Tendonitis of the shoulder joint
Mostly inflammation in the shoulder region begins with a tendon bag( tendobursitis) or the vagina of the shoulder joint( tendosinovitis, tenosynovitis) and only then spreads to the tendon itself - this pathology and is diagnosed as tendonitis of the shoulder joint.
In this article:
This disease affects not only people, they are sick and animals. Modern medicine distinguishes two forms of its manifestation: acute and chronic.
Causes of tendinitis of the shoulder joint
There are a lot of sources that can provoke the nucleation and progression of the inflammatory process in the human body. And in order to prevent the disease, it is necessary to remove the cause provoking it, and for this, the "enemy" must be known. We learn the most common causes of tendonitis of the shoulder joint:
- It is quite high risk to acquire this disease in people whose professional activity is associated with heavy physical exertion. The athletes of such sports as tennis, basketball, volleyball, hammer throwing( nuclei, spears), handball, gymnastics are considered to be in the risk zone."Dangerous" and such professions: almost all construction( painter - plasterer, mason), drivers of vehicles and many others.
- Numerous microtrauma associated with increased motor activity.
- The presence of a history of human diseases related to the bone and muscle system:
- Reactive arthritis.
- Gout is a disease associated with a malfunction that occurred in the work of metabolic processes. It has a negative effect on bone, connective and muscle tissue.
- Osteoporosis is a pathology in which bones lose their strength, become more brittle and can easily break.
- Rheumatoid arthritis.
- And others.
- Congenital or acquired pathology of tendons, loss of elasticity and elasticity.
- Problems with posture.
- Infectious diseases, provoked by pathogenic flora. Disease bacteria quickly spread with blood throughout the body and primarily affect its weakest point.
- Stressful, depressive states of a person can provoke muscle spasms, which causes an increased burden on connective tissues.
- To provoke tendinitis of the shoulder joint, the allergic reaction of the body to taking medications can also occur.
- Inherited or received in the process of life joint dysplasia.
- Diseases of the endocrine system: diabetes, thyroid disorders.
- Deterioration of the body's defenses.
- The need for a long time to use gypsum or a tight bandage.
- An error in the prescribed therapy and in the process of rehabilitation rehabilitation after surgical intervention associated with the shoulder joint area.
- Features in the anatomical structural configuration of the patient - if the violations are associated with a deviation in the normal structure of the shoulder joint, then its degradation can cause the formation of a foci of inflammation, and hence the development of tendonitis of the shoulder joint.
- Osteochondrosis of cervical vertebrae can provoke this pathology.
- May lead to this development of events and a long stay in the draft, climatic cataclysms( fell under the cold pouring rain).
Symptoms of tendinitis of the shoulder joint
In principle, any inflammatory process, the symptoms of tendinitis of the shoulder joint begin to manifest pain symptoms.
- First, a person feels pain in the shoulder only during movement, but gradually it begins to pester and in the rest position.
- Hyperemia begins to appear on the skin of the shoulder area: the epidermis becomes reddish, when touched, its greater density and increased temperature are felt.
- When driving, even without using a phonendoscope, you can hear light clicks.
- In some cases, minor swelling can be observed, which slightly limits movement in the joint. It is difficult for a person to take an item from a shelf or put it back, and there are problems with clothes.
- Over time, pain can also appear during sleep. And after a while, spread to the elbow joint.
- Pain can be either monotonous, or sharp and prolonged.
- Prolonged disregard of the problem can lead to complete or partial atrophy of the muscular tissue of the shoulder region. This pathology is much more difficult to cure, and sometimes it is simply not possible.
Calcifying tendinitis of the shoulder joint
If in the process of some disease or lifestyle, on the tendons of the shoulder zone salt is observed, the specialists diagnose already calcifying tendinitis of the shoulder joint. In the tissues adjacent to the salt accumulations an inflammatory focus begins to form( this pathology often infects people after 40 years).The reasons for the emergence of this pathology have not been thoroughly studied, but physicians suggest that this development of the scenario can be facilitated by multiple micro-ruptures, injuries, and age-related wear of connective tissues. Not the least role in this process is played by the lack of oxygen in the cellular and intercellular layers of the tendons.
For calcifying tendinitis of the shoulder joint, there are inherent pain sensations that appear when the upper limb moves( it is very hard to raise your hand).As a result of this change in position, discomfort begins to increase, the pain symptomatology intensifies mainly at night. The protocol of medical therapy attributed to the attending physician largely depends on the radiography data.
Tendonitis of the supraspinatus of the shoulder joint
The joint of a man is a rather complex, it is possible to say, unique design, from the joint work of all elements of which the adequate functioning of the "mechanism" as a whole depends. One of these components is the supraspinatus, which completely fills the supraspinal fossa of the scapula. Its main function is to divert the shoulder and stretch the joint capsule in order to protect it from infringement. Tendonitis of the supraspinatus of the shoulder joint can develop if the muscle capsule is injured by an acromioclavicular joint, an acromial-beak-like ligament or the acromion itself. Such damage is fraught with the subsequent deterioration of the physiological characteristics of the joint complex, the induction, slow or rapid inflammation and thinning of the tendon, which leads to complete degradation of the shoulder joint. And as a result, a person can get tendinitis of the supraspinous muscle of the shoulder joint.
Diagnosis of tendinitis of the shoulder joint
Time passes and any mechanism begins to wear out, the human body is no exception. Joints, muscles and connective tissues also have their limits, so frequent microcracks, bruises, other negative effects and lead to pathological changes in the human body. Diagnosis of tendonitis of the shoulder joint includes:
- Detection and analysis of patient complaints.
- Survey of a specialist aimed at determining the location of pathology, pain symptoms during palpation of the area, determining the mobility of the joint, establishing the presence of edema and hyperemia.
- It is necessary to differentiate this disease from other pathologies. For example, arthritis is characterized by constant pain even at rest, whereas tendonitis of the shoulder joint is pain associated with motor activity.
- Laboratory tests usually do not show any changes. An exception is tendonitis, which developed on the basis of bacteriological damage to the patient's connective tissue( infection or rheumatoid processes).
- The radiography method will be informative only if the calcifying tendinitis of the shoulder joint is diagnosed. In this case, a cluster of calcinates( crystals of calcium salts) can be seen on the film - this is a rather late stage of the disease.
- Computer and magnetic resonance tomography makes it possible to determine degenerative changes in the structure of the shoulder joint: tendon rupture, structural structure defects. Such a survey result may indicate the need for surgical intervention.
- Sometimes an ultrasound is used as an additional diagnostic. This technique allows you to establish changes that have affected the structure of connective tissue, its contractility.
Treatment of tendinitis of the shoulder joint
First of all, it must be said that the treatment of tendonitis of the shoulder joint largely depends on the stage and severity of the course of the disease. If the disease is diagnosed early in its development, the treatment protocol is fairly sparing, and includes:
- Maximum limitation of mobility and load on the affected joint, and, consequently, on the affected tendon.
- Cold therapy is used as an auxiliary therapy.
- For fixing the joint and bringing it to rest, use tires, bandages, the imposition of elastic bandage.
- Active physical therapy:
- Laser therapy.
- Shockwave therapy
- Magnetic therapy.
- Exposure to ultraviolet and ultrasonic rays.
- In case of a chronic manifestation of the disease, mud and paraffin baths, lidase-based electrophoresis are practiced.
- Not the last place is taken by medicinal treatment - antibiotics, painkillers and anti-inflammatory drugs, antimicrobial drugs.
- After relief of the acute form of the disease and the effective course of therapy, the doctor connects the patient with a set of exercises of therapeutic physical training.
- If there is no exacerbation, the massages of the affected area are shown.
In the case of more severe forms of lesion, treatment of tendonitis of the shoulder joint begins with conservative therapy using anti-inflammatory drugs. If the tendonitis of the calcifying form is diagnosed, then a procedure is carried out to remove the salt deposits. To do this, two needles with a large opening are inserted into the joint and saline is washed out with a physiological solution. Then add cold therapy, massages, physical therapy, medical exercises. If such measures do not lead to a positive result, then one must resort to surgical methods of treatment. In this case, it would be appropriate to use an arthroscope - a medical device equipped with a video camera. It is introduced into the lumen of the joint and carries out the necessary manipulations. But a classical strip operation can also be carried out. The term of postoperative rehabilitation usually lasts two to three months, but it's not until three or four months later that you return to your usual active life.
Drug therapy may include multidirectional drugs. They are classified as non-steroid drugs.
This anti-inflammatory and analgesic is not prescribed for patients under 12 years of age. The drug is administered orally( orally) immediately after ingestion. The average daily dosage of the drug is 0.2 g, divided into two doses. Nimesil is prepared immediately before the reception. To do this, pour the contents of the sachet into a glass of warm water and mix well. Duration of treatment is no more than two weeks.
It is not recommended to take the drug if a history of man is diagnosed: ulcerative lesions of the stomach or duodenum, arterial hypertension, internal bleeding, congestive heart failure, severe degree of renal dysfunction, hypersensitivity to the component composition of the drug. Contraindicated drug nimesil during pregnancy and during breastfeeding.
This drug is used externally. Before the procedure, the skin area in the area of inflammation should be washed and toweled. Gel a small layer on the skin( length of the path to 3 cm).Strongly not rub. The number of daily procedures is from three to four. It is not recommended to use more than ten days.
To contraindications of the drug include: acute phase of erosive and ulcerative lesions of the gastrointestinal tract, internal bleeding, dermatoses of a different nature, a tendency to allergic manifestations, renal and hepatic insufficiency, bronchospasm. Nyz is not prescribed to women during pregnancy and lactation, as well as to children under the age of seven.
It has pronounced analgesic properties, while the active substance( ketorolac tromethamine) is an excellent anti-inflammatory agent with a moderate antipyretic effect. In the form of tablets, the drug is prescribed once for 10 mg. In case of severe pathology, the same dosage can be taken, but up to four times a day. The need for re-introduction is determined only by the attending physician.
Ketorol is not recommended for people suffering from individual intolerance to the components of the drug, acute form of erosive and ulcerative lesions of the digestive system, problems with blood coagulability, stroke, respiratory problems. Do not prescribe the drug and women in the period of bearing the baby and breastfeeding, as well as children under 16 years.
This excellent analgesic and antipyretic agent is taken with a lot of liquid. For patients older than 12 years, the starting dose of the drug is 0.2 g, taken three to four times throughout the day. If necessary, a single dose can be raised to 0.4 g, while the maximum amount of a drug that is allowed per day is 1.2 g. For babies from 6 to 12, the drug is prescribed in an amount of 0.2 g four times throughout the day. Do not forget that nurofen can be given to children, whose weight has already reached 20 kg. The gap between the injections of the drug should not be less than six hours.
The drug is categorically contraindicated if there is a history of the patient: cardiovascular insufficiency, severe form of arterial hypertension, ulcer pathology of the gastrointestinal tract, hypersensitivity to the components of the drug, as well as in case of pregnancy( its third trimester), lactation and at the age ofchildren under six years old.
Physiotherapy in tendinitis of the shoulder joint
In the treatment of tendinitis, exercises of physical therapy are simple enough and are no longer directed to the pressure of the patient's joint, but rather to "developing" it, gradually making more deviation. The doctor can offer such exercises:
- To carry it out, you will need a towel( it should be a long one).Throw it through some horizontal pole, holding hands separately for each end. Begin to smoothly lower the healthy upper limb down, while the patient hand will slowly begin to rise to the ceiling. At the moment when the first signs of pain appear, the movement is stopped and locked in this position for three seconds. After this, very smoothly return to the starting position.
- It is necessary to take a stick, ideally a gymnastic one, but any other one will do. Operate the stick vertically on the floor at arm's length from the victim. With a sick hand write the letter "O".The circle should be as much as possible.
- Healthy hand help to fix the palm of a sick hand on a healthy shoulder. With a healthy brush, grasp the elbow of the affected arm. We begin very carefully, without jerks, to raise the elbows by the elbow, following the sensations in the shoulder joint. At the upper point, fix the position for three seconds and smoothly lower it down. Daily, the amplitude of the rise should be slightly increased.
- Hook your hands in the lock in front of you. Smoothly begin to raise your hands up. In this case, the main load goes to a healthy limb. She is like a tug behind a sick person.
- Put the chair in front of you, a little behind him. A healthy upper limb leans against his back, while the body is bent in the lower back, the diseased limb simply hangs. We begin to carry out the patient's hand motion of the pendulum, gradually increasing its amplitude. Movements can be made back and forth, and to the right - to the left, and circular motions.
- Upper limbs raise in front of him parallel to the floor and fold the palm of the left hand to the right elbow, and the palm of the right hand to the elbow of the left arm. In this situation, we begin to swing them in one direction or the other.
The natural treatment of tendonitis of the shoulder joint
Quite additional help can be provided by folk medicine with analgesic and anti-inflammatory properties:
- Curcumin is effective in the treatment of tendonitis, which, with a daily dosage of half a gram, is taken together with food as a condiment. He declared himself as an excellent remedy to relieve pain, and copes well with inflammation.
- Fruit cherries insist in a glass of boiled water and drink two to three times a day as tea. Tanning substances of berries perfectly remove the inflammation and strengthen the effect on the body.
- A glass of collected partitions of the Voloch( walnut) walnut is poured into half a liter of vodka. Insist in a dark place for three weeks.30 minutes before meals, take 30 drops of tincture, washed down with a large volume of chilled boiled water.
- The infusion, made of a mixture of two constituents, perfectly showed itself: the sassaparilla root and the ginger root were taken in equal proportions. A teaspoon of the crushed composition is poured into a glass of boiling water and drunk instead of tea. It is desirable to tea like this twice throughout the day.
- In the first day after the injury, a cold compress should be applied to the sore spot, and warming therapy is preferred on the next days.
Prevention of tendonitis of the shoulder joint
To prevent the emergence of this pathology, prevention of tendonitis of the shoulder joint is necessary.
- Before you begin more active exercise( increased stress), you must first warm up and stretch muscles and tendons.
- If possible, avoid prolonged monotonous monotonous movements.
- Be more attentive, thereby minimizing the likelihood of injuries and static or dynamic overloads.
- The growth of loads and its intensity should be gradual.
- Mandatory load periods should alternate with the rest time.
- Regular exercise and active rest will enable you to constantly keep your muscles and ligaments in tone.
- If in the process of work or playing sports there is pain, the action must be stopped and rest. If the pain symptomatology does not go away after a break, you should consult a doctor.
- In any action, adhere to the safety rules.
Forecast of tendonitis of the shoulder joint
If to speak about the future, the prognosis of tendinitis of the shoulder joint is favorable enough, but the responsibility for the expected result is borne by the patient himself, how responsible he will be in the treatment of physical exercises. After all, you have to force yourself to do this by overcoming laziness.
Any disease is much easier to prevent than to mess with. This statement is acceptable and to such a pathology as tendonitis of the shoulder joint, a fairly common inflammatory disease. There is no need to make great efforts if the therapy has captured the initial stage of the disease. But if the primary process is neglected, the pathology can go into a chronic phase, which already requires much more effort. But the danger is that chronic tendonitis can develop into immobilization of the joint and, as a consequence, atrophy of the muscular and connective tissues of the shoulder joint, which in time can lead to irreversible consequences. So do not rely on "maybe it will pass itself."Only a specialist is able to deliver the correct diagnosis and give effective recommendations.
Tendonitis of the shoulder jointTendonitis of the shoulder is a common inflammatory-degenerative pathology of the shoulder joint, not directly related to acute shoulder trauma. Long, high loads on the shoulder cause microtraumas of the muscle tendons that form the capsule of the shoulder joint, their inflammation and subsequent degeneration.
Causes of tendinitis
Social groups most prone to tendinitis of the shoulder:
- people 40-60 years of age( this is due to the age-related decrease in the tendon elasticity);
- athletes( weightlifters, tennis players, swimmers, baseball players);
- people whose work is associated with an exorbitant burden on the shoulder( painters, builders, loaders, etc.);
- lovers work on the ground, truck farmers;
- women in the climacteric period( hormonal restructuring weakens the tendons).
Factors provoking tendonitis of the shoulder joint:
- Excessive long-term load on the shoulder;
- shoulder injuries;
- rheumatoid articular diseases( gout, arthritis);
- inadequate restorative treatment after surgery and trauma, cervical osteochondrosis( spikes appear in the tendons of the shoulder);
- congenital anomalies of development of the shoulder joint;
- bacterial infections( gonorrhea);
- is an allergy to medical therapy;
- curvature of the spine;Thyroid pathology, diabetes mellitus.
The mechanism of tendonitis
The capsule of the shoulder joint is formed by 5 muscles: supratemporal, small round, subacute, subscapular( form a rotator cuff of the shoulder) and a large biceps( biceps).Since the hollow of the shoulder joint covers the head of the shoulder only partially, the load, when held in the correct position and during movements, falls on the muscle tendons.
Tendon tissue is capable of regeneration. The stress resulting from heavy loads disappears during the rest period. The absence of a respite after hard work leads to microtraining( the emergence of microcracks) of the ligamentous apparatus of the shoulder and the development of inflammation. Most often, the ligaments are damaged at the place of attachment to the bone, then the inflammation seizes the entire muscular capsule and other periarticular structures. With the continuation of the influence of the irritating factor in the tendons, there are spikes with ossification elements. The muscle capsule can rupture because of the significant degenerative thinning of the tendons.
Shoulder tendonitis: symptoms
The onset of tendonitis is associated with a sharp onset of acutely or dull aching pains. Soreness increases when trying to raise your hand up( take a cup from a high shelf, put on a sweater, etc.).Often, increasing pain by night leads to insomnia. Palpation of the damaged tendon is accompanied by soreness.
Important! Unlike arthritis, in which the pain is constant and diffuse, the pain is localized in tendinitis, occurs only when certain movements are performed and disappears at rest.
Passive movements are usually not limited. Depending on the localization of inflammation, there are characteristic signs:
- tendonitis of the cuff of the shoulder - pain spreads over the upper-outer surface of the shoulder with possible irradiation to the elbow;
- small-round tendonitis - a positive resistance response to active external shoulder rotation;
- inflammation of the scapula muscle - a positive resistance response to active inner shoulder rotation;
- biceps tendonitis - pain spreads over the upper-to-front surface of the shoulder, rotation and retraction are not disturbed.
The patient is able to raise his hand only by 90º, keeping even a small load becomes problematic, throwing your arm behind your back is impossible.
Inflammation of the shoulder tendons leads to thickening of the joint capsule. On the side of the lesion, the thickening can reach 2 mm. Local inflammatory reaction is typical: insignificant puffiness, reddening and local hyperthermia. Sometimes the vagina of the damaged tendon forms an effusion with subsequent suppuration.
Degeneration of joint tissues
Tendonitis is often accompanied by calcification of tendons. At the place of micro-ruptures, rough adhesions are formed, which reduce the range of both active and passive movements of the shoulder. Calcifying tendonitis( tendinosis) is characterized by the prevalence of symptoms of degeneration of tendons and their ossification. When listening to the joint with a phonendoscope, and often at a distance, crepitation is heard( squeaking, crunching).The development of degeneration leads to thinning of the tendons, weakness of the limb, the rupture of the joint capsule is possible.
Features of development of shoulder tendinitis
Inflammation of tendons of the shoulder joint develops wavyly with gradual deterioration of the condition.
Intense nagging pain occurs only occasionally with abrupt movements. On the roentgenogram changes in the joint are not fixed.
Pain sensations are more pronounced, limited activity of active movements appears. Radiography reveals the signs of osteosclerosis and periostitis, the formation of osteophytes located on the tubercles of the humerus is recorded.
Painful seizures last up to 8 hours. The pain arises even at rest. Radiography: the interval between the head of the shoulder and the acromion is narrowed, the upper subluxation and erosion at the anterior edge of the acromion are fixed.
The diagnosis of "tendonitis" is established on the basis of the characteristic clinical signs and the conduct of motor tests( the limitation of certain movements).To confirm the diagnosis, the treating specialist can prescribe:
- ultrasound( detection of hypoechoic sites of irregular shape);
- radiography, KR-arthrography( X-ray with the introduction of a contrast agent in the joint);
- MRI of the shoulder joint( tendon ruptures and degenerate areas are defined);
- blockade in the area of the rotator cuff of the shoulder( the introduction of anesthetics in combination with corticosteroids in tendonitis reduces pain).
Treatment of tendinitis
Treatment for tendonitis of the shoulder depends on the stage of pathology.
At the first stage of tendonitis, it is enough to temporarily exclude the load on the shoulder and limit its mobility( immobilization).Avoid pain-causing movements followed by 2-3 weeks. Therapeutic exercises to strengthen the shoulder muscles and increase mobility are carried out with a gradual increase in the load.
Important! Prolonged immobilization increases the risk of developing adhesive arthritis.
Also shown are the preparations of the NSAID group inside by up to 5 days and topically. Local therapy of NSAIDs and conducted 2 weeks.in the acute period. With prolonged flow, ointments that improve blood flow( with capsaicin, etc.) are effective.
Stage II requires supplementation with injection treatment in the joint cavity( lidocaine, bupivacaine in combination with triamcinolone).Anesthetics with short action are used in the diagnosis of pathology, for the therapeutic effect, drugs with long-term action are used. Miorelaxants are used only with pronounced pain and in rare cases( weight of side effects).
Important! Injections with corticosteroids can reduce the production of collagen, thereby reducing the elasticity of the tendons. Therefore, hormonal treatment is carried out only in an acute period with an interval of 2-3 weeks. It is not recommended for tendonitis of the biceps.
Physiotherapy procedures accelerate recovery: electro- and phonophoresis, magnetic currents, cryotherapy, laser therapy, ultrasound and paraffin applications.
In the third stage with the above treatment, a resection of the anterior part of the acromial process is performed. Surgical removal of scar tissue and partial excision of aponeuroses of tendons is shown when the conservative measures are ineffective and the development of the narrowing of the blood vessels.
In order to exclude the development of tendonitis, prolonged serious loads on the shoulder should be avoided, combined with hard work with short-term rest. Do not test your body for strength, hard work should be preceded by warm-up, and it is advisable to increase the load gradually( by 10% in physical exercises).
At the appearance of the slightest soreness, a short rest is needed. The effectiveness of treatment of tendonitis depends on the patient's compliance with all medical recommendations and the proper implementation of special medical exercises.
Tendonitis of the shoulder is a disease of the tendons
Movement and stability of the shoulder joint are possible due to the muscles and tendons:
- they provide true and full volume of movements( the full volume is possible with the help of the scapula);
- muscles and tendons of the rotator cuff hold the head of the humerus in the articular cavity and withstand the necessary gaps between the surface of the head and cavity, and also between the upper tubercle of the joint and the acromion of the scapula.
Tendons are soft tissues and are also prone to inflammatory diseases. If such a process is observed in the shoulder, then tendonitis of the shoulder joint is diagnosed.
Tendonitis refers to periarticular diseases and can be combined with other similar pathologies:
- enthesitis - inflammation of the tendon at the site of its attachment to the bone;
- by tenosynovitis - concomitant inflammation and tendons, and bags;
- bursitis - inflammation of the articular cavities and bags surrounding the tendon.
Muscles of the rotator cuff of the shoulder joint
Bursitis or synovitis usually precedes tendonitis.
Types of tendinitis of the shoulder joint
The following types of humeral tendon pathologies are diagnosed:
- tendonitis of the rotator cuff tendons:
- of the supraspinatus, subacute, circular and subscapular;
- tendonitis of the biceps tendon( biceps);
- calcifying tendonitis;
- partial or complete rupture of tendons.
Causes of tendinitis
The development of tendonitis may be preceded by:
- Chronic elevated sports or occupational loads:
- of tennis players, volleyball players, baseball players, weightlifters, gymnasts, acrobats, etc.;
- builders, drivers, movers, etc.
- Permanent microtrauma.
- Reactive, infectious, allergic, rheumatoid arthritis.
- Degenerative changes in bone structures( osteoarthritis).
- Cervical osteochondrosis.
- Long-term immobilization of the shoulder after trauma or surgery.
- Congenital dysplasia of the shoulder joint and other causes.
Symptoms of tendinitis of the shoulder joint
A healthy shoulder joint, thanks to the hinge type, provides the full volume of motion during flexion, extension, retraction, reduction and rotation( rotation).A limited angle of movement and the resulting pains speak of inflammation of the tendons, bags and capsules, as well as of injuries in the joint itself or its plexus.
How to distinguish inflammation of different tendons
- Symptoms of tendonitis of the supraspinous tendon and subacromial bag:
- With the shoulder leaning over an angle exceeding the range of 70 to 90 °, there are painful sensations due to the compression of the tendon of the supraspinum with the humerus muscle to the acromion of the scapula and compression of the subacromial sac.
- A further increase in the angle of lift leads to unlocking the clutch of the head of the shoulder with the acromion( at this point you can hear a click), after which the pain passes.
- Symptoms of tendonitis of the subacute and round muscle tendons:
- Pain in rotational external movements( when trying to get something from the top shelf or comb).
- Symptoms of inflammation of the tendon of the subscapular muscle:
- Pain in internal rotation( retraction of the hand behind the back).
- Tendonitis of the biceps tendon:
- Painful sensations at the moment of flexion of the arm in the elbow joint, either with lifting of the gravity, or with supination( turning outwards) of the forearm, for example, when the door is closed with a key.
Calcium deposits in the tendon of the supraspinatus of the shoulder
Calcification of the tendons can occur:
- in the advanced stage of arthrosis, when the lesions extend beyond the cartilage;
- in places of micro-injuries and injuries.
Around the calcium deposits in the tendon tissues begins inflammation. Due to the fact that it is impossible to excrete calcinates, it is already difficult to cope with such tendonitis, and it becomes chronic.
How to distinguish tendonitis from other pathologies
- Symptoms of acromioclavicular joint damage:
- Leaving the arm at the maximum possible angle of 180 ° is accompanied by pain.
- Anterior subluxation of the head of the shoulder:
- Severe shoulder pain and severe limb movement combined with a modified contour of the shoulder with a forward and downward shifted head.
- Retractile capsulitis:
- All movements( both passive and active) are restricted.
- There are no inflammatory and degenerative inflammations in the joint itself, but there are signs of capsular fibrosis and regional osteoporosis.
- Pulmonary exit syndrome, plexitis:
- Pains are not associated with movements, unlike tendonitis, and are caused by:
- by compression of the neurovascular bundle emerging between the clavicle and the first rib;
- with inflammation of the brachial plexus.
- Pains are not associated with movements, unlike tendonitis, and are caused by:
Separately it is necessary to talk about a subacromial syndrome, as it refers to violations of stability in the shoulder joint and can create the ground for strains of the tendons and even a rupture.
The compression of the tendon and subacromial sac is due to a narrowing of the space between the head of the humerus and the acromion of the
. The disbalance of the muscles and tendons of the rotational cuff results in a reduction in the distance between the acromial process and the head of the shoulder joint. When the shoulder moves tendon supraspinatus, subacute, subscapular and round muscles all the time is traumatized. This is the subacromial syndrome.
There are three degrees of subacromial syndrome in the tendons:
- Inflammation, edema and hemorrhage.
- Fibrous changes, thickening, partial tears.
- Complete gaps plus degenerative changes in the bones of the joint with the involvement of the acromion of the scapula and humerus of the humerus.
- Primary diagnosis is based on a test assessment of pain in motion and palpation.
- Diagnosis can be confirmed by radiography, however, it mainly detects calcium deposits.
- A more accurate examination( MRI, CT) can reveal degenerative inflammatory processes in the tendons, as well as micro-trauma.
Treatment of inflammatory diseases of tendons
- At the beginning, the restriction of movements is introduced for two to three weeks.
- For the removal of pain and inflammation are prescribed orally NSAIDs:
- nimesil, ketorol, nurofen.
- Local treatment in the form of ointments and gels - with NSAID content and irritant effect:
- Nise, capsaicin.
- For severe pain, glucocorticoids are injected into the periarticular tissues of the shoulder( except for biceps tendonitis).
- Physiotherapy methods are effective:
- electro- and phonophoresis;
- shock wave therapy( UVT) - especially this method is effective in calculating tendinitis.
Therapeutic exercise and prevention
LFK is the main treatment for tendonitis. Active movements( the rotation of the shoulders, the lifting of the arms above the head, the swing, the spreading of the hands to the sides) should be used when the pain subsides.
In a period when the movements are still causing pain, you need to use the exercises of such a plan:
- Postisometric relaxation: a combination of tension in a diseased shoulder joint followed by relaxation without movement.
- Passive exercises with a diseased shoulder using a healthy arm.
- Tightening of a sick hand with the help of improvised means( rope or cord, thrown over a pipe or crossbar at the top).
- Leaving a sick hand to the side with a support on a gymnastic stick.
- Pendulum movements of the patient with a hand in a relaxed state.
Tendonitis of the shoulder joint will not develop :
- If we dose the load, limiting their intensity and duration.
- Invalid methods for weak general training:
- did not do anything for a year, but suddenly they wanted to dig up a plot at the dacha for a day;
- independently decided to plaster the walls and ceilings, etc.
- Before any active load, whether sports or work, an easy warm-up warm-up is needed.
- Arrange necessarily rest breaks for long periods of time.
Video: Treatment of tendinitis of the shoulder.
Tendonitis of the supraspinatus: an effective treatment without surgery in the clinic Stopartros( Moscow)
Several muscular groups participate in the shoulder joint movements, each of which is responsible for a certain direction of movement. The muscular muscle is responsible for leaning the shoulder to the side, inflammation of the tendon of the supraspinous muscle accompanied by the appearance of pain in the shoulder is called the tonsil of the supraspinatus.
Who has the greatest risk for tendonitis?
It is believed that tendonitis of the tendon of the supraspinatus affects people who engage in sports professionally, as well as those who have a fairly active and mobile way of life. Daily exhausting workouts make themselves felt. However, in people who have a full-fledged way of life, inflammation of the tendon of the supraspinous muscle can develop, for example, when performing an exercise that is not peculiar to physical exercise - washing windows, chipping firewood, etc., that is, the load that man does not perform daily and is considered critical enoughfor him.
The most common place of inflammation occurs where the bone and tendon connects. During the progression of the disease and maintaining the load on the shoulder, other muscles can also be involved in the inflammatory process: the subacute and subcellular muscles of the shoulder. Very often, when examining patients with tendonitis of the supraspinatus, tendonitis of these muscles is also revealed.
Causes of tendonitis
Tendonitis also has a number of reasons that will help you identify the disease at an early stage.
- intensive training and load,
- bacterial infections and rheumatic diseases.
In addition, it is also necessary to take into account the features of the anatomical structure of the body, which may have a predisposition to the appearance of this disease.
Tendonitis of supraspinatus symptoms
The most famous symptom is pain in the tendon area with active shoulder movement, the pain is localized in the deltoid muscle region, more along the anterior surface of the shoulder joint. Note that with passive movements, pain can not disturb a person at all. Active movement in the shoulder, sometimes accompanied by a crunchy sound and clicks. This is due to the thickening of the tendon against the background of inflammation, and the appearance in its thickness of areas of scar tissue( fibrosis) or calcium crystals. In addition, the injured area may slightly swell.
If you find yourself experiencing one of the symptoms, consult a doctor for advice. He will prescribe you a course of treatment and help get rid of the pain in the shortest possible time.
Diagnosis of tendonitis of the supraspinatus
- US-diagnostics Non-invasive examination of muscles, ligaments, tendons, joints with the help of ultrasonic waves.
- Radiography It is used for bone injuries - dislocations and fractures, arthrosis of joints, osteochondrosis of the spine.
- Analyzes Allow to diagnose tissue inflammation, biochemical disorders, to determine the level of calcium and phosphorus in the blood.
- Magnetic resonance imaging High-precision method for diagnosis of joints and spine with informativeness up to 99%.
Treatment of tendonitis of the supraspinatus
In order to get rid of the disease, first of all it is necessary to create rest to the affected area of the body, excluding all physical activity. The most effective and rather popular method is the injection of corticosteroids into the affected area. Such injections quickly relieve pain and eliminate the disease in the shortest possible time. However, this should not be taken into account because in addition to reducing inflammation of the tendon, such injections lead to an increase in the fragility of the tendon, increasing the risk of its complete rupture. After such a procedure, the patient is credited with physiotherapy, which helps to relieve the symptoms of the tendon.
It should be noted that the calcifying tendinitis of the supraspinatus can be treated not only by the above methods. In the last years the method of shock wave therapy has been the most successful - the sound wave penetrates deeply into tissues, causing destruction of pathological tissues - scars, calcium crystals, which allows one to get rid of the cause of inflammation of the tendon and thereby remove the inflammation completely.
In conclusion, I would like to note that you can use the services of our clinic. The Medical Center Stopartrosis specializes in the treatment of tendonitis of the supraspinatus, we use modern and non-surgical methods of treatment, the effectiveness of which is proven by thousands of recovered patients.
Treatment of tendinitis of the shoulder, arthroscopy of the shoulder joint, anatomy of the shoulder joint
Moscow, Berzarina 17 bldg.2, metro Oktyabrskoe pole
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In 2009, he graduated from the Yaroslavl State Medical Academy, majoring in "medical business".
From 2009 to 2011 he passed clinical residency in traumatology and orthopedics on the basis of the Clinical Hospital of Emergency Medical Care. N.V.Solovyov in the city of Yaroslavl.
From 2011 to 2012 he worked as a physician as an orthopedic traumatologist in the ambulance hospital No. 2 in Rostov-on-Don.
Currently he works at the clinic "Medline-Service" and at the Moscow doctor's clinic in Moscow.
2012 - training course in foot surgery, Paris( France).Correction of deformities of the forefoot, minimally invasive operations with plantar fasciitis( heel spur).
2014 - took part in the V All-Russian Congress of the Society of Hand Surgeons, Kazan.
2014 - Advanced training "The use of arthroscopy in traumatology and orthopedics"
Scientific and practical interests: foot surgery and hand surgery.
Tendonitis tendonitis and podkromialno-fake bursitis. Diagnosis and treatment
Tendoniditis and podkromialno-fake bursitis are discussed together, because pathological processes are closely interrelated. Tendonitis is a common cause of shoulder pain and is usually associated with the degenerative changes that occur in this tendon in old age. Tendons of small round, subacute, supraspinatus and subscapular muscles go together and attach to the large and small tubercle, forming a rotational cuff.
Tendonitis can develop in any of these tendons, but most often it occurs at a "critical point" where the cuff passes in the immediate vicinity of the coracoid-acromial arch, where it is formed by the site of the tendon of the supraspinatus.
The tendon of the supraspinous muscle , together with other tendons forming the rotational cuff, is subject to age-related degeneration and, as a consequence, to repeated injuries. When these tendons pass under the acromial process and the beak-acromial arch, small discontinuities appear in these relatively avascular structures.
The healing process is accompanied by by the inflammatory response of , leading to tendonitis of the tendon of the supraspinatus. A patient with a disease at this stage usually complains of deep aching pains in the shoulder, which increase with retraction and internal rotation. As a result of the inflammatory reaction, particles of calcium salts are deposited inside the tendon. This phase is called hidden, it does not appear on radiographs. With further development of the process, the tendon swells, as calcium retains water and the inflammatory process continues. This is the absorption phase.A. The tendon of the supraspinatus and the counterfeit bag are normal. Pay attention to the close contact of the tendon-bag complex with the acromial process and the beak-acromatic arc( the arc is removed).B. The tendon is infiltrated by inflammatory cells, and persistent relapses cause calcium deposition. B. Calcium deposits lead to swelling of the tendon( "swelling phase").D. With further development of the process, calcium particles merge( "calcification phase"), which is already visible on the roentgenogram. D. Calcium absorbs water, which causes the tendon to bulge into the overlying bag( "swelling phase").E. With further development of the process, a breakthrough of calcium and inflammatory exudate occurs in the overlying bag. G. As the liquid accumulates at opposite ends of the bag, the latter takes the form of an hourglass. H. If treatment is started on time, the full resolution of the process can occur at any stage before the breakthrough. I. After the breakthrough, the constant recurrences of tendonitis and bursitis inevitably lead to the development of chronic adhesive bursitis.
Particles calcium are joined and finally become visible on the roentgenogram. This process is called the phase of calcification. Calcium particles absorb water from surrounding tissues, which leads to the swelling of the tendon and the filling of a podkromialno-fake bag that forms the roof of the tendon of the supraspinatus. This stage is called the swelling phase, in which the tendon becomes an obstacle to free painless withdrawal, and the patient complains of increasing pains in the tendon.
Attempting the tendon to move inside the beak-acromial arch, at about 70 ° of the lead, causes severe pain. As the process develops, the swollen tendon eventually breaks into the overlying synovial bag, which causes a strong inflammatory reaction leading to bursitis. At this stage of the disease, the patient often complains of severe pain that precedes the rupture, then deep aching pain in the shoulder, and finally, the abduction becomes relatively free.
This fluid and inflammatory transudate can lead to edema of the pacromial synovial bag and its deformation in the form of a dumbbell allowing partial withdrawal and reduction limited by the enlarged ends of the synovial bag;the hand is delayed at approximately 30 ° of the lead. Further reduction or withdrawal leads to increased pain, and the patient resists any attempt to raise his hand above this point. The whole process can be resolved before the breakthrough stage by the complete restoration of the tendon and synovial bag.
After the breakthrough, although the process of in the treatment of can be resolved, the tissues never return to their original state. The process can progress and lead to chronic bursitis and, finally, adhesive pericapsulitis( adhesive bursitis).
Clinical picture of supraspinous tendinitis and podkromialno-fake bursitis
The disease is mainly affected by women aged 35-50 years. It is more often observed in people leading a sedentary lifestyle. Patients usually complain of deep washing pain in the shoulder, irradiating to the deltoid region. Pain can irradiate to the entire limb. On examination, spot soreness is usually found in the place of the tendon of the supraspinatus, which is the above-described "critical point".
The pain intensifies with the lead and internal hand rotation .The beginning, as a rule, gradual, but can be sharp after an overload of a humeral joint or at employment by unusual work when it is necessary to hold a hand longly lifted upwards. After 2-3 days, pain in the shoulder increases with increasing intensity. After the breakthrough into the bag, the formerly strong pain is replaced by a deep aching, as the fluid moves inside the bag laterally and the patient regains relatively free outflow.
In the latent phase and absorption phase( benign tendonitis ), radiographs are usually negative. In other phases, calcification and cystic changes along the large tubercle, accompanied by sclerosis, become visible. However, these changes develop only when the process is chronic. Calcification can sometimes be found in patients with asymptomatic disease.
Treatment of supraspinous tendinitis and podkromialno-fake bursitis
In the initial acute phase , ice packs are applied to the shoulder for 20 minutes to adequately cool the deep tissues of the shoulder. The patient should immobilize the shoulder joint for a short time in the acute inflammatory phase, prescribe salicylates or other anti-inflammatory drugs. In severe cases, decreasing doses of prednisone or injections of a steroid analgesic mixture( introducing a small amount every 1-2 mm) are applied to the place of greatest soreness.
By , the acute process is prescribed hot compresses and massage instead of cold. The best forms of thermal procedures are diathermy and ultrasound. All these patients are recommended circular exercises to prevent rigidity of the shoulder joint. Patients with acute calcifying bursitis may find it useful to aspirate calcium with a needle with a large lumen if the calcium has a paste-like consistency.
After this, steroid hormones are introduced into the synovial bag of .It should be emphasized that the shoulder should never be immobilized for any relatively long period of time, since in patients older than 40 this can lead to the development of an adhesive capsulitis.
Tendonitis of the rotator cuff of the shoulder is a pathological condition in which inflammation of the soft tissue structures of the surrounding shoulder joint occurs. It can be: capsule of the joint, tendons of the shoulder bicep, supraspinatus or all taken together. This inflammation causes limitation of movements and pain in the shoulder joint area. Anatomy of the shoulder joint
Anatomy of the shoulder joint is as follows: it consists of two bones, it is the humerus( namely, the head of the humerus), the scapula( namely, the articular process of the scapula).Surrounded by a fibrous capsule, which consists of ligaments.
These ligaments perform a very complex function - they keep the humerus in the articular cavity of the scapula fairly firmly and simultaneously allow the hand to carry an incredibly large range of movements.
Causes of tendinitis of the shoulder
- Wrong treatment of the shoulder joint after trauma or surgery;
- Long-term immobilization( gypsum, dressing gown);
- Cervical osteochondrosis;
- Injuries, intense physical activity;
- Diabetes mellitus and thyroid disorders are risk factors for the development of this disease.
The disease affects 1 in 50 adults at a certain stage in their lives, mostly at the age of 40-60 years. Women suffer more often than men because of hormonal changes during menopause.
Shoulder tendonitis symptoms of
Shoulder tendonitis occurs when the joint capsule becomes inflamed, thickens and the surrounding tissues are involved in the process. These processes dramatically affect the amount of movement in the shoulder joint due to severe pain. If the patient for a long time limits his movements in the capsule, spikes are formed and even if the inflammation abates, it is very difficult to develop a normal amplitude of movements. That is why exercise therapy is so important in the phase of inflammation and pain. There is a wide range in severity and duration of symptoms. Some types of periarthritis can develop as a result of cicatricial changes after trauma or surgery. That can quite sharply limit the movement.
- The main symptom of tendonitis in the shoulder of patients is the restriction of movements in the shoulder joint in everyday life: it is hard to get a cup from the cupboard, take something off the shelf, sometimes pain occurs when donning clothes to the shower and most unpleasant during sleep.
- Due to the development of the contracture of the shoulder joint( restriction of movements), the amplitude and passive movements decrease. That is, the doctor at the inspection can not lift the patient's relaxed arm. This is a rather serious stage( neglected), which is very difficult, and sometimes impossible, to cure to the end. The patient can not independently wind his arm behind his back, raise it more than 90 degrees. Slowly starts to atrophy deltoid muscle, biceps.
- Pain in the shoulder joint. Dull, aching, but can become acute with irradiation( movement) on the shoulder to the elbow joint area.
Shoulder tendonitis diagnosis of
The diagnosis of tendonitis of the shoulder is usually set, based on patient complaints, medical history and physical examination. The physician will gently move the shoulder in all directions to determine if passive movements are limited and painful. A range of movements when someone moves the shoulder is called "passive movement."The physician should compare this with the range of movements that the patient can perform-the range of "active movements.") In patients with tendonitis, both active and passive movements are restricted.
If the examination suggests that limiting only active movements is a secondary symptom,there may have been damage to the rotator cuff of the shoulder( muscles pulling the shoulder, raise the arm above 90 degrees.) One of the key signs that helps distinguish periarthritis from damage to the rotator cuff of the shoulder is the amplitude of the active movementsIn the absence of data on the trauma( which the patient may not remember) or the operation, an MRI is prescribed to identify the thickening of the capsule, the tendon sheaths, and the compression of the rotator cuff between the acromial process of the scapula and the humerus head
Tendonid tendonitis andpodkromialno-fake bursitis Diagnosis and treatment
The pathological condition of the joint, caused by inflammatory processes in the tendons and other elements of the shoulder, formed by soft tissues, is called tendinitis.then one of the most common diseases of the shoulder joint, not related to trauma, and are the result of inflammation of the tendons of muscles.
The disease is well known to many people experiencing in their activities a significant load on the muscles of the shoulder joint. First of all, they include sportsmen and people engaged in agricultural work.
Older people( 40-60 years) are more likely to suffer from tendonitis, and women in this group are more prone to tendon inflammation due to hormonal adjustment in the coming menopause at this time.
Dangerous tendinitis is that if untimely access to a specialist, a rupture of tendons forming a muscle capsule may occur with an unpredictable result.
Tendonitis is observed in several forms. It happens to be calcifying, appearing because of the accumulation in the tendons of calcareous formations( crystals of calcium phosphate).
No less known is tendonitis of the shoulder joint rotas, which occurs due to ruptures of the rotaries, that is, supporting the shoulder in its joint of muscles and tendons.
Constant overvoltage of the shoulder girdle due to intense physical exertion causes the appearance of microtraumas of tendons of the supraspinatus, which leads to the launch of an inflammatory process in them - tendonitis. Most often it is provoked by athletes because of the friction of the tendons about the bone when performing physical exercises.
The most common causes of the disease include:
- A lot of physical stress on the shoulder joint for a long time;
- Wrongly formed tendons;
- Features of anatomical structure of people, for example, limbs of different length;
- The presence of various injuries associated with the shoulder joint;
- Infectious processes caused by the presence in the body of bacteria of various kinds;
- Presence of rheumatic diseases, such as arthritis or gout;
- Incorrect posture;
- Allergic reactions of the body to certain medications.
In the formation of the joint of the shoulder, the joint cavity and the head of the bone are involved. Four tendons, together with the ligaments constituting the rotary cuff, keep the head in the shape of a ball in the cavity, allowing the shoulder to function reliably. Damage to tendons, caused by heavy loads on them, often cause tendonitis.
The inflammation inherent in this disease begins in the supraspinous muscle, involving in the process an articular capsule, other muscles, a subacromial bag. In the event of pain, a person begins to limit the hand in motion, which leads to the formation of adhesions in the capsule. Spikes, in turn, become limbs of mobility of the shoulder, lead to new micro-fractures in soft tissues, followed by further inflammation of the tendons and the following adhesions and small scars. It ends with micro-fractures of less strong tendons, which are thinned and degenerate against the background of inflammation.
A clear sign of tendonitis of the shoulder is the appearance of sharp pain in the damaged joint with active movement and the presence of swelling on its surface. The pain in this case can be of a different nature - from acute to dull and aching. The probing of the intercampoon groove also causes painful sensations. Contracture( limited mobility due to contraction of soft tissues) joint significantly reduces the range of any human movement.
Symptoms of calcifying tendinitis are more diverse.then not only the sensation of pain, but also some stiffness, limited opportunities in the movements of the shoulder. A sign of this tendinitis is the appearance of a crunch in the shoulder when the arm moves.
In some cases, symptoms are not observed at all.
Tendonitis rotary can be distinguished by the pain when the arm rises or is thrown forward. Progressive disease does not allow even minor movements to be done: squeeze a hand or push something, get the book off the shelf, without experiencing any pain.
The late stages are characterized by the sensation of pain, both with the movement of the hand, and in its calm state. Often the pain is given in the elbow joint, a not pronounced swelling appears.
Tendonitis is diagnosed mainly during visual examination. Sometimes it is differentiated from the trauma of the rotary humeral cuff. They differ only in the volume of passive and active movements, which is the same for tendinitis, and different( less active) in case of trauma to the rotary cuff.
If an orthopedist has doubts about the correctness of the diagnosis, the patient also receives a referral to magnetic resonance shoulder therapy. Tendonitis in MRI is determined by the thickened shell of the tendons and the joint capsule, and the trauma is indicated by the presence of a rupture.
When diagnosing, a radiograph of the shoulder joint is performed, which allows excluding diseases such as arthrosis or the consequences of dislocations and fractures.
Calcific tendonitis is determined on X-ray images of calcification sites.
Tendonitis has 3 stages of the disease, defined by the roentgenogram, according to which treatment is prescribed.
- The first stage. At the initial stage, outpatient treatment is prescribed with recommendations for limited movements in the affected limb. But the immobilization of the joint( maximum immobilization) is contraindicated, because in this case inflammatory processes in it, the development of adhesive arthritis are possible. To relieve the sensation of pain and eliminate the inflammatory process in the shoulder joint, an orthopedist prescribes anti-inflammatory drugs. Exercise exercise therapy completes this stage of treatment. They are aimed at the return of normal operation of the shoulder joint and strengthening of muscle groups.
- The second stage. If the patient has this stage of the disease, the treatment is supplemented with glucocorticoids and local anesthetics, which are administered intra-articularly. The first drugs relieve the inflammatory process in the tendon, and the second can achieve rapid anesthesia.
- Third stage. The advanced stage of tendonitis is most difficult to treat. The procedures performed in the previous stages are ineffective here. There is a need to remove( resect) a part of the acromion. Sometimes, redression of the shoulder is indicated under general anesthesia, in which the doctor "rips" the joint capsule, which makes it possible to increase the amplitude of motion. There is also an operation to dissect the capsule and the rotator cuff, which can be in the classical version( open access) and arthroscopic( small incision).After the operation, physiotherapeutic procedures and exercise therapy are again appointed, and the rehabilitation period, as a rule, lasts up to three months. Treatment of calcifying tendonitis consists in the elimination of calcareous formations and inflammatory processes in the shoulder. It can be conducted conservatively or operatively.
If the form of the disease is defined as mild, then the following procedures are limited:
- electrotherapy( pain relief).
- bone-correlated shock wave therapy( impact on the diseased portion of low frequency pulses with increased vibration).
- Subacromial infiltration( intensive anesthesia).
- Ultrasonic massage( providing enzymatic activation and improving the supply of cells with oxygen).
- Joint flushing( by way of puncture, the joint is flushed to remove lime formations).
If the desired effect is not achieved with such treatment, the orthopedic physician prescribes surgical intervention, during which an incision is made and the calcareous mass is removed through it.
Rehabilitation consists in wearing a special bandage and performing prescribed by the doctor exercises to prevent tissue death.
Tendonitis rotary in an easy stage is treated by restriction in the movement of a sick hand and ensuring its rest.
Severe same degree of disease, in which a complete rupture of the tendon is determined, requires surgical treatment.