Pain in shoulder and arm

definition

The shoulder is a demanding and complicated joint apparatus that can be damaged quickly. The shoulder is related on the one hand to the muscles of the shoulder girdle and on the other hand to the muscles of the upper arm.
Because of this, shoulder pain can have many causes.
In many cases, the pain is due to acute overload or chronic wear and tear.

The damage is usually evident in the form of pain. This pain can also radiate to the arm or neck and get worse as the arm moves.

Sometimes other organs can also project into the shoulder area, e.g. can manifest in shoulder pain during a heart attack.

causes

As mentioned briefly, the pain in the shoulder or arm can have a wide variety of causes. One possibility in acute pain can be a biceps tendon tear or a broken upper arm.

A dislocated shoulder also causes severe pain, but it can often be recognized by the misalignment of the joint.

If the pain is more chronic, e.g. wear and tear of the shoulder joint can be assumed. A herniated disc in the area of ​​the cervical vertebrae can also cause chronic pain in the shoulder and arm.

Bursitis of the shoulder

In addition to tendons, muscles and bones, the shoulder joint also consists of bursae. These are important to ensure smooth movement of the joint.

There are three bursae in the shoulder joint: the Bursa (Bursa) subdeltoidea, Subacrominal bursa and Subcoracoid bursa. However, these bursae can become inflamed, causing pain when moving the shoulder.

This inflammation of the bursa is called Bursitis. In the case of inflammation, they are mostly Subdeltoid bursa and the Subacrominal bursa affected (please refer: Subacromial bursitis).

As a therapeutic measure in the chronic course of the inflammation, there is the option of removing the bursa endoscopically (through small skin incisions). This procedure will Bursectomy called.

Read more on this topic at: Bursitis of the shoulder

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of Dr. Gumpert.

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

Lime shoulder

The calcified shoulder describes the calcification of the shoulder joint. It often occurs in middle age, i.e. between the ages of 30 and 50.
In the case of the calcareous shoulder, calcareous crystals are deposited on the attachments of the tendons. The tendons of the rotator cuff muscles (shoulder muscles) are usually affected.

The cause of the deposit is probably the reduced blood flow to the shoulder. If the arm is now moved, calcium will rub against the tendons. Especially when moving over the head, pain in the shoulder occurs here. Additional deposits inside the bursa are also possible. When the bursa calcifies, there is more pain.

Read more on the subject at: Lime shoulder

neuritis

Neuritis is the inflammation of nerves. In most cases, the cause of the inflammation is pressure on the nerves.
Particularly on the shoulder, where the muscles are often active, there can be strong pressure on the nerves. The risk of neuritis is high, especially when working on one side for a long time.
If the nerve is inflamed, the pain often radiates to the entire arm and is felt to be very intense.
Often an entire muscle group is affected in neuritis, which is innervated (supplied) by this nerve. Often there is also a tingling sensation or the feeling that the hand is falling asleep.

It is important for treatment to find the cause. If the neuritis is caused by chronic stress (such as chopping wood), this activity should be stopped and the shoulder should be spared.

Rotator cuff damage

The rotator cuff is a functional muscle group that is responsible for the various degrees of movement of the shoulder and that holds the shoulder in its position.
It surrounds the shoulder like a "coat" and consists of four muscles: Supraspinatus muscle, Teres minor muscle, Infraspinatus muscle and Subscapularis muscle. These muscles can also tear the tendons, which then lead to acute pain.
The tendon tears can occur partially or completely.

The damage to the rotator cuff is also related to the impingement syndrome, as the tendon of the supraspinatus muscle is chronically trapped here and can ultimately tear due to the friction.

Read more on this topic at: Impingement syndrome

Anatomy of the shoulder

Anatomy of the shoulder
  1. Humerus head
  2. Shoulder height (acromion)
  3. Shoulder joint
  4. Collarbone (clavicle)
  5. Raven bill process (Coracoid)
  6. Shoulder joint (glenohumeral joint)

Figure shoulder muscles

Illustration of the muscles of the right shoulder: A - front view and B - muscles of the back

Shoulder muscles

  1. Scapula-hyoid bone muscle -
    Omohyoideus muscle
  2. Anterior stair muscle -
    Scanelus anterior muscle
  3. Head turner -
    Sternocleidomastoid muscle
  4. Collarbone - Clavicle
  5. Deltoid - M. deltoideus
  6. Raven bill process upper arm muscle -
    Coracobrachialis muscle
  7. Subscapular muscle -
    Subscapularis muscle
    (second layer)
  8. Two-headed upper arm muscle
    (Biceps) - M. biceps brachii
  9. Pectoralis major -
    Pectoralis major muscle
  10. Scapula lifter -
    (second layer) -
    Muscle levator scapulae
  11. Upper bone muscle -
    Muscle supraspinatus (second layer)
  12. Scapula bone -
    Spina scapulae
  13. Small round muscle -
    Muscle teres minor
  14. Subbone Muscle -
    Muscle infraspinatus
  15. Large round muscle -
    Muscle teres major
  16. Trapezius -
    Muscle trapezius
  17. Broad back muscle -
    Muscle latissimus dorsi

    Rotator cuff
    = 4 muscles (7th + 11th + 13th + 14th) -
    covered by the deltoid

You can find an overview of all Dr-Gumpert images at: medical illustrations

Bruised shoulder

With a shoulder bruise, the muscles and vision of the shoulder have been crushed by force (e.g. a fall). The damage to muscles and tendons can cause pain.
The contusion is sometimes accompanied by a visible hematoma (bruise) and swelling, but it can also occur without any external symptoms.

In order to treat the bruise, the shoulder should be moved as little as possible. In addition, cooling and compressing the shoulder can aid healing. In most cases, the shoulder will heal within two weeks. If pain persists after this period, it should be clarified whether the bones or tendons may have been more severely injured.

Read more on the subject at: Bruised shoulder

Accompanying symptoms with pain in the shoulder and arm

The accompanying symptoms of shoulder and arm pain can be very different as there are many causes that cause the pain.

In addition to pain when moving, pain at rest can also occur. Chronic muscle tension can be the cause of pain without moving the shoulder.

Overheating of the shoulder joint can also occur as an accompanying symptom when there is pain in the shoulder. The overheating here is mostly due to an inflammatory process and the resulting increased blood flow.

Restriction of movement of the shoulder can be another accompanying symptom. This is also called “frozen shoulder” or “frozen shoulder” and is caused by a shrunken joint capsule. The reduction in size of the capsule reduces the range of motion.

In addition to the shoulder, the arm can also be affected. This can also cause pain in the arm and hands. Numbness or tingling in the arms or hands can often be associated with the pain.

In addition to symptoms, the triggers of which are localized on the shoulder, symptoms can also occur on the shoulder, which are caused by clinical pictures from other parts of the body.

A heart attack can cause sudden pain in the left shoulder. In addition, there may be pain behind the sternum (breastbone) and the affected person feels that the chest is narrowed. Difficulty breathing can also occur.
In the event of a heart attack, a doctor should be consulted urgently!

In the case of biliary colic, there is pain in the right shoulder and colic-like pain in the abdomen. The pain has an increasing and decreasing character. A doctor should also be consulted here.

This article might also interest you: Pain under the shoulder blade

diagnosis

In order to diagnose pain in the shoulder and arm area, the patient must first be asked questions. A thorough anamnesis (discussion of the symptoms) should be used to find out exactly where the pain occurs, whether it radiates to another region (e.g. the neck or arm) and in what period of time it occurs.
Accompanying symptoms such as numbness or tingling should also be described in the conversation. The mobility of the shoulder joint and arm can then be checked during a physical examination.
In addition to mobility, the condition of the skin must also be taken into account. Here the skin should be examined for overheating, reddening, swelling or bleeding.
The neurological examination checks the condition of the nerve tracts.

If inflammation is suspected, the shoulder joint is often punctured to rule out bacteria in the joint. Finally, imaging methods such as X-rays, MRIs, ultrasound or CT can be used to get a view of the shoulder and arm and to rule out breaks or other injuries.

Treatment of shoulder pain

The pain in the shoulder and arm should be treated based on its cause.
In addition to pain therapy, it is absolutely necessary to find the cause of the pain.

If a dislocated shoulder joint is the cause of the pain, it can be adjusted again. In the case of non-rheumatic inflammation of the shoulder, drug therapy is used to fight the bacteria or to let the inflammation subside.

Massages and physiotherapy can relieve tension and misalignments that cause pain. Physiotherapy is often prescribed to strengthen the muscles and improve posture as a result.

For example, if the cause of the pain is a broken bone, surgical intervention is usually necessary.

Various measures can be used to reduce the pain in the shoulder or arm. On the one hand, drug-based pain therapy can lead to rapid pain relief.
Treatment with cold therapy can reduce severe pain. Here the shoulder is cooled and the pain perception is reduced.
If the pain is only mild, heat therapy is preferred. This relaxes the muscles and promotes blood circulation and thus healing.

Duration of shoulder pain

The duration of the pain is very dependent on the underlying disease. For this reason, no generally valid duration can be given.
In the case of tension-related pain, relief can be achieved in a short time, sometimes after hours.
Surgery is often necessary for more complicated clinical pictures such as torn tendons or fractures. After surgery, it can take weeks or months for the broken structures of the shoulder to heal.
Inflammations often subside in days if properly treated.

Pain in the armpit

If the shoulder pain is felt particularly strongly in the armpit, this can provide clues about the disease.

A disease with typical pain in the armpit is osteoarthritis of the shoulder joint. Osteoarthritis damages the joint cartilage. This could be due to ignition, wear and tear or an accident.

The joint cartilage ensures that the joint surfaces can slide well and that there is as little friction as possible in the joint. With osteoarthritis, the cartilage is damaged and there is friction in the joint, which can be painful.
In most cases, shoulder osteoarthritis pain can be described as dull. They are also reinforced when the arms are moved above the head. For example, throwing objects or working overhead can increase the pain.

Read more on the subject at: Symptoms of shoulder osteoarthritis

Pain in shoulder when raising arm

If you raise your arm and feel pain, some diseases come into question for which this symptom is characteristic.

One example is the impingement syndrome. This results in the tendon of the supraspinatus muculus being pinched. When the arms are raised sideways over the head, the humerus and the shoulder roof come closer together. The tendon of the supraspinatus muscle lies between these bones. Increased stress can lead to strong friction, which can then result in a tear in the tendon.
The so-called "arc-of-pain" typically occurs in impingement syndrome. Here, the patient spreads his arms sideways from the body. The pain should start at an angle of 60 ° between the arm and the body and at an angle of 90 ° the pain subsides again.
The pain can also pull into the arm.

In addition to the impingement syndrome, a shortening of the pectoralis minor muscle can also be responsible for the pain when lifting the arm.
The pectoralis minor muscle (also known as the “small chest muscle”) connects the shoulder with the chest. With stress, too vigorous training or chronic poor posture, the muscle shortens, which pulls the shoulder forward. Then raising the arm can cause pain.

Pain in the shoulder and elbow

If the pain in the upper arm was preceded by previous exercise or exercise, a muscle strain may be considered. In the event of a muscle strain, the muscle is overstretched and the individual muscle fibers are damaged.
This creates a pain that extends from the shoulder to the elbow and occurs mainly when the muscle is moved and stretched.
A fracture of the humerus can also cause pain from the shoulder to the elbow.

Pain in the shoulder and fingers

If the pain occurs from the shoulder to the fingers, a problem with the nerves can usually be assumed. In many cases it is a so-called neuralgia (nerve pain), which can extend over the entire arm and up to the shoulder blade.
Often times, tingling or numbness occurs with the pain. The reason for the neuralgia is in many cases an inflammation of the nerves (Neuritis). This often results from a one-sided, excessive load.
For example, assembly line jobs can lead to neuralgia because the same movement is often performed for an entire shift. The posture also mostly remains the same and leads to a very one-sided strain on the muscles.
The hardening of the muscles can press on nerves and thus block the blood supply to the nerve. This metabolic disorder then leads to pain.

Herniated discs can also lead to neuralgia. These can occur in the area of ​​the cervical vertebrae, which can lead to pain radiating to the arms. This can also lead to paralysis of the muscles (see: slipped disc of the cervical spine).

Pain mainly in the upper arm

In the case of pain in the shoulder and upper arm, which occur particularly in the upper arm, a break (fracture) of the upper arm bone (Humerus) to assume. The pain then occurs particularly in the upper arm, but can also radiate into the shoulder joint. If there was a fall before the pain mentioned, this suspicion is plausible.
Therefore, especially in the case of severe falls, an X-ray of the upper arm should usually be taken to rule out a break.
Indirect trauma can also lead to a broken arm. Indirect trauma means that the fall was caught by the outstretched arm or elbow and the humerus still breaks.
If there is a fracture, it usually affects the head of the humerus. Here the bone is a little weaker and breaks more easily, especially in older people.

Read more on this topic at: Pain in the upper arm

Pain at night

If the pain in the shoulder and arm area only occurs at night, unfortunately many clinical pictures can be the cause. Osteoarthritis, inflammation of the bursa (bursitis), calcified shoulder or inflammation in case of pain during the night are possible.
This is because during the day the joint space in the shoulder joint is pulled apart by the weight of the arms. This results in less friction and pressure in the joint. If you lie in bed at night, the gap in the shoulder joint tends to narrow, which can then lead to pain. In order to counteract the nocturnal pain, an orthopedic surgeon should be consulted, who can examine the shoulder specifically for a cause.