The shoulder is the most flexible joint of the body: as a ball joint, which is largely stabilized by muscles and tendons, it allows a large range of motion. However, the shoulder is also prone to injury and wear disorders - shoulder pain is therefore a common symptom in people of all ages.
Classify shoulder pain correctly
In addition to causes in the shoulder joint itself but also diseases of the cervical spine and neck can cause discomfort in the shoulder. We have compiled the nine most common causes of shoulder pain for you and explain the methods the doctor uses to diagnose.
1. Acute pain in case of overwork and injury
After an accident or an acute overload - for example, when bench presses - it can cause sudden pain in the shoulder. Usually there is an overstretching or tearing of the capsule or a tendon.
A dislocation of the shoulder (dislocation) as well as a fracture of the clavicle or the humeral head, however, are usually expressed by very severe pain. A movement of the affected arm is then almost impossible, which is why the arm is held in a protective posture on the body.
In a so-called Schultereckgelenkssprengung the bands between collarbone and shoulder roof tear or partially. In addition to severe shoulder pain, a so-called "piano key" phenomenon may occur: the outer end of the collarbone stands upright and can be pressed down like a piano key.
2. Rotator cuff tear due to injury or wear
Common causes of shoulder pain are damage to the so-called rotator cuff. This refers to the tendons of four muscles, which run from the scapula to the humeral head and are responsible for rotational movements in the shoulder joint and for the lateral lifting of the arm. In addition, they stabilize the humeral head in the socket.
Damage to rotator cuff tendons may occur as a result of acute injury or gradual erosion. Typical symptoms include pain in the shoulder and upper arm pain, which occur depending on the affected tendon, especially during internal rotation, external rotation or lateral lifting of the arm. If there is a complete tear of one or more tendons, there may also be a lack of strength in the described movements.
3. Impingement syndrome: tightness in the shoulder joint
A wear-related damage to the rotator cuff is often based on a so-called impingement syndrome (shoulder constriction syndrome). There is too little space between the humeral head and the shoulder roof, which causes the tendons to narrow.
Most often, the tendon of the supraspinatus muscle is affected, as it leads through the narrowest part of the joint. An impingement syndrome is usually characterized by shoulder pain, which occurs especially when lifting the arm 60- 120 degrees, since in this movement, the space under the shoulder roof is the narrowest.
Left untreated, an impingement syndrome can lead to inflammation or rupture of the supraspinatus tendon as the tendon rubs permanently against the roof of the roof. At this advanced stage of the disease, shoulder pain may occur at rest and at night.
4. bursitis: shoulder pain and swelling
Inflammation of the bursa under the roof of the shoulder (subacrominal bursitis) can both be the cause and consequence of the impingement syndrome. For bursitis is often caused by permanent mechanical irritation - for example, in sports, in constant "over the head" work or when an impingement syndrome is present.
In addition, the following causes can lead to a bursitis of the shoulder:
- Rheumatoid arthritis
- Calcium crystals in a calcar shoulder, which penetrate into the bursa
Conversely, inflammatory swelling of the bursal may narrow the rotator cuff, resulting in impingement syndrome. Symptoms of bursitis include shoulder pain and reduced mobility, as well as swelling and overheating of the shoulder.
5. Biceps tendon: pain through bodybuilding
Although the long tendon of the biceps muscle is not part of the rotator cuff, it originates at the upper edge of the shoulder joint socket and can cause shoulder pain in case of irritation, inflammation or a tear. Cause is often wrong or too intense training in bodybuilding.
When irritation or inflammation of the biceps tendon, the pain usually occur at the front of the shoulder and can radiate into the upper arm. A complete rupture of the biceps tendon often manifests itself in addition to weakness in the arm flexion - under certain circumstances, a '' beaded '' muscle belly can be visible.
6. Kalkschulter by wear
In a Calcarea (Tendinitis calcarea) comes to deposits of calcium crystals in a tendon of the rotator cuff - usually the supraspinatus tendon is affected. The cause is a wear-related lack of blood supply to the tendon.
Symptoms of a calcified shoulder include shoulder pain when lifting the arm and pressure pain on the front of the humeral head. However, there are usually no signs of inflammation - such as swelling or overheating of the joint - on. If the crystals break into the bursa or into the joint, it can lead to a sudden worsening of the complaints.
7. Frozen shoulder: Nocturnal pain and stiffening
"Frozen shoulder" means "frozen shoulder" and refers to a condition in which, due to inflammation, the joint capsule is adhesively bonded and, as a result, transient stiffening of the shoulder.
The causes of a 'frozen shoulder' are unclear - but it seems to be related to metabolic diseases such as diabetes mellitus. In addition, a frozen shoulder can occur after injury or surgery on the shoulder.
The disease occurs in three phases: First, it comes to shoulder pain, especially at night. When the pain subsides after a few weeks or months, a restriction of movement - especially in the case of rotational movements and sideways lifting of the arm - comes to the fore. In the third phase, the symptoms finally resolve on their own.
8. Osteoarthritis of the shoulder rather rare
Osteoarthritis of the shoulder, in the true sense of articular cartilage wear, is rare, as shoulder (unlike knee or hip) usually does not weigh large weights. A joint wear on the shoulder therefore usually occurs only as a result of injury - such as a fracture of the humeral head - or an infection of the joint. Damage to the rotator cuff may also promote osteoarthritis of the shoulder.
9. Shoulder pain left: do not rule out myocardial infarction
If shoulder pain on the left side suddenly and without apparent cause on, should always be thought of a heart attack - especially when added to nausea, wheezing, anxiety or general malaise.
Because sometimes a heart attack is not expressed by chest pain, but by non-specific complaints. Pain may radiate in the stomach, back or shoulder. In this case, you should immediately consult a doctor or an emergency room.
Diagnostics: Ultrasound helpful
In order to diagnose a disorder of the shoulder, the doctor first raises the medical history (history) and performs a physical examination to check the joint function. In many cases, a suspected diagnosis can already be made on the basis of the described complaints and functional tests.
To ensure the diagnosis, an ultrasound of the shoulder is often helpful. Thus, for example, the condition of the rotator cuff can be assessed or an articular effusion can be established as an indication of an inflammation. On an X-ray, on the other hand, especially the bones can be well assessed - for example, to detect osteoarthritis or to exclude a fracture or a bone tumor.
Arthroscopy with unclear cause
Magnetic resonance imaging (MRI) details the soft tissues of the joint and is therefore often used to diagnose unclear shoulder pain. However, if no cause can be found, joint arching (arthroscopy) of the shoulder may be performed. In this case, a treatment - such as the sewing of a torn tendon - can be carried out immediately.