gets impinged when the shoulder is moved. Calcium, after all, is hard and inflexible. It cannot slip underneath the subacromial space without exerting pressure.
This disease most often affects middle-aged patients (> 40 years of age). Women are affected more often. For reasons that are not fully understood (possibly reduced blood flow to tendon inserts), calcium deposits appear in the attachment area of the supraspinatus tendon (= part of the rotator cuff). These deposits often result in inflammation of the synovial bursa and the associated severe discomfort. Relapsing acute pain attacks occur in the course of the disease. They are probably caused by calcium deposits forcing their way into the synovial bursa. These calcium deposits are so disruptive that, in most cases, it is necessary to remove them. This is done by means of targeted injections, shockwave therapy, or a surgery using keyhole technique (arthroscopy).
When every movement is painful
Pain due to joint wear (osteoarthritis) begins gradually. It sometimes disappears and then comes back. The movements are becoming increasingly difficult; overhead movements and getting dressed and undressed are slower and painful. Our patients mostly complain of pain at rest and when bearing weight, which requires frequent use of pain medications. The night's sleep is often disturbed, and neck muscles are tense.
In the early stages, mobility and pain can be improved without a surgery. An injection into the joint is possible in these cases. Hyaluronic acid is used when there is still sufficient cartilage. This may help improve sliding movement. A combination with cortisone is just as possible as injecting anti-inflammatory naturopathic preparations. Alternatively, a few millilitres of patient's own blood can be processed into the so-called platelet-rich plasma (PRP). This can be injected into the affected area.
For pain treatment, we offer both Chinese body acupuncture and special ear acupuncture, either as standalone treatments, or in addition to the conservative measures.
In special cases, X-ray irradiation with a radiotherapist may help improve symptoms.
In some cases, minimally invasive keyhole surgery (arthroscopy) can remove disturbing corners and calcium and improve mobility. If all of these measures are unsuccessful, a new shoulder joint (shoulder replacement, prosthesis) may be considered.
The shoulder joint has little bony support. It owes its stability to the perfect interplay between ligaments, joint capsule, and muscles. If these important building blocks do not work optimally, shoulder may become unstable. We differentiate between congenital and trauma-related instabilities.
1. Congenital instability
Arbitrary dislocation of the shoulder joint (shoulder dislocations), which may be triggered without the use of force, are due to general tissue weakness. It is a congenital weakness of the supporting tissue, which leads to an increase in joint play. Other joints are often affected as well (e.g. the kneecap). Non-surgical treatments, which consist of intensive exercise and training programs, have proven effective for this condition. Surgeries are only carried out in exceptional cases.
2. Instability caused by trauma
In these patients, the initial dislocation (luxation) was triggered by an accident (e.g. during sports or at work). This initial accident causes damage to the joint capsule, the ligaments, and the fibro-cartilage ring (labrum). Osseous damage to the shoulder socket and the head is also common. In the aftermath, further dislocations occur without another accident, especially in young patients.
This is where a shoulder-stabilizing surgery helps.
Maximum load on the shoulder results in wear
The rotator cuff, which runs from the scapula to the humeral head, consists of four different tendons. It is responsible for stabilising the shoulder, and for rotating and lifting the arm sideways.
Tendon wear is the most common cause of rotator damage to the rotator cuff. This damage increases with age. The symptoms are usually triggered suddenly by minor movements. However, accidents (sports or work accidents) may also be the cause. The supraspinatus tendon is most commonly affected. The arm can usually no longer be raised sideways without issues. Pain typically occurs at rest and at night. Larger tears cause a significant loss of strength.
Smaller tears in the early stages may heal through conservative therapy. An injection of patient's own blood (platelet-rich plasma, PRP) can support this healing process. In older patients, surgical intervention should only be considered if conservative therapy has been unsuccessful. In young or athletic patients, minimally invasive surgery (arthroscopy) with suture of the torn cuff is necessary at an early stage. If there is frozen shoulder in addition to the injury to the rotator cuff, shoulder mobility should be improved with the help of physiotherapy prior to the surgery.
Stiffening of the shoulder can be caused by the disorders described above, such as impingement syndrome, calcific tendinitis, shoulder instability, or rotator cuff ruptures.
In most cases, however, frozen shoulder develops as a separate disorder. Hormonal changes (menopause) or blood sugar and thyroid disorders have been proposed as causes. The capsule shrinks progressively along with increasing and usually very painful restriction of movement. In all cases, long-term conservative treatment options (physiotherapy, medication) should be exhausted first. If this treatment is unsuccessful, the shoulder can be treated with minimally invasive keyhole surgery (arthroscopy).