How can I straighten my shoulder

Rotator cuff syndrome

Rotator cuff syndrome: Persistent shoulder pain and restricted mobility that originate in the muscles, tendons, and bursae of the four rotator cuff muscles that surround the shoulder joint. The causes are excessive and incorrect loading of the shoulder joint through sport or overhead work, but also age-related signs of wear and tear. If rotator cuff syndrome is not treated, there is a risk of secondary diseases such as rotator cuff tear or frozen shoulder.

The therapy is initially conservative with painkillers, physiotherapy and cortisone injections into the joint. Surgery is sometimes necessary if there are complications, e.g. B. the suture of tears in the rotator cuff.

Leading complaints

  • Diffuse shoulder pain with certain movements, mostly when lifting, spreading and turning the arm inward
  • Nocturnal shoulder pain, especially when lying on the affected shoulder
  • Pain can radiate into the arm.

When to the doctor

Within the next few weeks if

  • moderate but persistent discomfort in the shoulder area.

Within the next few days if

  • the symptoms suddenly started while lifting a load or during sport or the shoulder pain is very severe and / or there is a pronounced restriction of movement.

The illness

The rotator cuff consists of 4 muscles, the tendons of which form a firm capsule that surrounds the shoulder joint. This capsule stabilizes the shoulder joint and, together with the deltoid muscle, holds the relatively large head of the humerus in the small joint socket. At the same time, thanks to its cuff-like construction, it allows the shoulder joint the greatest possible freedom of movement. The individual muscles move the arm as follows:

  • The subscapularis muscle turns the upper arm inward and helps move it forward or backward
  • M. supraspinatus (upper bone muscle) lifts the arm to the side and supports the external rotation
  • Infraspinatus muscle turns the arm outward and helps pull it towards the body
  • M. teres minor (small round muscle) also pulls the upper arm towards the body and helps with external rotation.

The long biceps tendon lies under the rotator cuff on the front of the shoulder; through them, the biceps muscle is attached to the shoulder blade above the shoulder joint socket. Parts of the rotator cuff and the long biceps tendon pull through an anatomical constriction that subacromial tightness. It lies between the head of the humerus and the roof of the shoulder, consisting of the roof of the shoulder (acromion), the raven beak process of the shoulder blade and a ligament that connects both. In addition to the tendons, there is also a bursa, the subacromial bursa, as a buffer in the subacromial space.

The schematic drawing of the right shoulder joint shows how many individual anatomical structures are involved in the formation of the joint and how closely they are in contact with one another. An anatomical constriction can be seen between the head of the humerus and the roof of the shoulder (acromion). Through them, inter alia. the tendon of the biceps.
Georg Thieme Verlag, Stuttgart

Disease emergence

The term rotator cuff syndrome is mainly used in practice as a working diagnosis: it remains (initially) open which structures are actually affected. The symptoms are mostly due to age-related signs of wear and tear in the shoulder area or excessive and incorrect loading of the shoulder. Typical causes are sports such as volleyball or javelin throwing or jobs with frequent overhead work such as electricians or mechanics.

The diagnosis is often used as a collective term for all pathological changes in the soft tissues in the shoulder area that lead to pain and restricted movement of the arm. The diseases belonging to this group (some of which are also complications or consequences of untreated rotator cuff syndrome in the narrower sense) such as rotator cuff tear, impingement syndrome, calcified shoulder, biceps tendon tear and frozen shoulder are discussed in the respective articles.

Complications

A course with repeated inflammatory reactions is common, especially if the cause is due to wear and tear. The complications depend on which structure is actually affected and what the final diagnosis is.

Diagnostic assurance

After the patient has described her pain in detail, the doctor carefully feels the shoulder. The pain caused by pressure gives the first clues as to which structures of the shoulder are irritated or injured. Function tests usually show an increase in pain when turning outwards or inwards and when lifting and spreading the arm against resistance. Typical tests are e.g. B.

  • Painful arc test: Here the patient has to lift the arm in a kind of arc sideways against resistance. Pain and restriction of movement in the range of the angle between 60 ° and 120 ° are typical for narrowing of the tendon of the supraspinatus muscle
  • Neer's sign: Here the examiner turns the forearm of the painful side inwards and at the same time touches the shoulder blade. Then she lifts her arm forwards and upwards, the pain suggests a tightness under the roof of the shoulders.

The doctor uses an ultrasound to detect pathological changes in the shoulder soft tissues such as tendinitis or defects in the rotator cuff. X-rays serve to rule out bone injuries; They also make possible calcifications in the area of ​​the tendons or the bursa visible. A raised position of the humerus head in the X-ray image is an indirect sign of damage to the rotator cuff.

Sometimes a CT or magnetic resonance scan of the shoulder is required for the precise clarification of the symptoms, if necessary with an injection of air or contrast medium into the shoulder joint Arthro-CT or arthro-MRI. Both make cracks and injuries to the capsule and rotator cuff visible through the air or contrast medium escaping into the surrounding tissue.

Differential diagnoses: Shoulder pain and restricted mobility are common in many shoulder diseases, such as: B. fracture of the humerus head or shoulder dislocation.

treatment

In the vast majority of cases, rotator cuff syndrome is treated conservatively. The doctors recommend an operation if the pain cannot be controlled with conservative therapy or if everyday life is severely affected by the restricted mobility.

Conservative treatment

Pain management. Pain relief and anti-inflammatory agents such as diclofenac (e.g. Voltaren® or Diclac®), ibuprofen (e.g. Dolgit® or Ibuprofen AbZ) or etoricoxib (e.g. Arcoxia®) help. These can be taken in tablet form, some are also available as a gel or ointment to rub in.

Cortisone injection. If the symptoms are very severe, the doctor will give cortisone (e.g. triamcinolone, e.g. Volon®) directly into the joint with a syringe to contain the inflammation and relieve the pain. Cortisone injections are used cautiously, as cortisone itself can lead to degeneration of tendons. In some cases the doctor also injects anesthetic agents such as B. lidocaine or mixtures of lidocaine and cortisone.

Physical therapy. In the chronic phase, applications with heat (red light, fango packs, warm baths), electrical stimulation and ultrasound treatments as well as TENS therapy (nerve stimulation) have proven successful.

Exercise therapy. In passive therapy, the therapist carefully mobilizes the shoulder joint to improve mobility and prevent it from stiffening. Active movements are also helpful: The basis of the treatment is regular, careful movement of the shoulder below the pain threshold, as is the case e.g. B. is taught as part of a shoulder school. Forced physiotherapy and massages aggravate the symptoms rather than alleviate them.

Muscle training. If the pain phase is over, the muscles of the rotator cuff should be strengthened with exercises as instructed by a physiotherapist, e.g. B. by lifting the arm to the side against resistance or turning outwards and inwards. In addition to strengthening, stretching exercises are also important so that the shoulder capsule does not shrink or is stretched again due to the inflammatory processes.

Operative treatment

Surgical procedures are often required for impingement syndrome or rotator cuff tear. In the case of strong adhesions and adhesions there is also a Joint mobilization Considered in order to give back at least part of its mobility to the diseased shoulder joint - which, however, sometimes fails due to the atrophy of the shoulder muscles after a longer course of the disease.

forecast

If the symptoms are due to excessive strain or improper strain, the chances of recovery are good - provided that treatment begins early and the shoulder is spared and not stressed during the healing phase.

In the case of wear-related rotator cuff syndrome, the prognosis is worse, there are often repeated attacks with renewed symptoms, resulting in complications such as frozen shoulder or rotator cuff tear.

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What you can do yourself

Heat and cold.

If the symptoms of rotator cuff syndrome appear acute or suddenly worsen, cold often helps. In this case, try e.g. B. with cold packs or moist, cool envelopes. Chronic complaints, on the other hand, react better to warmth. Lie down in bed e.g. B. a heat pillow under the shoulder to alleviate the particularly excruciating nocturnal pain.

Shoulder school.

Think about shoulder-friendly exercise in everyday life. These tips from Stiftung Warentest's shoulder school will help:

  • Exercise regularly and use your pain-free range of motion as much as possible and as often as possible.
  • Avoid holding your arms forward for a long time and propping up your elbows.
  • Carry loads close to your body and distribute them evenly between both arms.
  • Hold up straight! A straight back prevents incorrect posture of the shoulders and overloading of the muscles.
  • Avoid pressure on the shoulder, d. H. it is better to lie on your back than on your side when sleeping.
  • Avoid extending movements, overhead work and forced support with your arms.
  • Do some shoulder-friendly exercise, such as cycling or running.

Shoulder exercises

. Regular movement of the shoulder helps to delay or prevent recurring flare-ups of rotator cuff syndrome. Examples of shoulder exercises are:

  • Pull your hands apart. Sit up straight. Hook your hands together in front of your stomach, pull them apart for 7 seconds, repeat 7 times. Repeat the exercise with your hands hooked in front of your chest and forehead.
  • Fist to fist. Sit up straight. Stretch your left fist forward at the level of the belly button, place your right fist on top of the left and press on it for 7 seconds. Place your left fist on top of your right, press for 7 seconds, work your way up this way until your fists are above your head. Then do the same thing down to the navel.
  • Arm swing. While sitting, bend your upper body forward, let your arm hang relaxed between your spread legs, rest your head on the other arm. Make small pendulum motions with your thumb pointing up for 30–60 seconds.

Complementary medicine

Authors

Author Dr. med. Michael Bedall in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:29


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.