The shoulder joint is primarily stabilized and moved by a muscle and capsule apparatus. This means that the soft tissues that stabilize and move the shoulder, such as muscles and tendons, are affected far more frequently. Shoulder pain therefore mainly occurs here and less frequently in the joint cartilage. You can find further information and selected shoulder pain doctors here.
In other joints, such as the hip or knee joint, the joint cartilage typically causes the pain. Shoulder pain, on the other hand, is often initially caused by a functional coordination disorder of the muscles surrounding the shoulder.
Local degeneration and chronic overloading of tendon attachments or other stabilizing soft tissues lead to permanent painful changes.
The anatomy of the shoulder joint © bilderzwerg / Fotolia
The shoulder is not affected by weight bearing, which leads to cartilage damage and therefore joint wear (osteoarthritis) in other joints of the body. Osteoarthritis of the shoulder joint is therefore rarely the cause of shoulder pain.
However, spontaneous local inflammation and often calcifying inflammation of the tendon insertions(calcific shoulder) are frequently the cause.
The acromioclavicular joint is the only bony connection between the arm-shoulder blade complex and the rib cage via the collarbone. It is therefore the first to be overloaded in functional shoulder disorders. This situation is often the starting point for shoulder pain. This explains why the acromioclavicular joint is most frequently affected by shoulder joint arthrosis.
As a rule, only individual structures of the shoulder joint are initially affected. For this reason, shoulder pain can often be localized to individual tendon insertions or soft tissue structures of the shoulder joint using certain provocative shoulder tests.
A series of sometimes very specific clinical examination methods are used for this purpose, which indicate the disorder or lesion of individual soft tissue structures.
As a rule, shoulder pain can be provoked by certain movements and stresses. It often radiates into the arm or neck. This already gives a clear indication of the affected structures.
Pain at rest, especially at night, indicates a chronic inflammatory process, such as tendinitis calcarea. Advanced wear and tear of the joint also shows these symptoms.
Initially, the treatment methods for shoulder pain generally include conservative therapy measures without surgery. Appropriate targeted and shoulder-centring physiotherapy can be used to treat malfunctions or coordination disorders of the shoulder joint and relieve painful soft tissue structures.
Accompanying physical measures to relieve local inflammation and irritation are often helpful. These include
Targeted local injection therapy on the affected structures is also often very effective. However, this requires the painful structures to be localized beforehand.
However, conservative measures no longer help if the damage to the muscle cuff or other soft tissue structures is already too advanced. Those affected then continue to suffer from pain.
In individual cases, arthroscopic shoulder surgery is then usually indicated :
This allows detached tendon parts as well as soft tissue structures on the shoulder and in the shoulder joint to be reconstructed or refixed. The indication for a surgical procedure is determined on a case-by-case basis. It depends on
The decision as to whether surgical intervention is necessary must be clarified on a case-by-case basis with the specialist treating the patient.
Targeted conservative therapy is very often successful, especially in cases of short-term shoulder pain. It should generally be carried out for at least six months in the case of spontaneous onset of pain.
In the case of more severe injuries or longer-term pain, a high percentage of the damage can be repaired by surgery. Larger tendon tears can also be reconstructed in individual cases by means of replacement surgery.
In cases of more severe arthrosis of the shoulder joint, endoprosthetic treatment with a shoulder prosthesis is also very successful. A shoulder joint prosthesis can also be implanted using a minimally invasive procedure.
Illustration of an artificial shoulder joint © SciePro | AdobeStock
If there is an extensive defect in the muscle cuff in combination with advanced osteoarthritis of the shoulder joint, the implantation of a so-called inverse shoulder prosthesis has proven very successful. It usually leads to an excellent restoration of the ability to use the severely damaged shoulder joint.
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