shoulder pain

Generally

Pain in the shoulder can occur at any age. Sometimes the shoulder pain is acute ( eg while exercising or after lifting a heavy load ), but more and more people also suffer from chronic shoulder pain ( eg due to joint wear ). The pain can have many different causes and severely limit the affected person in everyday life.

Behind the shoulder pain, for example, may be a so-called Impingementsyndrom ( bottleneck syndrome ) stuck, but also acute injuries, inflammation or signs of wear in the shoulder joint. An example of this is the shoulder bruise.
Pain in the shoulder is often treatable by consistent and long-term applied physiotherapy for muscle strengthening, surgery is only necessary in a few cases.

Most shoulder pain originates from the soft tissues of the shoulder joint, which means that it does not affect the bones but rather muscles, tendons, joint capsule, synovial fluid and bursa.

Pain restricts mobility in the shoulder, many everyday operations, such as putting on a shirt, combing hair or blow drying, require good coordination of the shoulder and arm muscles.
Often it comes to restraint, which is why an early therapy is particularly important. Depending on the cause, the pain in the shoulder can occur in different places and with different movements and activities. Also problems at the cervical spine can lead to pain symptoms in the shoulder and radiate up to the arm or the hand.

anatomy

The so-called shoulder girdle is formed by two bones on each shoulder side, ie by the two clavicles ( claviculae ) and shoulder blades ( scapulae ). The scapula forms the shoulder joint together with the humerus.

In addition, the scapula forms two bony prominences, the acromion and the coracoid .

The shoulder joint is significantly stabilized by four muscles and their tendons, the so-called rotator cuff. The four muscles (supraspinatus muscle, infraspinatus muscle, teres minor muscle, and subscapularis muscle) move from the scapula to the humerus, where they attach to their tendons.
For this reason, they lay around the head of the humerus like a cuff and form a "roof" over the shoulder joint.

The space under the shoulder-roof, the subacromial space, is often affected by wear problems in the shoulder joint. A bursa facilitates sliding between the tendons and the bony shoulder roof. This can lead to shoulder pain, for example, through inflammation.

The shoulder joint is primarily moved and mobilized by muscles and tendons, resulting in a large range of motion. However, this increases the risk of instability, making the shoulder joint vulnerable.

causes

Wear on the shoulder is caused by chronic overloading and imbalances in the muscles.

In activities performed above the head, as in painters or handball or tennis players, painful shoulder wear is particularly common.
This mainly affects the movements in the shoulder, painful inflammation and swelling are the result. An Impingement Syndrome (constriction syndrome ) is a constriction between the roof of the shoulder and the humerus. The tendon and the bursa are exposed to a constant state of irritation, which causes inflammation.

In the shoulder, it may cause tearing, adhesions and shrinkage of the joint capsule in the area of ​​the soft tissue, resulting in shoulder pain.
Joint wear (osteoarthritis) can be another cause of shoulder pain. The shoulder joint arthrosis will be favored by overstressing (such as years of strength training), joint narrowing in old age, rheumatic diseases (eg rheumatoid arthritis) or circulatory disorders.

Damage or tearing of the muscles or tendons of the rotator cuff ( rotator cuff tear) causes pain and can severely restrict the mobility of the arm.

Painful shoulder joint inflammation ( periarthritis humeroscapularis ) may result in lack of movement resulting in shoulder stiffness ( capsulitis adhaesiva ) or the so-called " frozen shoulder ".

The so-called Calcarea ( Tendinosis calcarea ) refers to a deposition of calcium crystals in the rotator tendon by recurrent minor tendon injuries or by local circulatory disorders of the tendon. The calculus shoulder is especially painful at night.

Even accidents, fractures and injuries in the shoulder area can lead to severe pain symptoms. Collarbone fracture ( clavicular fracture ) or injuries to the humerus (eg humeral head fracture ) are common. Distortions of the shoulder joint ( shoulder joint dislocations ) can cause severe pain and have various causes. The shoulder is often recurrent, resulting in a chronic unstable shoulder, which should be treated surgically in the context of a joint mirror.

Other causes of shoulder pain include tendinitis or bursitis (subacromial bursitis). These are mainly caused by mechanical overload, infections, rheumatic diseases and gout. Tension and hardening of the shoulder muscles due to incorrect posture and stress, for example due to sitting too long, puts strain on the shoulder, back and neck and can lead to pain. In addition, shoulder pain can also come from the spine, caused by nerve inflammation or nerve injury, by rheumatological diseases and also by internal diseases (eg, heart attack, biliary colic, lung tumors, etc.).

symptoms

Shoulder pain can have a variety of causes. For example, these can occur after lifting heavy loads.

Since the causes of shoulder pain are very different, different symptoms may be in the foreground.

Frequently, shoulder pain (eg due to an impingement syndrome or a rotator cuff injury) affects the mobility of the arm.
The arm is often barely lift due to the pain and many everyday activities are difficult. The shoulder pain is particularly common in the lateral abduction of the arm ( abduction ) and are particularly strong at an angle of about 60 to 120 degrees, which is why doctors and therapists also speak of the " painful arc " or " painful arc ".

Nightly shoulder pain is also typical if you unconsciously lie down on your aching side or turn your body to sleep. When the pain comes from the cervical spine, there is often radiating pain from the shoulder to the arms and hands.

In tendonitis, shoulder pain can be triggered in very different arm and shoulder movements, depending on which muscle tendon is affected.

  • Tendinitis in the shoulder
  • Tendinitis in the arm
  • These symptoms indicate a stiff shoulder
  • Pain under the scapula

ahead

There are many different causes for pain that occurs at the front of the shoulder. Here are the anterior rotator cuff, the biceps tendon, a part of the joint capsule, the shoulder joint ( Acromio-clavicular joint ) and various soft-tissue structures such as bursae or tendons. Alternatively, a frontal shoulder pain may arise in a progressive manner, that is, damage to structures not directly located on the anterior shoulder.

On the one hand, anterior shoulder pain can be caused by inflammation or entrapment of the joint capsule. Furthermore, bursa ( bursa ) are also located in the anterior region of the shoulder to ensure a smooth sliding of the muscles. Inflammation of these bursitis (bursitis) in the appropriate area can cause anterior shoulder pain. As in the knee or hip joint, osteoarthritis (wear) can occur in the shoulder. Osteoarthritis can affect both the actual shoulder joint between the scapula and humerus ( humero-glenoidal joint ), as well as smaller joints such as between the collarbone and the scapula ( Acromio-clavicular joint ). In this case, the pain projects on the anterior shoulder area. Such a degenerative change is always a creeping process, whereby the pain initially only occurs dependent on the load. Also, degenerative changes of the soft tissues such as muscle or tendon tears may be the cause. The biceps tendon is particularly frequently affected. Also, dislocation of the shoulder joint ( dislocation ) can cause anterior shoulder pain, as the most common direction of dislocation is forward and downward.

Shoulder pain on the back side

In the case of posterior shoulder pain, the pain is mainly concentrated on the back of the shoulder joint. Again, the pain can be caused by more distant structures and be forwarded only to the posterior shoulder joint.

The cause is a vertebral block usually the cervical spine, more rarely the thoracic spine, in question. The often occurring pain radiate from the cervical spine into the back of the shoulder and arise by hooking the vertebral joints of two adjacent vertebral bodies. This often happens through jerky movements from sleep or an accident. The pain is not caused directly by the blockage but by a reactive tension of the muscles. In addition, significant restrictions on movement occur.

A cervical disc herniation may also cause back pain on the shoulder. Furthermore, movement disorders of the scapula are the cause in question. This is caused by tendinitis on the scapula ( enthesopathy ), malformations of the scapula or muscle tension.

Another cause may be a tear in the posterior part of the rotator cuff (infraspinatus muscle and teres minor muscle ). The pulling, stinging pain is load-dependent (especially with external rotation), is located under the rear shoulder roof and can radiate up to the upper arm. Often, the tear comes about as a result of an impingement syndrome. This years-long bottleneck syndrome is increasingly causing wear on the tendons of the muscles of the rotator cuff. The pre-damaged tendons can be torn by a sudden movement. The tearing of a not previously damaged tendon by an accident is much rarer.

Finally, it can come in bench press, especially by incorrectly performed exercises, a variety of injuries. These range from simple muscle soreness to muscle breakage and can all trigger pain on the back of the shoulder.

At night

At night, increased pain may occur, as the joint space is compressed while lying down and can press on irritated structures.

Normally one expects that by the sleep and the rest at night also the shoulder pain decreases clearly. Often, however, this is not the case, so wake the person after a few hours sleep from severe pain in the shoulder. A renewed fall asleep is out of the question. The pain, the insomnia and exhaustion represent a great suffering for the sufferer.

The reason for this phenomenon is the different conditions in the shoulder joint during the day and at night. By day (sitting / standing), the arm hangs like a weight with a few kilograms of mass on the shoulder, thus increasing the joint space by simply "pulling it apart". The expansion of the structures can be only a few millimeters, but ensures that irritated and inflamed structures are somewhat relieved. At night while lying down, the joint space contracts again and the structures are closer together. So just this relaxation causes a compression of soft tissues (tendons, bursae), which causes pain and wakes the affected person.

In the short term, a type of stretching device can help prevent the pain at night. One loop is placed around the wrist and another around the ankle, which is then connected with an expander rope. Due to the pulling force on the arm, a hanging arm is simulated as during the day. Alternatively, the shoulder joint should be distended at night if the person is aroused by pain, which should make the pain disappear in the short term. However, this type of first aid should only be used for a few weeks, until the cause of the pain is clarified and treated.

Night pain in the shoulder is not a diagnostically very significant symptom and can occur in the context of multiple diseases of the shoulder. Both in the case of osteoarthritis, as well as in congestion syndrome, as well as in the lachrymation or bursitis (bursitis), a nocturnal occurrence of pain is possible.

diagnosis

To provide the correct diagnosis of pain in the shoulder, some information of the medical history are important ( anamnesis ), as they give first clues to the causes.

Already known shoulder injuries, in which movements the pain occurs, how long the complaints exist, whether nocturnal pain occurs and risk factors for increased shoulder wear (eg due to sports or work) must be requested by the attending physician.

A physical examination for shoulder pain may consist of a series of examination procedures and methods that allow an assessment of the function of the muscles of the shoulder joint.
Typical clinical functional tests include, for example, the Jobe test ( side differences speak for a tendon tear , an irritated tendon or an inflammation of the bursa), the neck grip ( both hands are placed in the neck ), the apron handle ( one holds with both hands to the back ) and many more.
The sampling of trigger points (points of irritation that cause pain in pain) may provide further clues as to the causes of the shoulder pain.

Also, the mobility of each joint in the shoulder joint must be checked. In order to rule out the cause of the shoulder pain being a nerve entrapment, a neurological examination may be necessary. Imaging techniques such as ultrasound ( sonography ), X-ray, magnetic resonance imaging ( MRI, MRI ) or computed tomography ( CT ) allow further insights into the painful shoulder joint.

In some cases, however, the diagnostic methods described so far do not lead to a clear diagnosis. So it may be necessary to perform an articulation ( arthroscopy ). In this minimally invasive surgery in " keyhole technique" a direct view of the shoulder joint is possible and if necessary, in the context of a joint mirroring also a treatment can be performed, such as the sewing of a tendon tear or the removal of inflamed tissue.

therapy

The treatment is aimed at shoulder pain always against the cause of the complaints. The earlier a treatment for the shoulder pain is started, the better are usually the healing prospects.

The affected person can often help themselves with the help of active movement and muscle strengthening, so that the symptoms are alleviated or even completely disappeared.

Taking painkillers eg non-steroidal anti-inflammatory drugs ( NSAIDs, eg Voltaren®) and cold packs can help against the pain in the shoulder, especially in the early stages.
Also, physiotherapy, active muscle strengthening, chiropractic, acupuncture, TENS treatments, or the direct administration of anti-inflammatory drugs to the painful area may be used to treat the shoulder pain.
The so-called black roll can also be used for shoulder pain.

For severe signs of wear in the shoulder joint, a joint prosthesis can be used. For example, if a rotator cuff injury is the cause of the pain, it may be necessary to protect the shoulder for a while to promote the healing process.
In severe cases, surgery can also be performed. The therapy of a shoulder stiffness includes in particular a physiotherapeutic treatment, with the aim to make the shoulder movable again. There are also treatment options using electricity, electromagnetic waves or ultrasound to counteract the aching shoulder.

There are numerous surgical techniques that can be used for certain causes of shoulder pain. For example, an operation can be used to correct the shape and position of the humerus, suture tendons, move muscles, release adhesions, remove diseased bursae or tissue, and much more.

homeopathy

Some sufferers first want to resort to homeopathic remedies to relieve their symptoms. Homeopathic remedies have no side effects, their use is controversial among medical professionals. However, homeopathy may be worth a try, especially for light and occasional ailments, before other measures have to be taken. However, the cause of the shoulder pain should be clarified by a doctor before this type of self-medication is used.

Ferrum phosphoricum (iron phosphate) is said to help combat tension and inflammation around the shoulder and is usually applied over several days and weeks. A similar, additional decongestant effect is said to Arnica. Rhus toxicodendron, the oak-leaved poisonum, helps with chronic joint diseases such as osteoarthritis and arthritis and can alleviate the discomfort caused by it in the shoulder joint.

tapes

Kinesio tapes (short for kinesiology, kinematics) are designed to help against tension, relieve pain and improve movement restrictions. Joint function is supported ( augmentation ) and compression can reduce swelling.

The tape strips are made of cotton and are coated with an acrylate adhesive, which ensures firm adhesion to the skin. The tapes are available in rolls or in pre-cut sections for specific body parts. They are glued to the shoulder, individually or in combination, following the muscle, ligaments or nerves. The stripes are stretched depending on the desired effect. As a rule, the taping is performed by specially trained physiotherapists. Affected persons who acquire the knowledge of the anatomical structures can also learn certain tape methods themselves. However, it is advisable to learn the right method in any case from a specialist, otherwise the symptoms can be aggravated.

exercises

Simple discomfort in the shoulder (pain, restricted mobility) is often caused by insufficiently trained or tense muscles. In this case, certain exercises can help to loosen, strengthen and stretch the muscles and so quickly relieve the symptoms. For shoulder complaints, however, many other causes come into question (osteoarthritis, bony damage, entrapments, etc.). In case of doubt, a doctor should always be consulted confirming that a workout to strengthen the muscles is the right way. In addition, when performing the exercises should always be paid to the correct posture and correct execution. For this reason, it is recommended that inexperienced ones be guided first by a professional trainer or physiotherapist.

To stretch the shoulder you stand upright, the legs should be placed hip-width. The head should be held straight, with the view going forward. Now, turn your shoulders 5 times forward, inhaling while lifting your shoulders and slowly exhaling while lowering. Then rotate your shoulders 5 times backwards.

With the shoulder puller, the shoulders are first pulled up to the ears and kept short, before they are lowered slowly. This exercise is also repeated 5 times, paying attention to a breathing rhythm.

To strengthen the shoulder, an exercise in quadruped stand can be performed. Use a blanket or mat as a support and bend your knees 90 degrees so that they are placed under your hips. The hands are under the shoulder. Head and back form a line, with the view directed to the floor. The right arm is slowly guided into the horizontal with the exhale, with the thumb pointing up and the fingers pointing forward. When inhaling the arm is returned, but before touching the floor again led to the horizontal. The exercise is repeated 5 times and then performed on the other arm.

There are many different exercises for individual muscle groups that should be shown by a physical therapist or trained trainer if possible. It is always important that the exercises are performed regularly (preferably daily) and over a longer period of time to achieve a long-term effect. If pain occurs during exercise or aggravation of symptoms, the exercises should be stopped immediately.

prevention

For a healthy shoulder, it is important to have a good posture and to move the shoulder a lot and make sense. Otherwise it will lead to a wrong position of the joint and a degeneration of the inactive muscles.

Overloading should be avoided. Targeted muscle training can be used to prevent shoulder pain and premature shoulder joint wear. Especially in permanently sedentary activities can lead to muscle tension. Relaxation exercises, regular short breaks and relaxation exercises for the shoulder and neck muscles can be preventative.

Drafts and cold as well as one-sided postures and movements should be avoided. The shoulder muscles and the shoulder joint should be stretched and warmed up before and after sports activities. Even a healthy diet protects the metabolism and the joints, which can be avoided shoulder problems. If it is known which stimuli trigger or amplify the shoulder pain, these should be avoided at all costs.

Pain and a feeling of stiffness in the shoulder should be taken seriously at the first appearance and a doctor should be interviewed.

Diseases of shoulder pain

An inflammation can be the cause.

Shoulder pain can be triggered by a variety of diseases.
Probably the most common cause of shoulder pain in the shoulder are tensions and hardening of the shoulder and neck muscles.
Through stress and a wrong posture ( eg by sitting too long ), the shoulder, the back and the neck are heavily stressed, which can lead to painful tension.

Mostly due to a trauma, but also due to unfavorable or abrupt movements with a " unheated " shoulder, it can lead to tears, adhesions and shrinkage of the joint capsule in the area of ​​the soft tissue, resulting in shoulder pain.

In addition, the muscles or tendons of the rotator cuff may be ruptured ( rotator cuff tear ), which often severely limits mobility of the arm.

A painful inflammation of the shoulder joint ( periarthritis humeroscapularis ) is caused by lack of exercise and in extreme cases can lead to shoulder stiffness ( capsulitis adhaesiva ) or the so-called "frozen shoulder".

Other disorders that cause shoulder pain include tendinitis or bursitis ( subacromial bursitis ).
Such inflammations are mainly caused by infections, mechanical overload, rheumatic diseases and gout.

Joint wear ( osteoarthritis ) can be another cause of shoulder pain.
The shoulder joint arthrosis is caused by:

  • chronic overloading ( eg through years of strength training ),
  • Imbalances in the area of ​​the muscles,
  • Joint space narrowing in old age,
  • Circulatory disorders,
  • rheumatic diseases such as rheumatoid arthritis.

In occupations or leisure activities that are performed above the head ( eg painters, handball or tennis players ), painful shoulder wear is particularly common.
The impairment of movements in the shoulder, it comes to painful inflammation and swelling.

In the so-called impingement syndrome (constriction syndrome ), there is a constriction between the shoulder roof and the humerus.
There runs a tendon, which is exposed to a constant state of irritation, causing inflammation.

Also diseases of the spine can cause shoulder pain.

Under certain circumstances, nerve inflammation or injury, but also rheumatological diseases or medical disorders ( eg, heart attack, lung tumors, biliary colic ) with the symptom "shoulder pain" can be noticeable.

If the shoulder pain occurs especially at night, a so-called calcarous shoulder ( Tendinosis calcarea ) can be behind it.
In the process, calcium crystals are deposited in the rotator tendon due to recurrent minor tendon injuries or local circulatory disorders of the tendon.

Injuries, accidents and fractures can also lead to severe pain in the shoulder area.
The fractured collarbone ( clavicular fracture ) or injuries to the humerus ( eg humeral head fracture ) are common.

Also a dislocation of the shoulder joint ( shoulder gel luxation ) can cause strong pain and have different causes ( eg trauma, unstable shoulder ).

Rotatorenmanschettenriss

The shoulder joint is stabilized mainly by the muscles of the shoulder girdle.
The term " rotator cuff " refers to the four muscles that hold the humerus in the socket of the shoulder. In a rotator cuff tear one or more muscles or tendons of this important muscle group are damaged.

Such a tear can have a traumatic ( accidental ) or degenerative ( wear- related ) cause.
In the case of a fall or an external impact of force, for example, the shoulder may become dislocated, in some cases a muscle of the rotator cuff may break.

In addition, such a rupture may occur with increasing age as it results in loss of cartilage and loss of strength from the tendon attachments of the muscles.

A rotator cuff tear causes pain of varying intensity and limits the mobility of the shoulder.
In particular, the lateral elevation of the arm ( abduction ) is in a rotator cuff tear no longer or only very painful feasible.

There are several ways to treat a rotator cuff tear. On the one hand, the tear can be surgically sewn or closed.
Thereafter, a complex physiotherapy treatment over months or years is usually necessary to restore the physical performance.
In addition, in about a fifth of cases, the shoulder pain persists even after the operation.

On the other hand, a conservative ( non-operative ) therapy can be sought.
Cortical injections into the shoulder and nonsteroidal anti-inflammatory drugs are possible.
Physiotherapeutic exercises are also used for the conservative treatment of rotator cuff tears, if necessary with local pain elimination.

Bizepssehnentendinitis

Inflammation of the long biceps tendon is also called biceps tendon endinitis.
Such inflammation often occurs in people with poor posture with shoulders hanging forward and causes severe shoulder pain.

The long biceps tendon lies in a narrow bony channel in the shoulder joint and is prone to overload and injury, as it is often exposed to friction in its narrow course.

Constant irritation can cause the tendon to swell and become inflamed. In the further course it comes in some cases further damage of the Bizepssehne in the form of fiberizing and the tendon becomes unstable.

Biceps tendonitis can also be caused by muscular dysbalance of the shoulder rotator cuff.
This refers to a malposition of the thoracic spine in which the retaining muscles at the back of the rotator cuff are too weak.

The dominant chest muscles pull the shoulders forward, it comes to " forward hanging shoulders " and the narrow channel through which the biceps tendon runs, continues to contract.

The diagnosis of biceps tendon endinitis 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 then made to lift the forearm against the resistance of the doctor.
In the case of a biceps tendon endinitis, pain in the area of ​​the anterior shoulder is provoked.

In order to treat muscular dysbalance and relieve pressure on the irritated and inflamed biceps tendon during biceps tendon sinusitis, targeted muscle training must be performed under physiotherapeutic guidance to strengthen the posterior rotator cuff. In most cases, this can bypass an operative transection of the biceps tendon.

shoulder osteoarthritis

Too strong shoulder pain occurs, among other things, in a shoulder osteoarthritis ( osteoarthrosis ).

The abrasion of cartilage in the humeral head and / or the shoulder joint socket causes joint wear in the shoulder joint.

The shoulder arthrosis is subdivided into a primary one ( no apparent cause, age-related wear of the joint ) and a secondary one ( after fractures or as a result of a humeral head necrosis ).

On the radiograph, a deformation of the humerus can be seen.
In addition, the decrease in articular cartilage is recognizable as narrowing of the visible joint space.

Shoulder osteoarthritis often results in restricted mobility.
In addition, it comes to movement-dependent pain in the shoulder joint and in many cases to a relapsing, inflammatory activation of the joint.

Die Schulterarthrose wird mit Medikamenten, physikalischen Therapien, Kühlung oder operativen Maßnahmen ( zB Arthroskopie, Prothese, künstliches Schultergelenk ) behandelt.

Bankart Läsion

Eine Bankart Läsion entsteht in den meisten Fällen durch ein Ausrenken der Schulter ( Luxation ) nach vorn im Rahmen eines Unfalls.

Die Bankart Läsion bezeichnet dabei einen Zustand, bei dem die sogenannte Gelenklippe ( Labrum glenoidale ) der Gelenkpfanne des Schulterblattes teilweise oder vollständig abgerissen ist.
Diese Gelenklippe stabilisiert eigentlich das Schultergelenk in der Pfanne und es kommt leicht zu weiteren Ausrenkungen der Schulter.

Häufig geht die Bankart Läsion mit einem Gefühl der Instabilität im Schultergelenk einher.

Von einer Bankart Läsion mit Schulterschmerzen sind in der Regel jüngere und sportlich aktive Menschen mit einem überbeweglichen Bandapparat.

ACG-Arthrose

Als Schultereckgelenk ( Akromioklavikulargelenk, AC-Gelenk, ACG ) wird die gelenkige Verbindung zwischen dem oberen Ende des Schulterblattes, der sogenannten Schulterhöhe ( Akromion ), und dem äußeren Ende des Schlüsselbeins ( Clavicula ) benannt.

Kommt es in diesem Bereich zu einem Gelenkverschleiß ( Arthrose ), so äußert sich dies in der Regel in einer schmerzhaften Bewegungseinschränkung der Schulter.

Die Behandlung einer solchen ACG-Arthrose richtet sich meist nach den individuellen Beschwerden.
Meist wird eine Therapie mit Krankengymnastik und physikalischen Anwendungen ( zB Kälte, Elektrotherapie ) versucht.

Sollten die Schulterschmerzen dadurch nicht ausreichend gelindert werden und die Bewegungseinschränkung nicht aufgehoben werden, kann eine Resektion des AC-Gelenkes erwogen werden.
Dafür werden die Gelenkflächen abgefräst und eine Art Meniskus aus körpereigenem Material zwischen die Gelenkflächen platziert.
Häufig kann die Schulter nach einem solchen Eingriff bereits nach zwei Monaten wieder voll belastet werden und ist schmerzfrei.

Herniated disc of the cervical spine

Auch ein Bandscheibenvorfall der Halswirbelsäule kann sich durch das Symptom " Schulterschmerzen " bemerkbar machen.

Bei einem Bandscheibenvorfall tritt ein Teil der Bandscheibe in den Wirbelkanal vor und drückt unter Umständen auf das Rückenmark oder von ihm ausgehende Nervenwurzeln.

Ein Bandscheibenvorfall kann ohne äußeren Anlass auftreten, häufig ist jedoch eine Überbelastung bei bereits vorgeschädigten Bandscheiben die Ursache für den Vorfall ( Prolaps ).

Typischerweise treten Bandscheibenvorfälle im Bereich der Lendenwirbelsäule auf und verursachen Rückenschmerzen, die bis in die Beine ausstrahlen können.

Doch kann ein Bandscheibenvorfall auch im Bereich der Halswirbelsäule auftreten und durch Kompression der Nervenwurzeln zu starken Schmerzen im Bereich der Schulter führen, da die versorgenden Nerven der Schulter der Halswirbelsäule entspringen.

Es ist nicht ratsam, bei einem solchen Bandscheibenvorfall Bettruhe zu halten und die Schulter zu schonen.

Viel mehr besteht die Therapie der Schulterschmerzen in einer medikamentösen Schmerztherapie und daraufhin durchgeführte krankengymnastische Bewegungstherapie.
Auch Wärmetherapie, Massagen und Elektrotherapie stellen Behandlungsmöglichkeiten dar.

Eine operative Behandlung eines Bandscheibenvorfalls der Halswirbelsäule ist in der Regel nur angezeigt, wenn die Schmerzen ambulant nicht mehr beherrschbar sind oder wenn neurologische Ausfälle auftreten.
Das ein schulterschmerzenverursachender Bandscheibenvorfall durch eine Operation behandelt werden muss, ist sehr selten.

Zur Vorbeugung eines Bandscheibenvorfalls ist ein konsequenter Muskelaufbau der Rücken- und Schultermuskulatur ratsam.

Durch gymnastische Übungen oder rückenfreundliche Sportarten ( zB Schwimmen, Tanzen, Laufen, Fahrradfahren ) können die Rückenmuskulatur gestärkt und die Schmerzen gelindert werden.
Außerdem erfahren die Bandscheiben bei diesen Sportarten wechselnde Druckbelastungen, was für die Versorgung der Bandscheiben mit Nährstoffen wichtig ist.

Auch ein ergonomisch richtiger Arbeitsplatz stellt eine wichtige Maßnahme zur Vorbeugung gegen einen Bandscheibenvorfall der Halswirbelsäule (HWS) dar.
Statische Sitzpositionen sollten vermieden werden und es sollte auf wechselnde Druckbelastungen ( zB Stehen, Gehen, Sitzen usw. ) geachtet werden.

eddy blocking

Theoretisch kann jeder Teil der Wirbelsäule von eine Blockierung betroffen sein.

Wenn durch eine Wirbelblockierung Nervenwurzeln gereizt werden, entstehen Fehlinfomationen, die im Gehirn Schmerzempfindungen auslösen.
So können auch Schulterschmerzen von Blockierungen in der Halswirbelsäule ausgehen.

Das bedeutet, dass es zu einer Fehlstellung oder Verschiebung von Gelenken der Wirbelsäule kommt, die durch eine plötzliche, ungewöhnliche Belastung ( zB Heben schwerer Lasten ) oder durch lang andauernde Fehlhaltungen bei Verkrümmungen der Wirbelsäule (zB langes Sitzen) verursacht werden.
Häufig kommt es zusätzlich zur Wirbelblockierung zu einer reflektorischen Anspannung der Rückenmuskulatur, was auch in der Schulter schmerzhaft empfunden werden kann.

Wirbelblockierungen können sich von selbst wieder lösen, durch sanfte Massage, Wärmeanwendung und Entspannung der Muskulatur.

Sollte dadurch keine Linderung der Beschwerden eintreten, kann eine chirotherapeutische Behandlung erwogen werden. Dabei kann das blockierte Gelenk wieder " eingerenkt " werden.
Allerdings ist Chirotherapie nur sinnvoll, wenn die Verspannungen der Muskulatur gleichzeitig gelöst werden, da die Wirbelblockierung sonst wieder kommen kann.

Weitere Informationen finden Sie unter Wirbelblockierung.

Subacromial bursitis

Bei einer Bursitis subacromialis ist der Schleimbeutel zwischen dem Schultereckgelenk und der Sehne des Obergrätenmuskels ( M. Supraspinatus, wichtiger Teil der Rotatorenmanschette ) liegt.
Dieser Schleimbeutel ist eine "Verschiebeschicht" zwischen Muskel und Knochen. Kommt es zu einer entzündlichen Veränderung dieses Schleimbeutels ( Bursitis subacromialis ), verklebt diese Gleitschicht und die Sehne des Muskels wird dünner.

Im weiteren Verlauf kommt es meist zu einem Zerreißen des Obergrätenmuskels ( Rotatorenmanschettenruptur ) und es resultieren chronische Schmerzen, die die Bewegungsfähigkeit der Schulter stark einschränken.

Die Diagnose einer Bursitis subacromialis kann meist einfach gestellt werden. Dafür werden genaue Informationen über die Krankengeschichte ( Anamnese ) und eine körperliche Untersuchung durchgeführt.

In der Regel kommt es bei einer Bursitis subacromialis zu Schmerzen im Schultergelenk, wenn der Arm zwischen 80 und 120 Grad seitlich vom Körper weggeführt ( abduziert ) wird.

Ergänzend können bildgebende Untersuchungen wie Ultraschall ( Sonographie ), Kernspintomographie oder Röntgen Auskunft über das Ausmaß der Schleimbeutelentzündung geben.

Die Behandlung einer Bursitis acromialis besteht zunächst in der Vermeidung weiterer Belastungen und Schonung des Schultergelenkes.
Auch krankengymnastische Übungen und schmerzstillende Medikamente können hilfreich sein.
Eine Kortison-Injektion in den Subakromialraum kann in vielen Fällen zur Linderung der Beschwerden führen.

Sollten konservative Maßnahmen jedoch keine Besserung bringen, kann eine chirurgische Entfernung des Schulterschleimbeutels angezeigt sein.

Impingement

Schulterschmerzen, die sich aufgrund einer Enge zwischen dem Oberarmkopf ( Caput humeri ) und dem Schulterdach entwickeln, werden als sogenanntes Impingement-Syndrom bezeichnet.

In diesem Bereich der Schulter besteht bereits natürlicherweise eine gewisse Enge, weshalb es häufig zu einer chronischen Reizung des Schleimbeutels und der Sehnenansätze ( meist Supraspinatussehne, Rotatorenmanschette ) kommen.

Ein erhöhtes Risiko für eine Impingement-Syndrom haben bestimmte Berufsgruppen wie Maler oder Überkopfsportler ( zB Tennis- oder Volleyball-Spieler ).

Zu Beginn treten die Schulterschmerzen nur bei Belastungen auf ( besonders bei Tätigkeiten mit angehobenem Arm ), später können sie auch in Ruhe auftreten.
Besonders ausgeprägt sind die Schmerzen meist beim abrupten Anheben des Armes zur Seite oder unter Belastung.

Um die Schulterschmerzen beim Impingement-Syndrom zu lindern können zunächst Therapiemaßnahmen wie Elektrotherapie, Salbenbehandlung, Kältetherapie, Bewegungsübungen und gezieltes Muskeltraining eingesetzt werden.
Auch entzündungshemmende Medikamente können eingesetzt werden.

Bei Versagen der konservativen Behandlungsmöglichkeiten, sollte die Ursache des Reizzustandes der Schulter behandelt werden.
Dazu kann der Raum unter dem Schulterdach im Rahmen eines operativen Eingriffs erweitert werden.
Der entzündete ( und meist verdickte ) Schleimbeutel wird entfernt und knöcherne Vorsprünge werden abgetragen. Dadurch soll auch die fortschreitende Schädigung der Sehnen der Rotatorenmanschette und ein gegebenenfalls drohender Sehnenriss verhindert werden.

3 Gentle Stretches to Reduce Shoulder Pain (December 2019).


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