What is this shoulder pain?
Very mobile and highly stressed, our shoulders become weaker with age. Frequent after 50 years, the pains concerning them can be muscular, tendinous, joint or bone. We must act quickly, because they become rapidly chronic (when they last beyond three months) if we do not consult and if we do not follow appropriate treatment. Action reaction !
It launches : it is tendonitis
This is the most common tendonitis, usually caused by repeatedly raising the arm, for example by pruning a hedge or painting a ceiling. But not only: an aging tendon, which thins with time and ignites after an insignificant effort, can create this type of affection. The pain appears when one raises the arm, becomes very troublesome at night, with an irritation of the external face of the limb (long biceps).
What solutions? The rest of the joint (no movement repeated above the horizontal), to which is added the taking of analgesics and anti-inflammatory, associated with a possible infiltration of corticosteroids in the acute phase. A rehabilitation of the joint by the physiotherapist can revive the production of collagen tendon by mobilizing the shoulder. It does not work ? A dental infection can also cause inflammation of the tendons! If the origin is not dental, the rheumatologist will look for other causes of tendinitis: osteoarthritis, calcifications, even a rupture of the rotator cuff.
It radiates : it is a rupture of the rotator cuff
The rotator cuff is a group of four tendons that, like a hat, cover the head of the humerus and control its rotation. However, this area can be worn due to physical and / or occupational activity, smoking (which clogs the arteries supplying the tendons), metabolic diseases or anatomical factors. And it happens that she "lets go", sometimes during a constraint of little importance. The pain is violent, strong at night, the shoulder loses mobility and strength.
What solutions? If the rupture is degenerative and the elderly patient, 20 minimum re-education sessions are prescribed to develop the compensatory muscles. They often avoid surgery. It is best indicated in a patient under 65 years of age with a small to moderate rupture, or in a person over 65 if the rupture of the tendons is complete.
It gets stuck : it is a retractable capsulite
It most often affects women when menopause is established, is manifested without clear cause or after metabolic disorders (diabetes, hyperthyroidism), a fall, a shock without fracture ... The envelope (capsule) that surrounds the shoulder ignites then stiffens. The pain is intense at first (especially at night) then fades, but the shoulder remains stiff and very mobile.
What solutions?Level 2 analgesics (paracetamol codeine type) are the most effective medications for pain relief, as well as the infiltration of a mixture of corticosteroids and anesthetics. Then, to soften the articulation and regain mobility, the physiotherapist will mobilize the shoulder gently, teaching the patient self-rehabilitation gestures. Sometimes, we complete the whole by balneotherapy in hot water.
It blocks: it is an acute calcium crisis
When it occurs, the shoulder is completely blocked as the pain is intense, permanent and generating insomnia. The evacuation of a part of the calcifications naturally present in the shoulder towards the stock exchange, located above the tendons of the rotator cuff, causes this acute crisis.
What solutions?Calcifications tend to disappear naturally in twelve to eighteen months, puncture or surgery are never considered from the outset. Gentle manual rehab relieves pain. The sending of compressed air on the injured area (shock wave), practiced by a rheumatologist, activates the disappearance of the calcification by "spraying" it and accelerates the healing of the tendons by revascularizing them.
It crackles: it is osteoarthritis of the shoulder
Also called omarthrosis, it is placed between the head of the humerus and the scapula, where the cartilage wears out with time. More rare than the hip and knee, it is nonetheless very debilitating, making the shoulder stiff and painful.
What solutions?Of course, the prosthesis is needed when the wear of the cartilage is important and the pain becomes permanent and unbearable. But, when osteoarthritis is not yet too important, a functional rehabilitation well conducted by the physiotherapist gives good results: it removes muscle contractures that put pressure on the joint and prevent the range of motion.
The classic radiography allows first of all to look for calcifications. But ultrasound is often performed to examine tendons and bursa (in case of tendonitis, rotator cuff lesions, acute calcium crisis ...). A CT scan or an MRI provide an accurate picture of the condition of the cuff (possible rupture of one or more tendons), the size of the calcifications and their location. As for arthrography (radio with injection of a contrast medium in the joint), it is sometimes practiced if one suspects a partial or total rupture of the rotator cuff or capsulitis.
Thank you to the French Society of Rehabilitation of the shoulder.
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