Shoulder
PainIntroduction The shoulder joint is the most
vulnerable joint in the body as it is very exposed and very mobile. The bony support
is quite limited and this consists of the acromion process of the shoulder blade
and the clavicle with the acromioclavicular joint. This is helped by some supportive
ligaments and several bursae, which are slime filled pockets that help to allow
different tissue levels to move around easily . There are also the supportive
shoulder girdle muscles and the muscles and tendons that are part of the rotator
cuff mechanism. With all of these support mechanisms for the shoulder joint it
becomes possible to forward flex 180° and abduct 180°as well. The first
90°of this range of motion is done within the acromiohumeral joint (the articulation
between the acromion and the humeral head). The 90°to 180°motion takes place
in the "subscapular joint". This is the summation of tissues underneath
the shoulder blade, situated between the chest wall and the shoulder blade. This
very soft connective tissue in cooperation with the subscapular bursa enables
us to reach up high, to throw and pitch baseballs, to play tennis, golf, to swim
with a breast stroke. Normally we have no pain. But when the shoulder is painful,
then we need to know why. This chapter explains to you why, and what structure
could be responsible for this pain. Treatment of shoulder strain/
supraspinatus tendinitis/ subacromial tendinitis: Various physiotherapy
treatment modalities such as TENS, ultrasound, laser treatments and range of motion
anbd strengthening exercises will help with the recovery from the painful shoulder.
Within the first 6 to 8 weeks anti-inflammatories by mouth or by local application
(see below) are useful in getting the swellijng and pain under control. Pain medication
may have to be given in addition for a short period of time (a few days). As anti-inflammatories
are hard on the stomach, the use of topical medications is very useful. At
a recent conference (Ref.7) Dr. Taunton, Professor at the Univeresity of BC, Vancouver,
and Sportsmedicine Director of the Allan McGavin Sports Medicine Centre in Vancouver,
talked about the use of topical non-steroidal anti-inflammatories in tendinitis
cases. Pennsaid is such a commercially available preparation that is applied to
the skin and penetrates considerably deep to reach the inflamed tendon. This preparation
is a mixture of the anti-inflammatory Diclofenac (1.5%) and the vehicle DMSO,
which also has anti-inflammatory properties. The doctor can even order copounded
medicine that the pharmacist mixes with Lecithin, 5 to 10% Diclofenac and use
this as cream or patch (saran wrap). There is an FDA approved non-drug
method available, IceWave patches
from Lifewave, which will control pain. This is mentioned in the book
"Breakthrough" by Suzanne Somers (Ref. 8) where newer insights of antiaging
medicine are also reviewed. Although the patches are placed over acupuncture points,
there are no needles involved. Nanotechnology, a newer technology, was used in
the manufacturing of these patches and infrared (heat) waves from body heat are
utilized to stimulate an acupuncture point, which modifies pain perception and
reduces pain to half or less. Medically this would be considered an excellent
pain reliever. For more info on the patches see the IceWave patches from Lifewave
link above (click "products"). In the US a 5 pack of the IceWave spray
is available that can be directly sprayed onto the skin in the area where the
pain is located. Shoulder
Strain/Sprain Most physicians use "strain" and "sprain"
synonymously. Either term simply means "soft tissue injury" of the shoulder.
In other words, when you bang your shoulder and it gets bruised for a few days,
it's that sort of injury. There may be a hematoma of the subcutaneous tissue and
within the muscles of the shoulder, but all of this resolves without any trace
of injury within 1 to 3 weeks. In the more serious strains where there is a loss
of range of motion and strength in the shoulder, a few physiotherapy visits make
a big difference in the recovery rate. Eventually, even in these cases, most patients
have a satisfactory recovery. Supraspinatus
Tendinitis As I explained above under "shoulder impingement"
and "rotator cuff tendinitis" when the tendon of the supraspinatus muscle
rubs repetitively from impingement or from overuse, the supraspinatus tendon gets
inflamed. This condition is called "supraspinatus tendinitis". It can
lead to a rotator cuff tear at the insertion of the supraspinatus tendon into
the rotator cuff. This is a common injury in baseball players (pitchers) or tennis
players. Subacromial
Bursitis Underneath the acromion is a bursa, which will get
inflamed with shoulder impingement and often becomes the cause of a chronic irritation
and decreased range of motion and loss of strength. For shoulder decompression
to take care of the shoulder impingement, this abnormally swollen and inflamed
bursa has to also be taken out and technically this often means that an open surgical
decompression procedure needs to be done.
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