Shoulder pain
Shoulder pain is one of the most common types of pain in the general population, and a real challenge because of the many structures involved in this region.
Only 20% of the head of the humerus (the arm bone) is in contact with the scapula (shoulder blade), which makes this joint prone to instability. As a result, shoulder pain mostly originates outside the joint, in the many tendons and muscles of the region.
The most common cause of shoulder pain is supraspinatus tendinopathy/tendinitis due to subacromial impingement, that is, inflammation of the supraspinatus tendon as it is pinched against the acromion. The pain usually gets worse when lifting the arm. This impingement is caused by a complex biomechanical imbalance of the shoulder that raises the head of the humerus. Image-guided subacromial bursa injections, peripheral nerve blocks and botulinum toxin injections are important treatment options that allow effective, pain-free biomechanical correction (treating the cause). When calcifications in the tendon worsen the impingement, ultrasound-guided breakdown and aspiration of the calcifications resolves it.
Adhesive capsulitis (frozen shoulder) is inflammation of the joint capsule that makes it stiff, so all shoulder movements are limited. It usually follows prolonged immobilisation or metabolic diseases such as diabetes mellitus. The main treatment is joint mobilisation to increase range of motion. Peripheral nerve blocks and image-guided intra-articular hydrodilatation are treatment options that speed up and ease recovery.
Other common causes include long head of biceps tendinopathy, subscapularis tendinopathy due to subcoracoid impingement (another type of biomechanical impingement), acromioclavicular osteoarthritis and glenohumeral osteoarthritis (the main shoulder joint), each with its own specific approach.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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