The Shoulder joint is the most agile joint of the human. Its great mobility is due to the relatively small bony joint surfaces. The movements in the shoulder joint are therefore not restricted by bony structures, as is the case with some other joints, for example the hip joint. In order to still achieve a certain stability of the joint, the shoulder surrounds the so-called Rotator cuff. This consists of four different muscles that wrap around the joint like a cuff, thereby stabilizing and protecting it in its position. Functional problems therefore often affect the rotator cuff muscles.
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At any age you can Shoulder pain occur and there are a variety of causes. The shoulder pain can be acute and occur, for example, during exercise or after lifting a heavy load. Often these are also chronic complaints (e.g. due to Joint wear).
Shoulder pain is usually very debilitating and severely restricts the everyday life of those affected, but through consistent and long-term use physiotherapy they can often be treated well to strengthen muscles. Only in a few cases is an operation unavoidable for shoulder pain. The pain usually comes from the soft tissues of the shoulder joint, which means that muscles, tendons, bursa, joint capsules and synovial fluid are affected. Also Diseases of the cervical spine can lead to severe pain in the shoulder, most of the time the pain then even radiates into the arm or hand.
Shoulder pain often affects the mobility of the arm, and many everyday activities are difficult to carry out. In order to be able to make the correct diagnosis, in addition to information about the medical history (anamnese) and physical exam also often like imaging tests Ultrasonic, roentgen, Nuclear spin (MRI) or Computed Tomography required. The therapy of shoulder pain is aimed specifically at the cause of the complaints and offers many possibilities, from drug treatment to physiotherapy exercises and surgical interventions.
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Under a anterior shoulder pain refers to a pain that is mainly (not always exclusively) concentrated on the anterior part of the shoulder joint. This includes pain in the anterior rotator cuff, the Biceps tendon, the shoulder joint (AC joint) and the collarbone (clavicle).
An anterior shoulder joint pain can be caused by direct damage to the anatomical structures involved or as transmitted pain in the case of damage to an anatomically distant location that is not causally an illness from Shoulder joint represents arise.
Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .
The shoulder joint is one of the most complicated joints in the human body.
The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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You can find me in:
Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.
Shoulder pain can be caused by a variety of medical conditions. The most common cause of shoulder pain in the shoulder area is tension and hardening of the shoulder and neck muscles. Stress and incorrect posture (e.g. sitting for too long) put a lot of strain on the shoulder, back and neck, which can lead to painful tension. Mostly through trauma, but also through unfavorable or abrupt movements with one unheated Shoulder, tears, adhesions and shrinkage of the joint capsule in the area of the soft tissue can occur, which leads to shoulder pain.
In addition, the muscles or tendons of the rotator cuff can be torn (rotator cuff rupture), which often severely restricts the mobility of the arm. A painful shoulder joint inflammation (humeroscapular periarthritis) is caused by a lack of exercise and in extreme cases can lead to frozen shoulder (capsulitis adhaesiva) or the so-called frozen shoulder. Other diseases that cause shoulder pain are tendinitis or bursitis (subacromial bursitis). Such inflammations are mainly caused by infections, mechanical overload, rheumatic diseases and gout.
$config[ads_text4] not foundJoint wear and tear (osteoarthritis) can be another cause of shoulder pain.Shoulder joint osteoarthritis is caused by chronic overstrain (e.g. from years of strength training), imbalances in the muscles, narrowing of the joint spaces in old age, circulatory disorders or rheumatic diseases such as rheumatoid arthritis. In professions or leisure activities that are carried out above the head (e.g. painter, handball or tennis player), painful shoulder wear is particularly common. The impairment of movement sequences in the shoulder leads to painful inflammation and swelling.
In the so-called impingement syndrome (bottleneck syndrome) there is a constriction between the shoulder roof and the humerus. There is a tendon that is exposed to constant irritation, causing inflammation. Spinal disorders can also cause shoulder pain. Under certain circumstances, nerve inflammations or injuries, but also rheumatological diseases or internal diseases (e.g. heart attack, lung tumors, biliary colic) with the symptom shoulder pain can become noticeable. If the shoulder pain occurs especially at night, a so-called calcified shoulder (tendinosis calcarea) can be behind it. Calcium crystals are deposited in the rotator tendon due to recurring minor tendon injuries or local circulatory disorders of the tendon.
Injuries, accidents and fractures can also lead to severe pain symptoms in the shoulder area. A fracture of the collarbone (clavicle fracture) or injuries in the area of the humerus (eg humeral head fracture) are common. A dislocation of the shoulder joint (shoulder joint dislocation) can also trigger severe pain and have various causes (e.g. trauma, unstable shoulder).
In no case does the “self” diagnostic agent replace a visit to your trusted doctor! We also make no claim to the completeness of the differential diagnoses presented (alternative causes). We assume no liability for the correctness of the self-diagnosis you have made! We strictly reject any form of self-therapy without consulting your doctor!
Using our “self” diagnostic is easy. Follow the respective link offered, where the location and description of the symptoms best match your symptoms. Pay attention to the point of the shoulder joint where the pain is greatest.
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For the exact anatomical assignment, we refer to the Anatomy Lexicon our page.
Here are some important location names:
Since that Shoulder joint is formed from many different structures (bone, Muscles, Ribbons and Joint capsule), shoulder pain can have completely different causes. For example, anterior shoulder pain can result from involvement of the joint capsule. This can become inflamed or pinched, causing pain in the front shoulder area.
Furthermore, there are so-called in the shoulder joint in some places Bursa (Bursa). These should prevent the individual structures from rubbing against each other when the shoulder joint moves. Bursae can become infected too. This state is then called a Bursitis. Depending on the position of the bursa, front shoulder pain can also occur here.
As with any other joint in the body, the joint surfaces can of course also wear out in the shoulder joint, which is called arthrosis referred to as. Not just at the actual main joint between shoulder blade and Humerus (Gleno-Humoral joint), osteoarthritis can develop. It can also wear out on the small secondary joint between Collarbone and shoulder blade (Acromio-clavicular joint), which can also lead to anterior shoulder pain. The wear and tear of the joint surfaces usually occurs in a gradual process that does not need to be noticed immediately. The causes are often recurring minor injuriesthat over time become a arthrosis of Joint to lead. Such minor injuries to the articular surfaces / the Cartilage come through, for example intense physical exertion come about, as it is with competitive athletes or with intense Strength training can be found. At the beginning, the first thing you notice is load-dependent shoulder pain.
Can also cause front shoulder pain degenerative tears of muscles and tendons in the area of Shoulder joint to lead. Here is especially the Biceps tendon to mention. Of the Biceps brachii muscle is the strongest flexor in the Elbow jointwhose long attachment tendon runs across the shoulder joint. Individual fiber strands of different ligaments and tendons in the shoulder joint area ensure that the long biceps tendon is well guided through the joint. They form the so-called "pulley loop". Damage to this guide can lead to inflammation and instability of the biceps tendon, which manifests itself in pain dependent on load and movement.
Also one dislocation (Dislocation) of the humerus head from the socket can lead to anterior shoulder pain. The most common dislocation of the humerus head occurs here forward down, because the shoulder goes well with the Muscle cuff is secured this However, there is no securing in the lower area of the shoulder joint.
$config[ads_text2] not foundThe capsule of the Shoulder joint is limp and wide. This allows a relatively large range of motion for the joint. At the end of the Joint capsule, i.e. in the area of the armpit, it forms a so-called when relaxed Recess. The recess represents a kind Reserve fold of the capsule and is used for the greatest possible movement of the Poor up.
Front shoulder pain can therefore always be caused by a Shoulder capsule disease arise. In the case of the so-called "Frozen shoulder“(Frozen shoulder) it comes to one shrinkage the capsule, associated Pain and one Restriction of movement in the Shoulder joint. The "frozen shoulder" can arise with or without known causes. Here it comes to a Inflammation of the capsulewhich causes pain. The inflammation automatically spares the shoulder joint to reduce pain. The Relieving posture unfortunately leads to a relatively quickly in the shoulder joint area Shrinkage of the capsule and related Loss of mobility. This disease is common Women between the ages of 40 and 60 are affected.
Further information on this topic can be found at:
In subacromial bursitis, the bursa is between the Shoulder joint and the tendon of the upper bone muscle (M. supraspinatus, important part of the Rotator cuff) lies. This bursa is a shifting layer between muscle and bone. If there is an inflammatory change in this bursa (Subacromial bursitis), this sliding layer sticks together and the tendon of the muscle becomes thinner. In the further course, the upper bone muscle tears (rotator cuff rupture) and chronic pain results, which severely limit the mobility of the shoulder.
The diagnosis of subacromial bursitis can usually be made easily. For this purpose, precise information about the medical history (anamnesis) and a physical examination are carried out. With subacromial bursitis, pain in the shoulder joint usually occurs when the arm is moved between 80 and 120 degrees to the side of the body (abducted) becomes. In addition, imaging examinations such as ultrasound (Sonography), Magnetic resonance imaging or X-ray provide information about the extent of the bursitis. The treatment of acromial bursitis consists first of all in avoiding further loads and protecting the shoulder joint. Physiotherapy exercises and pain reliever medication can also be helpful. A Cortisone Injection in the subacromial space can in many cases relieve the symptoms. However, if conservative measures do not bring about any improvement, surgical removal of the shoulder bag may be indicated.
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Shoulder pain caused by a tightness between the head of the humerus (Caput humeri) and the roof of the shoulder develop, are called so-called Impingement Syndrome designated. In this area of the shoulder there is already a certain tightness, which is why there is often chronic irritation of the bursa and the tendon attachments (usually Supraspinatus tendon, Rotator cuff). Certain occupational groups such as painters or overhead athletes (eg tennis or volleyball players) have an increased risk of an impingement syndrome. At the beginning, shoulder pain only occurs during exercise (especially when doing activities with a raised arm), later it can also occur at rest. The pain is particularly pronounced when the arm is suddenly lifted to the side or under strain.
To alleviate shoulder pain in impingement syndrome, therapeutic measures such as Electrotherapy, Ointment treatment, cold therapy, movement exercises and targeted muscle training can be used. Anti-inflammatory drugs can also be used. If the conservative treatment options fail, the cause of the irritation of the shoulder should be treated. For this purpose, the space under the shoulder roof can be expanded as part of a surgical procedure. The inflamed (and usually thickened) bursa is removed and bony protrusions are removed. This is also intended to prevent progressive damage to the rotator cuff tendons and possibly an impending tendon tear.
Further information on this topic can be found at: Impingement Syndrome
For more information, see: Rotator Cuff Tear
The shoulder joint is mainly stabilized by the muscles of the shoulder girdle. As Rotator cuff one describes the four muscles that hold the humerus in the socket of the shoulder. A rotator cuff tear has damaged one or more muscles or tendons in this important muscle group. Such a crack can have a traumatic (accident-related) or degenerative (wear-related) cause. In the event of a fall or external force, the shoulder may dislocate, for example, and in some cases a muscle in the rotator cuff tears. In addition, such a tear can occur with increasing age, as there is a loss of cartilage substance and a loss of strength in the tendon attachments of the muscles.
A rotator cuff tear causes pain of varying intensity and limits shoulder mobility. Especially the lateral lifting of the arm (Abduction) can no longer or only very painfully be carried out in the event of a rotator cuff tear. There are several ways to treat a rotator cuff tear. On the one hand, the tear can be sutured or closed. After that, extensive physiotherapeutic follow-up treatment over months or years is usually necessary in order to restore physical performance. In addition, in about a fifth of cases, shoulder pain persists after the operation. On the other hand, conservative (non-operative) therapy can be aimed for. Cortisone injections are used for this in the shoulder and nonsteroidal anti-inflammatory drugs in question. Physiotherapy exercises are also used in the conservative treatment of a rotator cuff tear, if necessary with local pain relief.
Further information on this topic is available at: Rotator cuff tear
Inflammation of the long biceps tendon becomes too Biceps tendonitis called. Such inflammation is common in people with poor posture, shoulders sloping forward, and causes severe shoulder pain. The long biceps tendon lies in a narrow bony canal in the shoulder joint and is prone to overloading and injuries as it is often exposed to friction in its narrow course. The constant irritation can cause the tendon to swell and become inflamed. In some cases, further damage to the biceps tendon occurs in the form of fraying and the tendon becomes unstable.
Biceps tendon tendonitis can also be caused by a muscular imbalance in the rotator cuff of the shoulder. This refers to an incorrect posture of the thoracic spine in which the holding muscles at the rear of the rotator cuff are too weak. The dominant chest muscles pull the shoulders forward, it comes to shoulders sloping forward and the narrow canal through which the biceps tendon runs continues to contract. The diagnosis of biceps tendon tendons is made with the so-called Yergason test in which the arm rests against the body with the elbow bent at right angles and an attempt is now made to lift the forearm against the doctor's resistance. In the case of a biceps tendon tendon, pain in the front shoulder area is provoked.
In order to treat a muscular imbalance and to achieve relief in the area of the irritated and inflamed biceps tendon in biceps tendon tendinitis, targeted muscle training must be carried out under physiotherapeutic guidance to strengthen the rear rotator cuff. In most cases this can avoid surgical transection of the biceps tendon.
Further information on this topic can be found at: Biceps tendon tendinitis
Severe shoulder pain also occurs with shoulder osteoarthritis (Omarthrosis). The abrasion of cartilage in the humerus head and / or the shoulder joint socket leads to joint wear in the shoulder joint. Shoulder arthrosis is divided into a primary (with no apparent cause, age-related wear of the joint) and a secondary (after bone fractures or as a result of humerus head necrosis). A deformation of the humerus can be seen on the X-ray.
In addition, the decrease in the articular cartilage can be seen as a narrowing of the visible joint space. Shoulder arthrosis often results in restricted mobility. In addition, there is movement-dependent pain in the shoulder joint and, in many cases, an inflammatory activation of the joint that occurs in bursts. The shoulder osteoarthritis is treated with medication, physical therapy, cooling or surgical measures (e.g. Arthroscopy, Prosthesis, artificial shoulder joint).
A Bankart lesion is caused in most cases by a dislocation of the shoulder (dislocation) forward in the course of an accident. The Bankart lesion describes a condition in which the so-called articular lip (Glenoid labrum) the socket of the shoulder blade is partially or completely torn off. This joint lip actually stabilizes the shoulder joint in the socket and further dislocations of the shoulder can easily occur. Often the Bankart lesion is accompanied by a sense of instability in the shoulder joint. From a Bankart lesion with shoulder pain, younger and physically active people with an overmobile ligamentous apparatus are usually found.
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As Shoulder joint (Acromioclavicular joint, AC joint, ACG) is the articulated connection between the upper end of the shoulder blade, the so-called shoulder height (Acromion), and the outer end of the collarbone (clavicle). If there is joint wear (osteoarthritis) in this area, this usually manifests itself in a painful restriction of movement of the shoulder. The treatment of such ACG osteoarthritis usually depends on the individual complaints. Therapy with physiotherapy and physical applications (e.g. cold, electrotherapy) is usually tried. If the shoulder pain is not sufficiently relieved by this and the restricted mobility cannot be removed, a resection of the AC joint can be considered. For this, the joint surfaces are milled off and a kind meniscus made of the body's own material placed between the joint surfaces. Often the shoulder can be fully loaded again after two months after such an operation and is painless.
Further information on this topic can be found at: Osteoarthritis in the shoulder joint
In theory, any part of the Spine be affected by a blockage. When nerve roots are irritated by a vertebral blockage, misinformation is created that causes pain in the brain. So shoulder pain from blockages in the Cervical spine go out. This means that there is a misalignment or displacement of the joints of the spine, which are caused by a sudden, unusual load (e.g. lifting heavy loads) or by long-term incorrect posture when the spine is bent (e.g. sitting for a long time). In addition to the vertebral blockage, there is often a reflex tension in the back muscles, which can also be felt painfully in the shoulder.
Vertebral blockages can be released by themselves through gentle massage, application of heat and relaxation of the muscles. If this does not relieve the symptoms, a chirotherapeutic treatment be considered. The blocked joint can be adjusted again. However, chiropractic only makes sense if the tension in the muscles is released at the same time, otherwise the vertebral blockage can come back.
Further information on this topic can be found at: Vertebral blockage
Also a Herniated disc of the cervical spine may be through the symptom Shoulder pain to make noticable. In the case of a herniated disc, part of the Intervertebral disc into the spinal canal and may press on the Spinal cord or nerve roots emanating from it. A herniated disc can occur without an external cause, but overloading of previously damaged discs is often the cause of the incident (Intervertebral discrolapse).
Typically, herniated discs occur in the area of the Lumbar spine on and cause Back painthat up radiate into the legs can.
However, a herniated disc can also occur in the cervical spine and, due to compression of the nerve roots, lead to severe pain in the shoulder area. It is not advisable to keep bed rest and to protect your shoulder with such a herniated disc.
Much more, the therapy of shoulder pain consists of a drug-based pain therapy and then physiotherapy exercise therapy. Heat therapy, massages and electrotherapy are also treatment options.
Surgical treatment of a herniated disc of the cervical spine is usually only indicated if the pain is no longer controllable on an outpatient basis or if neurological deficits occur.
Consistent muscle building of the back and shoulder muscles is advisable to prevent a herniated disc. Through gymnastic exercises or back-friendly sports (e.g. swimming, dancing, running, cycling), the Back muscles strengthened and the pain relieved. In addition, the intervertebral discs experience changing pressure loads in these sports, which is important for the supply of the intervertebral discs with nutrients. An ergonomically correct workplace is also an important measure to prevent a herniated disc. Static sitting positions should be avoided and attention should be paid to changing pressure loads (e.g. standing, walking, sitting, etc.).
Further information on this topic can be found at: Herniated disc of the cervical spine
Bench press shoulder pain is common. This is because the exercise has a great potential for injury. The main problem is with the bench the trainee lies on during the exercise. This is usually too wide and prevents the natural movement of the shoulder blade, which at a certain angle would normally slide backwards when moving downwards. The bench prevents this, so that instead an unnaturally strong movement occurs in the humerus. This leads to overloading of the external rotators of the shoulder and damage to the joint capsule. On the other hand, there is less strain on the inner shoulder muscle (M. subscapularis). This is weakened over time, so that ultimately an imbalance of the shoulder muscles results (muscular imbalance). During the pushing movement, the humerus literally shoots into the joint socket, where it compresses the anterior joint capsule and the long biceps tendon. In the long run, this leads to damage to the joint complex and pain in the front shoulder area.
prophylaxis: If you want to avoid the pain of bench press, you should only use narrower benches or exercise benches with cutouts for the shoulder blades. This allows the shoulder blade to be perform normal movements and muscles and joints are not overloaded to the same extent. Also should be on a good technique with appropriate reach, as well as weights adapted to the training stand.
Also at Bodybuilding / strength training Front shoulder pain may occur. These often do not occur as a result of an accident, but are rather the consequence of incorrect or overloading. Since in bodybuilding or strength training, the large muscle groups be trained (large pectoral muscle – Pectoralis muscle, upper trapezius – Trapezius muscle and the Deltoid – Deltoid muscle), it comes in the field of shoulder to a muscular imbalance. During the training, the opponents of the individual muscles may be neglected, so that the pulling force in one direction always predominates. In strength training, it is particularly important to always train the player and opponent of a joint. An example of this is the biceps and Triceps at the poor call. By the bilateral training one achieves good ones stability in the joint and no one-sided excessive strain on the individual structures. The consequence of this one-sided training can be a change in the position of the humerus head in the socket, which can lead to functional restrictions and pain.
In addition, the increased muscle mass and expansion of the muscles in the shoulder area can lead to constrictions, so that Tendons get trapped in their bearings, which can also cause shoulder pain. By overload or overexertion, pathological changes can also occur in the area of the muscle tendons (so-called Tendinopathies). The tendon is often affected Supraspinatus muscle, a muscle of Rotator cuff. The symptom can be a so-called Painful arc come, that means that there is one Spreading the arm between 60 and 120 ° causes severe pain can come.
Certain technical errors in strength training can lead to front shoulder pain. For exercises with the lat pull-up bar, for example, the rule applies that you should rather pull the bar towards your chest than towards your neck. Another technical flaw is the bench press with wide braces Elbow. This increases the burden on the Shoulder joint in contrast to tight-fitting elbows. If shoulder pain occurs after training, you should refrain from doing exercises for a few days or weeks.
Shoulder pain can have many causes. Depending on the location of the complaints, there are clinical pictures that typically cause complaints in these specific areas of the shoulder.The pain does not have to relate exclusively to the front shoulder area, but also to the front of the upper arm if necessary. The structures in the area of the shoulder joint that lead to pain in the anterior shoulder area when injured, such as a torn muscle fiber in the shoulder or inflammation, are typically the anterior joint capsule and the long biceps tendon.
The so-called pulley lesion describes damage to the long biceps tendon in its course through the shoulder joint. The tendon usually runs protected by a tendon sheath in a bony groove over the head of the humerus through the shoulder joint. If there are signs of wear and tear (degenerative changes) in the joint or other injuries, for example a tear in the rotator cuff, the position of the biceps tendon can change. It no longer runs protected in its channel, but gets between the bony structures and is trapped and damaged between them. In the long run, the tendon becomes very thin and can even tear. Chronic inflammation of the tendon can also occur. Ultimately, shoulder joint arthrosis can also develop. The pain from the biceps tendon damage is mostly concentrated in the front part of the shoulder.
Therapy: Relocating the biceps tendon back to its original position usually does not succeed because the entire shoulder joint is usually already too damaged. Instead, in this case the damaged part of the biceps tendon is removed so that the disruptive factor is removed from the joint. This is mostly perceived by the patient as a pain reliever. The loss of function that the removal of the biceps tendon entails are usually no longer a significant disadvantage due to the previous damage to the joint.
A muscular imbalance of the shoulder is present when the muscles that attach to the top and front of the shoulder (deltoid muscles, pectoral muscles) are more pronounced than the rear shoulder muscles (M. infraspinatus, M. teres minor). This leads to the shoulder joint being misaligned. The front and upper muscles pull harder in their direction of pull and the rear shoulder muscles cannot do anything to counter this. This permanently pulls the humerus out of its socket and exerts pressure on the surrounding structures, e.g. on the biceps tendon. This manifests itself in uncomfortable shoulder pain, especially in the front shoulder area. Secondarily, an impingement syndrome can develop due to the muscular imbalance.
Cause: Young athletes often suffer from muscular imbalance, especially those who practice throwing sports. These also strengthen the upper and front shoulder muscles so that they become even stronger and the imbalance is further increased. Throwing athletes should therefore also specifically train the rear shoulder muscles in order to avoid the development of an impingement syndrome.
