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 with it. 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 joint
The pathological condition associated with the inflammation of the tendons of the muscles that surround the shoulder joint is commonly called tendonitis. The disease develops in adulthood after reaching 45-55 years, especially in women during menopause, which is associated with hormonal changes in the body. However, it can occur in young people as a result of intense sports or heavy physical labor. Tendonitis of the shoulder joint responds well to conservative treatment in the early stages of the formation of the disease. With the progression of the pathology and the chronicization of the disease, one has to resort to surgical intervention, but even in this case it is difficult to achieve complete restoration of the motor function of the upper limb.
Causes of the disease
The shoulder joint has a complex structure that allows you to make movements in a large volume. The articulation forms the head of the humerus, which is immersed in the articular cavity of the scapula. Around the bones are tendons and ligaments forming a rotator cuff of the shoulder and holding the joint in a physiological position. The cuff consists of the tendons of the subscapular, subacute, small round, supraspinous muscles of the shoulder and a long head of the biceps. Under the influence of adverse factors, the rotational cuff can be damaged by the acromioclavicular joint, beak-acromial ligament or anterior part of the acromion during movements of the upper limb.
Location of the tendons of the muscles that are affected by the shoulder tendinitis
The causes of shoulder tendinitis include:
- professional sports( tennis, handball, basketball, volleyball, javelin throwing, gymnastics);
- profession related to physical labor( builders, masons, plasterers, painters);
- diseases of the musculoskeletal system( osteoarthritis, gout, rheumatoid arthritis, osteoporosis);
- osteochondrosis and intervertebral hernia of the cervical vertebral column;
- congenital or acquired dysplasia of the shoulder joint and underdevelopment of the ligamentous apparatus;
- autoimmune and allergic pathology;
- is a chronic infectious process in internal organs;
- frequent colds, hypothermia;
- disease of the endocrine system;
- prolonged immobilization of the upper limb due to fractures, dislocations, subluxations;
- improper management of the rehabilitation period after surgical intervention in the shoulder region;
- injury of the upper half of the body.
At the onset of the disease, the inflammatory process occurs in the tendons of the muscles of the shoulder joint, the most common are the supraspeed muscle fibers. Absence of treatment leads to the spread of pathology to surrounding soft tissues - articular capsule, subacromial bag, muscles.
In the joint structures degenerative processes are formed, which causes microtraumatism during the movement by hand and contributes to the progression of the disease. With a long course of tendonitis formed spikes, which violate the full activity in the shoulder joint. One of the varieties of the disease is calcifying tendonitis, which develops as a result of the deposition of calcium salts in the periarticular tissues, calcification, triggering the inflammatory process. This variant of the disease is more often formed in the senile age as a result of involutive processes in the body.
Clinical manifestations of
Due to inflammation of the tendon muscles in the shoulder area thicken and cause discomfort in certain types of movement in the initial stages of the disease, and in neglected cases of the pathological process - at rest. It is the pain syndrome that causes patients to seek medical help. It should be noted that significant discomfort occurs at the stage of serious anatomical disorders in the soft tissues of the shoulder joint. Therefore it is important at the first symptoms of tendinitis to seek medical advice for diagnosis of the disease and timely therapy.
Calcinate for inflammation of tendons of the shoulder joint on the X-ray diffraction pattern
Depending on the manifestation of the pain syndrome, 3 stages of the pathological process are distinguished.
- The first stage - the emergence of discomfort only during sharp movements of the patient with his hand( swing up, tipping behind his back).
- The second stage is the appearance of pain after intense physical exertion on the upper limb.
- The third stage - the pain syndrome does not depend on the severity of the load, occurs at rest and at night, the attack lasts 5-8 hours.
Clinical manifestations of the disease include:
- pain when lifting the upper limb forward above the waist;
- impossibility to throw your arm behind your back;
- crunching in the shoulder joint area when moving;
- swelling, less reddening of the skin and increased local temperature in the lesion site;
- at the initial stages of inflammation, the pain is muffled, as the pathology progresses, it becomes sharp and more intense;
- increased discomfort in the evening, painful syndrome during sleep when turning to the side of the aching joint;
- spread of pain along anterolateral shoulder surface, at the elbow joint;
- decrease in the volume of passive and active movements of the upper limb.
The increase in the intensity of painful sensations causes patients to spare the affected hand and deliberately reduce the movements in the shoulder joint. This causes atrophy of the musculoskeletal system, the appearance of adhesions and contracture of the shoulder, which leads to a permanent disability.
When the first clinical signs of the disease appear, you need to see a doctor to diagnose the pathological process. The earlier the disease is detected, the faster it is possible to achieve recovery and reduce the likelihood of the transition of tendonitis into a chronic form. Diagnosis of the disease includes the following stages:
- collection of patient complaints( nature of pain, possible causes of the disease, concomitant pathology);
- examination of the patient( listening to breathing, cardiac tones, palpation of the shoulder joint and surrounding muscles, checking the volume of passive and active movements of the affected upper limb);
- laboratory diagnostics( general analysis of blood and urine);
- instrumental diagnostics( radiography, ultrasound, CT, MRI);
Kind of tendon of the shoulder joint for arthroscopy
Based on the results of diagnosis, the doctor makes the final diagnosis and determines the therapeutic tactics. In the general analysis of the blood, signs of inflammation( high ESR, leukocytosis) are revealed, on the roentgenogram, the formation of calcicates is detected. The most informative is computer( CT) and magnetic resonance( MRI) tomography, which allows to determine pathological changes in tendons and soft tissues. Ultrasound( ultrasound) helps to study the condition of the internal structures of the joint, ligaments, muscles, vessels and conduct differential diagnosis with other diseases. Arthroscopy is performed with the help of endoscopic equipment, which allows direct examination of the affected anatomical structures.
Depending on the stage of the pathological process, you can treat tendonitis with both conservative and surgical methods. With the timely access of the patient to the doctor, non-invasive methods of therapy are prescribed, including:We also recommend reading: Treatment of shoulder and shoulder periarthritis
- medicines: antibiotics in cases of the infectious cause of the disease, taking into account the sensitivity of pathogenic microflora;non-steroidal anti-inflammatory drugs( NSAIDs) - nimesil, nise, diclofenac;hormonal preparations - splitting of the shoulder joint by glucocorticoids( blockade);analgesics for relief of pain - cfalgin, tylenol, pentalgin.
- physiotherapy in the period of remission of acute process: electrophoresis with analgin, lidase;shock wave therapy;applications of paraffin;ultrasound, magnetic therapy, laser therapy.
- exercise therapy( LFK).
In an acute period of illness, the diseased joint is relieved by limiting the mobility of the shoulder, however, complete immobilization is contraindicated because of the risk of rapid formation of tendon adhesions. To treat tendonitis by radical methods is prescribed with ineffectiveness of conservative therapy and the formation of a stable contracture of the shoulder joint. Conducted redress of the shoulder under anesthesia, in which the surgeon tears the capsule of the joint through active movement in the joint, which allows you to get rid of adhesions.
Splitting of the shoulder joint with glucocorticoids effectively removes pain
In severe cases, open surgical procedure is used with the dissection of the rotator cuff of the shoulder in the area of adhesions and fibrosis. In recent years, less traumatic surgery with arthroscopic equipment has been used. In this case, the endoscope is inserted through a small incision of the skin and makes an accurate dissection of the scar tissue. Rehabilitation after surgical treatment is from 2 to 3 months.
In order to prevent tendonitis, it is necessary to regularly exercise or exercise to strengthen the muscles and increase the elasticity of the tendons involved in the movement of the shoulder joint. Professions with intensive physical activity and monotonous movements of hands require optimization of the work process by alternating work with full periods of rest. Be careful when lifting weights and performing sudden movements with upper limbs, which can lead to a trauma to the tendons. It is equally important to avoid hypothermia, infection, timely treatment of chronic diseases.
Tendonitis of the shoulder joint has a favorable prognosis for recovery in the early diagnosis of the pathological process and complex therapy. Chronic course of the disease causes limitation of mobility of the joint due to the formation of fusion, fibrosing of the tendons and capsule, the formation of calcifications in soft tissues. Progression of tendonitis in the absence of therapeutic and preventive measures can lead to disability and a decrease in the quality of life.
Tendonitis of the shoulder is a disease of the tendons
Movement and stability of the shoulder joint is 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 restrain 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 susceptible 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 of both the tendon and the bag;
- bursitis - inflammation of articular cavities and bags surrounding the tendon.
Muscles of the rotator cuff of the shoulder joint
Bursitis or synovitis usually precedes tendonitis.
Types of tendonitis 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 hinged type, provides the full volume of motion during bending, 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 sac:
- When the shoulder is pulled over an angle exceeding the range of 70 to 90 °, there are painful sensations due to pressing the humerus tendon of the supraspinatus to the acromion of the scapula and compression of the subacromial sac.
- A further increase in the angle of lift leads to unlocking the coupling of the head of the shoulder to the acromion( at this point you can hear a click), after which the pain passes.
- Symptoms of tendonitis of tendon of subacute and round muscle:
- 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, conjugated either with lifting of 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 supraspinum muscle 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-injury and damage.
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 movements 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.
- Breast exit syndrome, plexitis:
- Pains are not associated with movements, in contrast to 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, in contrast to tendonitis, and are caused by:
Separately, it is worthwhile to talk about subacromial syndrome, as it refers to impaired stability in the shoulder joint and can create the soil for deformities of the tendons and even rupture.
Depression of tendons and subacromial sac due to a narrowing of the space between the head of the humerus and the acromion of the
. The imbalance of the muscles and tendons of the rotational cuff results in a decrease 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 the tendons
- At the beginning, the restriction of movements is introduced for two to three weeks.
- For the removal of pain and inflammation, orally, NSAIDs are prescribed:
- nimesil, ketorol, nurofen.
- Local treatment in the form of ointments and gels - with an NSAID content and irritant effect:
- nise, capsaicin.
- For severe pain, glucocorticoids are injected into the periarticular tissues of the shoulder( except for biceps tendonitis).
- Methods of physiotherapy 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 still cause 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 a crossbeam 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.
- Unacceptable emergency methods with weak overall fitness:
- 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, be it sports or work, you need an easy warm-up warm-up.
- 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 Stopartrose( Moscow)
Several muscular groups participate in the movements of the shoulder joint, 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 of 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 workouts and loads,
- 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
- Ultrasound diagnosis Noninvasive 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 diagnosing joints and spine with an informative value of up to 99%.
Treatment of tendinitis of the supraspinous muscle
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.
Tendonitis of the shoulder joint
The commonest disease of the shoulder joint, not associated with trauma, is the tendonitis of the tendons of the muscles that form the muscle capsule. The tendons of these four muscles attach to the large and small tubercles of the humerus. In the intertubercular furrow passes the tendon of the long head of the biceps muscle, starting from the superarticular tubercle of the scapula.
When the muscular capsule breaks, the tendon of the supraspinous muscle first of all is damaged. Almost always the tendonitis of the tendon of the supraspinatus develops first, then the inflammation gradually spreads to the entire muscular capsule, the subacromial bag, the joint capsule and other structures, eventually leading to ankylosis of the joint.
The cause of tendonitis of the tendon of the supraspinatus is the damage to the muscular capsule by the anterior edge of the acromion, the beak-acromial ligament and, sometimes, the acromioclavicular joint;this leads to inflammation, degeneration and thinning of the tendon. As a result, the thinned tendon breaks, the tendons of the subacute muscle and the long head of the biceps muscle can also be torn.
Over time, with tendonitis, as a rule, there is an improvement, so enough conservative treatment.
Some experts believe that improvement occurs in all cases, regardless of the treatment, while others insist on the need for injections of glucocorticoids into the affected structures - as with arthritis of the shoulder joint, and in the defeat of tendons, tendon sheaths and synovial bags.
Periarthritis is a collective term describing inflammation of the tissues around the shoulder joint and combining a number of similar syndromes in the outcome of which contracture develops. Most experts agree that an active therapeutic tactic is needed to prevent contracture.
Tendonitis of the tendon of the supraspinatus and tenosynovitis of the long head of the biceps brachium muscle can lead to inflammation of other tendons, synovial bags, articular capsule, cartilage, bones and surrounding muscles.
Tendonitis of the tendon of the supraspinatus( even with the involvement of other parts of the muscle capsule) and tendovaginitis of the long head of the biceps brachii muscle do not affect the amount of passive movements in the shoulder joint. Limitation of mobility can cause inflammation of the joint capsule( adhesive arthritis), synovial bags and muscles.
Sudden sharp or dull pain in the shoulder, a symptom of the painful arch. Soreness in the palpation of the anterior margin of the acromion and intercampa groove. The diagnosis is confirmed if the pain occurs when a local short-acting anesthetic is injected under the acromion.
- I stage: norm
- II stage: osteosclerosis, periostitis, cysts;osteophytes of tubercles of humerus
- III stage: narrowing of the gap between the acromion and the head of the humerus, the upper subluxation of the shoulder, erosion of the anterior margin of the acromion.
An X-ray contrast test reveals a rupture of the muscle capsule and a communication between the subacromial sac and the joint cavity.
I stage: rest with a gradual increase in the load;immobilization is contraindicated because of the risk of adhesive arthritis;Exercise therapy to strengthen the muscles and increase the mobility of the joint;Aspirin and other NSAIDs.
II stage: same as Stage I, plus injections of local anesthetics and glucocorticoids, eg 3 ml 1% lidocaine, 3 ml 0.5% bupivacaine, or 20 mg triamcinolone( as a long-acting drug);local short-acting anesthetic is used for diagnosis, long-acting anesthetic and glucocorticoid provide therapeutic effect.
III stage: same as for the I and II stages, plus resection of the anterior part of the acromion.
"Tendonitis of the shoulder joint" and other articles from the section Joint Diseases
Tendonitis of the shoulder joint - clinical picture of the disease
Tendonitis of the shoulder joint is a pathology that affects people, regardless of their age, sex and professional activity. However, most often this disease affects patients older than forty years, as well as people actively engaged in sports or manual labor, loading the same zone.
Most often in clinical practice tendinitis tendon of the muscular muscle
Causes of the occurrence of
- Prolonged physical exertion on the shoulder joint.
- Infectious diseases.
- Pathologies of rheumatic nature( arthritis or gout).Anatomical features of the structure of the body.
- Incorrect development or weakening of tendons.
- Non-observance of correct posture.
Characteristic symptoms of
When the patient is diagnosed with tendonitis of the shoulder, the most common symptoms of this pathology are the limitation of mobility and the occurrence of long-lasting pains not passing through the site of inflammation and in nearby areas. In some cases, pain may increase gradually, as the inflammatory process develops. Often, patients complain of a creaking sound( crepitation) that occurs when the limb moves. It can be heard even from a distance. The inflamed area is hyperemic, the local body temperature is increased. In some cases, tendonitis is complicated by the deposition of calcium salts in the shoulder joint, which leads to a weakening of the tendon and joint bag. In the passive state, pain is often absent, but pain begins to increase by night. Due to the forced position of the body and the severity of the pain syndrome, patients are disturbed by sleep. Also there are difficulties with the rotation of the hand. As a rule, the pain begins in the upper part of the shoulder and ends with a large brachial muscle on the back. Most often, the inflammatory process is localized in the rotator cuff of the shoulder, the extensor muscles of the wrist and the tendons of the biceps muscle.
Tendonitis of muscles of the rotator cuff of the shoulder
When the muscles of the cuffs are damaged, patients complain of pains that appear in the upper outer part of the shoulder, radiating to the elbow. Pain syndrome occurs after unusual physical exertion( work with high-raised arms).In case of a lesion of a small round muscle, a positive test of the resistance of the active external rotation of the shoulder is noted during a diagnostic examination. If the subscapular muscle is affected, a positive test of resistance to active internal rotation is positive. Such tests are conducted in the case when there is a suspicion of tendinitis tendons of the supraspinatus.
Inflammation of the long biceps head
Tendonitis of the tendon of the long bicep head is accompanied by pain in the upper-anterior divisions of the shoulder girdle. Typically, such pains occur due to overexertion of the biceps muscle after lifting weights. In this case, the removal and rotation of the shoulder is not broken. In the process of diagnosis, a resistance test of the active supination of the hand is carried out. Patients with chronic tendinitis, as a rule, are examined using the method of magnetic nuclear resonance. In the course of this study, areas with abnormal impulses are revealed, indicating degenerative changes in the tendons.
At rest, pain is usually absent
Treatment of tendonitis of the shoulder joint, first of all, provides for complete resting of the affected area. Special straps, tires or bandages are used for this. Primary therapy for damage to the ligament of the shoulder includes:
- Protection of the shoulder joint from the load.
The main methods of secondary therapy include:
- Anesthesia and anti-inflammatory therapy.
Clinicians note a positive trend in the treatment of tendinitis by injecting corticosteroids directly into the lesion. These drugs quickly eliminate soreness and contribute to the attenuation of the inflammatory process.
Note: however, injections of corticosteroids do not provide a complete cure, and they are able to increase the rate of collagen degradation and reduce its synthesis, which reduces the tensile strength of the tendon and leads to its rupture. Therefore, this treatment of tendinitis of the shoulder is justified only in the acute period( once every 2-3 weeks).
Not bad non-steroidal anti-inflammatory drugs( for internal reception).However, their long-term use is recommended only for chronic overstrain conditions. Also for pain relief in the shoulder area patients are prescribed simple analgesics and muscle relaxants. With the development of muscle-tonic syndrome, it is recommended to use muscle relaxants, which reduce the pathological muscle tension and reduce the severity of the pain syndrome. An effective method of treatment is local therapy with the use of gels and ointments, which include NSAIDs. If necessary, these drugs can replace systemic non-steroidal anti-inflammatory drugs. As a supplement to the main course of treatment, physiotherapeutic procedures are prescribed to the patient. Well-proven ultrasound treatment, as well as laser and magnetic therapy. In the case of the development of a strong inflammatory process and with the ineffectiveness of standard treatment, patients are treated with antibiotics. Operative intervention is recommended only when all conservative methods and the program of physiotherapeutic procedures have failed, and also if the patient shows signs of stenosing tendinitis( which is characterized by constriction of blood vessels) or Osgood-Schlatter disease. In the course of surgical intervention, dissection or partial excision of tendon aponeuroses and scar tissue is performed. Such an operation requires two or three months of rehabilitation, including the gradual use of exercise exercise for stretching and development of strength.
Note: Treatment of tendonitis of the shoulder joint will be effective only if the patient complies with all the expert's recommendations regarding the resting of the inflamed extremity without exception. If you continue to do the usual work, the disease will only progress in the future.
In order to prevent the development of the pathological process, whenever possible it is necessary to avoid work that requires keeping hands in the raised position for a long time, and also to avoid the monotonous movements in the joint for a long time. Before performing any physical exertion, it is recommended to perform a small warm-up beforehand. The rate of loading should increase gradually.
Warning! Categorically it is not recommended to work at the limit of your strengths and capabilities. When the slightest signs of pain occur, a short rest is required.
If the pain senses appear constantly, it is wiser to abandon the work or movements that cause them.
Pain caused by tendinitis( can be both acute and dull, aching) is associated in the vast majority of cases with the implementation of some kind of action by hand with damaged tendons. Pain clearly increases, for example, when the arm is raised.
Strengthening pain by night can cause insomnia, but more often at rest, the pain decreases until completely absent. Palpation of the shoulder joint is almost always accompanied by painful sensations .Warning! Arthritic pain is permanent and as if spilled around the joint. With tendinitis, there is a high localization of pain - pain is localized in the joint bag. Also, pain occurs only when performing movements in certain directions.
Mobility is limited to the occurrence when trying to perform movement in one direction or another, unbearable pain. And what is important is that often passive movement, that is, without stress, can not cause tangible pains - there is an ordinary tolerable pain.
In case of involvement of a certain part of the articular mechanism, the following mobility limitations( painful sensations that do not allow further movement in the chosen direction) arise:
- inflammation of the cuff of the shoulder covers the entire upper-outer surface of the shoulder with pain, with the pain can be given even to the elbow;
- a small round muscle with inflammation will resist the pain when the shoulder moves outward;
- subscapular muscle during inflammation exerts resistance to the movement of the shoulder inwards;
- inflammation of the tendons of the biceps muscle does not affect mobility, but is accompanied by painful sensations on the upper-anterior surface of the shoulder joint.
Inflammation of tendons of the shoulder joint may be accompanied by thickening of the joint capsule. In a place of defeat of tendons, such thickening can make up to 2 mm. Visually, inflammation is accompanied by swelling and redness. To the touch, the temperature of the affected area is locally increased. Sometimes inflammation can be accompanied by suppuration.And do you know how arthritis differs from arthrosis? Read here.
Degeneration of joint tissues
Inflammatory process, exciting tendons, unfortunately, leads to the appearance of adhesions, which lead to a decrease in joint mobility. There is a possibility that the situation may change into calcifying tendenitis( this is called tendinosis), which is characterized by increased ossification. This process can be heard when even without the use of a phonendoscope, creaks and crunches are heard in the joint.
It is worthwhile to protect joints from excessive loading at the onset of such a moment, because thinning of the tendons can lead to rupture of the joint bag.
Tendonitis of the shoulder joint treatment
Of all the research methods for determining tendonitis of the shoulder joint and concomitant diseases, such as bursitis of the shoulder joint, ultrasound is preferred.Warning! Tendonitis of the shoulder joint is a progressive disease that, when develops concomitant problems, may require surgery.
Therefore, one should not approach with disdain for the arising pain. The good news is that most situations of tendonitis are reversible and well treated.
The therapeutic effect will depend on the degree of neglect of the disease.
As with most soft tissue injuries in the initial treatment phase, you need to concentrate on three simple things:
At an early stage of the disease, you probably will not be able to fully raise your hand or sleep comfortably. The first goal is to give the shoulder joint a rest, so as not to suffer pain with each change of posture and movement. This means that it is necessary to completely stop making movements or actions that will provoke the onset of pain. All the rest is possible. Exclude the load should be 2 to 3 weeks.
Ice is a simple and effective means for reducing pain and fighting swelling. Apply it for 20-30 minutes every 2 to 4 hours in the initial phase of the disease or when you notice that the temperature in your shoulder joint has increased.
To support and protect your shoulder from growing injuries, you may need to wear a sling to provide relief from pain. Perhaps, even you will have to sleep for some time in a semi-lenient state with support for pillows. This point should be discussed with the doctor.Warning! Prolonged inactivity can trigger the development of adhesive arthritis.
In this regard, is still very careful, but perform therapeutic exercises to strengthen the shoulder muscles and to increase the mobility of the .With a very slow and gradual increase in load!
Anti-inflammatory drugs are used to reduce pain and swelling. However, should not be used in the first 48 to 72 hours after the first appearance of pain. In extreme cases, if the pain is intolerant, at this time, paracetamol can be taken.
After 72 hours, if the process continues, we turn to the use of non-steroidal anti-inflammatory drugs( NSAIDs).In the form of tablets or capsules for 5 days. can be used as a simple and effective tool for .Very cheap domestic drug( cost in the area of 25 - 40 rubles).However, it should not be taken simply for prevention. Only in moments of exacerbation is short-lived.
Against the background of the use of drugs for internal use, local therapy should be used. In an acute period within two weeks, ointments or gels should be used to improve blood flow in the joint bag. It is better to see that the ointment or gel was with capsaicin. There are many proposals in the pharmacy - ask the pharmacist. And it is better at the doctor.
In the second stage of the disease, treatment is usually supplemented with injections that are carried out directly into the joint cavity. Most often as a drug for injection use lidocaine or bupivacaine. Although for bupivacaine there is a domestic analogue called BlokkoS( the price in Moscow is 813 rubles for 10 ampoules).But this is all the subject of discussion with the doctor. Do not engage in self-treatment at advanced stages.Warning! If you are prescribed corticosteroid injections, then you should be aware that these drugs affect the reduction in collagen production in your joints, reducing the elasticity of the tendons.
And is also a hormonal treatment of , which can affect your hormonal background( the consequences are a significant increase in body volume and volume).This treatment is acceptable in an acute period and the interval between courses should be decent.
As usual, physiotherapeutic procedures are used at all stages of the disease. Find a good( according to the responses of friends) physiotherapist and he will prescribe those procedures that are right for you.
When the disease is neglected, when all the measures taken have not produced results, surgical intervention is prescribed.