What You Should Know About Shoulder Injury...
When you are involved in strength training or fitness, the shoulder girdle causes so many chronic problems and usually hurts more often than any other part of the body.
Simply put, the four joints that make up the shoulder girdle are stressed all day long, and not just during exercise. This happens both when you hold down the computer mouse at work, and when in your free time you enthusiastically point your finger at the smartphone screen (it is quite possible that both of these “sports” will be added to the program of the 2020 Olympic Games).
The shoulder girdle is an incredibly complex complex of soft tissues that comprises several joints that work together to produce smooth and powerful movements in coordination with the rest of the body.
The likelihood that the most talented sports medicine specialist, even with advanced orthopedic knowledge, will identify the exact origin of pain only by palpation is as small as the ability of a snowman not to melt in the heat.
One thing remains true: movement determines everything. Where there are clear, correct and necessary movements, there is the opportunity to train without feeling like an awl is piercing you every time you strain your shoulder.
Today, assessing posture in a doctor's practice has become a waste of time. No matter who is being assessed, an elite athlete signing million-dollar checks or an overweight mother of four, one thing is true: their posture is far from ideal.
Computers and smartphones aren't going anywhere anytime soon. Because of them, most people's posture will become even worse over the years. But athletes, athletes and fitness fanatics will still move, and this will help them.
Assessing shoulder mobility and joint motion with a few simple tests can have a big impact on your future training.
All you need is your own body, a mirror and a willingness to look at yourself without a shirt.
The shoulder is a ball-and-socket joint that allows movement in three planes, making it one of the most mobile joints in the body.
A wide range of motion also makes the shoulder joint more susceptible to injury, especially when athletes push their bodies to peak endurance and strength levels.
It is important to know and be able to evaluate the movement of the shoulder joint in order to screen yourself for possible mobility impairments and movement dysfunction. Here are the three main planes and the movements that the shoulder makes in these planes:
Sagittal plane: Flexion / Extension
Frontal plane: Abduction/Adduction
Horizontal plane: External Rotation / Internal Rotation
Horizontal plane: Horizontal abduction / adduction
Remember, we are not cybernetic organisms. We can make smooth movements in all planes at the same time.
This makes the isolated shoulder movements described above not very suitable for assessing your own range of motion. This means that they will not allow you to determine the range of corrective movements that will relieve your shoulders from aching pain.
Screening for functional internal and external rotation of the shoulder joint can play a huge role in not only identifying mobility deficits, but also identifying localized areas of pain in the shoulder girdle.
The term “functional” does not mean testing mobility under any special conditions. It simply refers to combined movements, assessing which we can say with a high degree of confidence about the health of the shoulder joint as a whole.
Functional internal and external rotation can be described as a combination of three different movements of the shoulder, smoothly transitioning into each other in a certain sequence and rhythm of the available range of motion.
Here are the components of each functional movement:
Functional internal rotation = internal rotation + extension + adduction
Functional external rotation = external rotation + flexion + abduction
These movements can be tested on one side or both. The first thing is important: when you are in a standing position, make sure that both arms move at the same time.
The Epley Scratch Test can show how both shoulder girdles work in coordination with each other and can also determine the capabilities of each shoulder joint individually.
Here the right arm moves, performing functional internal rotation, and the left one, at the same time, performing functional external rotation. The goal is to bring your fingers together enough that they touch behind your back. Then the hands change and you check the other side.
During the test, you can slightly change the position of the spine (bend, for example) or gradually raise your lower arm up.
Pay attention to the distance between the palms during simultaneous functional internal and external rotation. Also note whether you experience pain and whether there is a difference between the range of motion on both sides.
What you feel is the most important aspect of this test, while hand coordination takes a back seat.
If you find asymmetrical movements, pain, or a noticeable lack of mobility (fingers not close to touching) during the Epley Scratch Test, it's time to try other tests to help find the source of the problem.
When you move with only one arm, the thoracic spine and rib cage do not provide additional mobility.
When both arms move toward each other during the Epley Scratch Test, the thoracic spine is easily tested to see how well it can provide additional range of motion when movement in the shoulder girdle is no longer possible. Doing the movements with just one arm allows you to focus only on the shoulder.
Test each shoulder individually during functional internal and external rotation. During functional external rotation, you should be able to touch your fingers to the prominent ridge of the opposite scapula.
In terms of testing functional internal rotation, touching the inferior angle of the scapula on the opposite side with your fingers indicates normal motion.
The testing positions are the same as for assessing simultaneous functional internal and external rotations.
It's possible that when you only tested one shoulder, the range of motion and rhythm was noticeably better. If so, your shoulder pain may be secondary to poor thoracic spine mobility.
If you have discovered this, then you now know exactly what the rehabilitation program should be aimed at. Focus on these three thoracic spine exercises before and after your workouts:
Now that we have some understanding of the movements performed by the shoulders during functional internal rotation with one and two arms, it is time to evaluate rhythm and coordination.
When your arm is raised, several sequential things must happen in order for a full, pain-free range of motion to be completed at the end point. First, all the joints in the shoulder complex must work together, but each one at the right time.
A healthy shoulder typically has a range of motion of about 180 degrees. Obviously, each shoulder girdle is as unique as the person who has it, so this is a fairly rough estimate.
In order for the shoulder to travel its full path without compensatory movements, the scapula and humerus must move synergistically and rhythmically. In sports medicine this is called the scapulohumeral rhythm.
Proper scapulohumeral rhythm means that for every 2 degrees of elevation movement of the humerus, the scapula should rotate upward 1 degree until the limit of motion is reached.
However, the numbers won't tell you anything. The point at which the blade stops rotating is more important.
When assessing your own scapulohumeral rhythm, it is important to track not only the range of motion, but also the moment when the scapula begins to move.
At approximately 120 degrees of arm elevation, the shoulder blade begins to rotate upward. If your shoulder blades become clearly visible on the sides of your body before reaching 120 degrees when you slowly raise your arms, this indicates that the posterior tissues of the shoulder are toned and tense.
In addition, the symmetry of movements on both sides should be assessed. Do your shoulder blades begin to rotate simultaneously or is their rhythm asymmetrical?
If the rhythm is disrupted, your best bet is to start working on soft tissue mobility in the back of the shoulder girdle.
This can be simple movements focusing primarily on the latissimus dorsi and other surrounding muscles using a foam roller or through self-myofascial release techniques. You can also use movements aimed at developing mobility, for example, adding stretching to your training program.
The choice is yours, and the only wrong decision is to do nothing at all.
If you are a big fan of figuring out the mechanics of human movement and the causes of its dysfunction, then you will most likely want to know exactly where in the shoulder joint causes discomfort every time you exercise.
Let's go back to testing the scapulohumeral rhythm and turn our attention to what triggers the pain.
The most common sites of injury in the shoulder girdle are the glenohumeral joint (GJ) and the acromioclavicular joint (ACJ). Although these two joints work together, they are responsible for different movements at different points in the arc of shoulder elevation.
According to the painful arc of the shoulder, if shoulder pain is present when your shoulder is at 45-120 degrees of motion, it is most likely due to HCS.
On the other side of the curve, if shoulder pain is only present at the end of the lift, between approximately 170-180 degrees, the part of the shoulder joint that is not functioning correctly is likely the AC joint.
If your self-diagnosis indicates a glenohumeral origin of joint pain and dysfunction, dynamic and static training with raised shoulders, especially with a load, will be the most effective way to continue exercise without pain.
Regarding the ACC, releasing unwanted tension at the end of the lift can be achieved by reducing the tone of the muscles and soft tissues of the posterior shoulder girdle, which allows for improved movement patterns of the scapula and the shoulder joint as a whole. How to relax muscles and reduce their tone has already been described above.
A fracture of the shoulder joint is considered a complex injury caused by a fall on the arm. Its treatment can be conservative or surgical. The choice of therapy will depend on the type and complexity of the injury.
A person's shoulder girdle is subjected to constant stress, which weakens not only tendons and ligaments, but also becomes the main cause of microcracks in bone tissue. Against the background of these pathological processes, when force is applied to this area, a fracture of the shoulder joint occurs. As a rule, such injuries damage the articular surfaces, on which cracks and fragments form. Treatment of the injury will primarily depend on the type of fracture.
The shoulder joint has a complex structure, as it is presented in the form of an articulation of three scapular bones, the clavicle and the tubular bone. Moreover, fractures can occur in both the distal and proximal parts. But the most difficult injuries are fractures of the shoulder joint.
Trauma is usually classified by area of localization:
It is worth noting that the injury can combine several types of fracture, which makes its treatment more complicated and makes it more difficult to develop the shoulder joint.
Treatment of shoulder fractures can be conservative or surgical. Its type is determined by the doctor and depends on the type of injury, age and health of the patient. This takes into account the subsequent development of the shoulder joint and complications that may arise.
Non-surgical treatment is usually prescribed for minor or no displacement. The damaged arm is fixed with a plaster splint or other hardening material. Such treatment requires long-term wearing of a fixing bandage. The duration of temporary immobilization depends on the complexity of the injury.
Treatment with surgical intervention involves the use of special devices that fix broken fragments of the shoulder joint. So, to fracture the greater tubercle, a fixing wire and special screws are used.
Treatment of more complex fractures may require the use of special plates or intramedullary pins. The requirements for such materials are quite high: they must be made of high-quality alloy and be durable.
Treatment based on prolonged immobilization of the limb has negative consequences for the muscles and causes a decrease in mobility in the joint. As soon as the fusion of the fragments has occurred, and the doctor has positively assessed this process, it is necessary to begin the restoration of the shoulder joint.
The development includes gentle exercise, which may be accompanied by severe pain, which requires the use of painkillers. Physical therapy should be carried out under the supervision of a physician. It is also necessary to periodically undergo radiographic examinations, which show how the development of the shoulder joint is progressing.
Rehabilitation begins with flexion and extension of the fingers of the injured limb, gradually introducing gentle movements in the elbow joint. After the cast is removed, development begins directly in the shoulder joint. Exercises that involve raising and lowering the shoulder will be very useful. You can also carefully raise and lower your arms and make circular rotations with your shoulders. Next, dumbbells are used to increase the load on the already strengthened joint.
Effectively carried out rehabilitation measures allow you to completely restore the lost functions of the shoulder joint and return to your normal lifestyle within 4-6 weeks. To consolidate the effect obtained, experts recommend regular tennis, swimming and physical activity in the gym.
The shoulder joint is considered the most mobile joint in the human body. Movements in this joint can be performed in 3 planes. Injuries in the shoulder joint occur due to an increase in the range of motion in this joint. Sometimes such actions are accompanied by a decrease in joint stability and the likelihood of damage to its structures.
Injuries to the shoulder and shoulder joint are most often the result of improper technique in performing sports exercises. Shoulder injuries are accordingly most common among athletes. The main symptom of a sports injury is pain in the area of the injury and pain when moving.
The structure of the shoulder joint is as follows:
Thanks to the ligament system, the head of the humerus occupies the correct position in the glenoid cavity of the scapula.
The most common shoulder injury is a shoulder injury, which can be open or closed. The cause of fractures is often road traffic accidents. This injury has its characteristic symptoms.
The main symptoms of a humerus fracture:
A significant symptom of a fracture is the characteristic crunch that can be heard during injury. Also obvious symptoms of a fracture of the shoulder bone are an increase in the volume of the limb, its deformation. With an open fracture of the shoulder, a wound and bleeding are visualized.
Diagnosis of a shoulder fracture is carried out by a specialist in order to exclude damage to nerves and blood vessels. If necessary, the doctor prescribes x-rays, MRI, CT.
If the victim exhibits symptoms of a humerus fracture, he must be given proper first aid. First aid for a fracture is performed in the following sequence:
Providing first aid consists of following these simple steps. Proper first aid affects further treatment and rehabilitation of the victim.
Providing first aid ends with transporting the victim to the medical center where the patient will be treated. After the victim is taken to the hospital, he will be provided with medical assistance. After diagnosis, the doctor will choose the appropriate treatment.
Treatment for a fracture may be:
Typically, conservative treatment of a fracture involves reduction. This manipulation consists of placing bone fragments in the correct position. Conservative treatment is used for simple fractures when there is no or minimal displacement of fragments.
In severe cases, the doctor uses anesthesia. More complex cases require surgical treatment. Surgical treatment helps eliminate displacement and fixate fragments. Fixation of fragments depends on the nature of the fracture. If avulsion of the greater tuberosity occurs, fixation is performed using wire, screw, and wire.
After the cast is removed, if the shoulder joint is damaged, contracture may develop. Contracture is a restriction of mobility in an injured joint. There is pain when moving, but development of the joint is necessary for the limb to function properly. Prevention of contracture is timely treatment of the injury that can provoke it.
It is very important that the fixation of the injured limb is done correctly. The risk of contracture formation is reduced when the injury is treated with traction.
When contracture develops, rehabilitation is necessary. Treatment of contracture involves the use of exercise therapy and massage. Development of measures is carried out to eliminate restrictions in the joint. Exercise therapy helps eliminate pain that occurs when moving a joint. Treatment of contracture is necessary to fully restore movement in the joint. Its purpose is also to eliminate pain when performing limb movements.
After treatment for a shoulder injury, rehabilitation is necessary. Rehabilitation after a fracture includes:
Exercise therapy is used to develop the upper limb after an injury during rehabilitation. Exercise therapy includes the following exercises to develop the joint:
After the cast is removed, the patient can perform new physical therapy exercises. Among the popular exercise therapy exercises during rehabilitation are:
These exercise therapy exercises are performed 10-15 times during rehabilitation after injury. Rehabilitation of the patient involves performing exercise therapy several times a day. The exercises should be supervised by a rehabilitation specialist. The article is for informational purposes only.
In the musculoskeletal system, the ball-and-socket joint is one of the largest and most mobile joints. Using the connection, you can perform abduction-adduction, flexion-extension and rotation of the human arm. The joint is strengthened by the muscular-ligamentous apparatus, tendons, and is surrounded by a cartilaginous lip, articular capsule and ligaments. The joint can be injured, damaged, dislocated or stretched. The shoulder joint is subject to degenerative-dystrophic diseases, which it is important to begin to fight in a timely manner.
The formation of the shoulder joint involves the scapula and the humerus. The structures that form the articulation are the head of the humerus and the glenoid cavity of the scapula. These elements are covered with hyaline cartilaginous tissue. The anatomical structure of the joint has its own peculiarities, since the elements forming the articulation lack congruence - the size of the head is almost 3 times larger than the glenoid cavity. This discrepancy is corrected by the articular lip, the so-called cartilaginous plate, which in its shape imitates the structure of the cavity.
The ball-and-socket joint is one of the largest joints in the human body.
Because the edges of the cartilage are curved, they form turns that completely capture the head of the joint and strengthen it, preventing displacement. The protrusion on the outer part of the head of the humerus is called the greater tubercle, the lesser is located more in front. The intertubercular space is the point where the brachialis muscle attaches. The arch of the articulation is formed by the humeral and coracoid processes. The arches of the right and left shoulders protect the joint from above, limiting the axis of movement.
The shoulder joint is surrounded by an articular capsule, and synovial bursae or bursae occupy a position nearby. The capsule envelops the entire outer region of the humeral head, securely attaching it to the neck. The upper and outer surfaces are reinforced with connective tissue muscle fibers, representing the synovial vagina. The joint is strengthened by a powerful corset; it is formed by the muscular-articular apparatus.
The structure of the human shoulder joint is complemented by the ligamentous apparatus, represented by the following ligaments:
The weakest points of the shoulder joint are the anterior zone of the shell, which is surrounded by the lower and middle ligaments of the shoulder girdle.
Near the joint there are synovial bursae containing intra-articular exudate. The liquid, preventing friction, ensures comfortable rotation around the axis and extension of the joint. It is important to keep in mind that each person has an individual number of bursas, but mainly the following types are present:
The structure of the humerus includes a developed muscular system, which strengthens and protects the shoulder joint from damage. When the muscular frame is intertwined, the rotator cuff is formed, which consists of the following muscles:
Thanks to the rotator cuff, a person can perform productive movements in full. The deltoid muscles are considered the most powerful, covering the entire joint. The biceps brachii muscle is located along the anterior humeral surface, strengthening it in the area of the scapula. The coracoid muscles of the shoulder joint are located on the inner surface of the joint, their main function is to protect the structures of the anterior and lower part of the shoulder. In the anterior, posterior and superior areas there are scapular muscles that protect the joint capsule from damage. The topographic anatomy of the shoulder joint and shoulder muscles is unique. The upper and posterior sections of the articulation are well strengthened by muscle-tendon structures, but the internal and lower structures are not protected. This is the reason why dislocations occur more often in this direction.
The main source of blood supply is the axillary artery, located in a narrow space between the shoulder muscle and the pronator muscle. This area is called the medial anterior ulnar groove. The shoulder joint is pierced by auxiliary vessels that transport blood, which contains oxygen and nutrients, to the joint. But due to the fact that the arteries are shallow, any type of injury can be dangerous, since the vessel wall is easily damaged.
The innervation of the right or left joint is provided by the thoracic, radial, subscapular and axillary nerve endings. They are responsible for the conduction of nerve impulses to the area of the human shoulder and shoulder blade. If an oblique or transverse fracture occurs, the limb is immobilized due to pain, as a result of which the person will not be able to perform even passive movements. Thanks to this reaction, the damaged areas will not be further injured, which will further ensure their normal fusion.
The structure of the shoulder joint is complex and multifunctional, thanks to which a person can perform the following movements with his arm:
Motor functions are provided by tendons and ligaments, synovial bursae that produce exudate, capsular volvulus and muscle groups. The following table will show which muscles are involved in performing a particular movement:
The shoulder joint is no less susceptible than others to various types of pathologies, which are important to diagnose and treat in a timely manner. Otherwise, the function of the joint is impaired, and in severe cases the person risks remaining disabled. The following pathologies are most often diagnosed:
Often the shoulder joint suffers from traumatic factors, resulting in:
Mechanical damage to the shoulder is dangerous due to degenerative changes in the joint.
Injuries are the cause of the development of a disease such as joint mouse. The pathology is characterized by the formation of a foreign body inside the joint capsule, most often a fragment of bone or part of cartilage. The shoulder joint is often affected by degenerative diseases:
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If the functionality of the shoulder joint is impaired, a person is bothered by characteristic symptoms, it is necessary to find out an accurate diagnosis and select a treatment regimen. To diagnose dislocations and subluxations, radiography in the axial projection is prescribed. Such an image will make it possible to see in which direction the head of the bone is displaced, as well as the presence of fractures and displacement of fragments. To obtain an accurate image, the patient must be positioned correctly, the type of which is determined by the doctor. If the injury is serious, with fractures and displacements, then the surgeon determines the type of resection and performs an operation to compare the damaged bones.
Hardware studies will determine the degree of damage to the joint tissue.
To diagnose degenerative-dystrophic pathologies, radiography is prescribed. Using the images, the doctor will be able to examine the condition of the bone structures and determine the degree of osteophyte growth. To assess the condition of soft structures and cartilage, an MRI examination is performed. After clarifying the diagnosis, a treatment regimen is selected. The conservative method involves taking groups of drugs, such as non-steroidal anti-inflammatory drugs, chondroprotectors, muscle relaxants, and vitamins. In addition to medications, auxiliary methods are used - physiotherapy, massage, and a course of therapeutic exercises.
The structure of the shoulder joint is unique and complex. Thanks to this feature, a person can perform a variety of movements and manipulations with the limb. The shoulder joint, like other articular joints of the human musculoskeletal system, is subject to various pathologies and damage that need to be treated in a timely manner. Therefore, in case of the slightest irregularities or damage, it is important to immediately consult a doctor. After all, the earlier the problem is diagnosed, the easier it is to get rid of it without negative consequences.
The shoulder joint is the most mobile joint in the human body, which provides us with the ability to perform a variety of movements with the upper limb. This is the main joint that connects the arm to the torso.
In animals, the shoulder joint is less mobile and more reliably strengthened by ligaments and muscles; its main function in this case is support. In humans, due to upright posture in the process of evolution, the shoulder joint has somewhat changed its structure, since now its main function has become not support, but providing a high amplitude of movements of the upper limb. Because of this, the joint has become less strong, which is its weak point, but at the same time such “victims” allow a person to perform a wide variety of movements with his hands.
Let us consider the structural features of this joint and its most common diseases.
Two bones take part in the formation of the shoulder joint: the humerus and the scapula. The articular surfaces are represented by the head of the humerus and the articular cavity of the scapula and are covered with hyaline cartilaginous tissue. The shapes of the articular surfaces of both bones do not correspond to each other, that is, there is no complete congruence.
For reference: articulation congruence is the mutual correspondence of the shape of the articular surfaces of the bones that connect to each other to form a joint. If the surface loses congruence, then movements in the joint become difficult, and in some cases even completely impossible.
Fortunately, nature took care of man and ensured the congruence of the shoulder joint due to an additional cartilaginous formation - the articular labrum, which is located along the entire circumference of the glenoid cavity of the scapula and, as it were, “encloses the head of the humerus in a cup,” providing both stability and mobility in the articulation.
MRI allows you to examine in detail the structure of the shoulder joint and identify possible disorders
According to its structure, the shoulder joint belongs to simple, complex and spherical joints. Movements in it are possible in all three axes.
A simple joint is an articulation in which no more than 2 articular surfaces take part.
A complex joint is one that contains additional cartilage formations to ensure congruence (in this case, the labrum).
A ball and socket joint is a characteristic of its shape. In this case, one of the articular surfaces is presented in the form of a convex spherical head, and the second forms the corresponding concave articular cavity. This form of articulation allows him to perform movements in 3 mutually perpendicular axes.
The shape and structure of the shoulder allow for high-amplitude movements along 3 mutually perpendicular axes
The shoulder joint is enclosed in an articular capsule, strengthened by intra-articular and extra-articular ligaments, and on the outside there is a powerful muscular frame that protects the joint and provides it with additional stabilization. Also near the joint there are several synovial bursae (bursae), which provide sliding for the muscle tendons that are attached to the shoulder joint.
The structure of the shoulder joint
The synovial membrane is attached around the circumference of the glenoid cavity of the scapula at the border of the articular cartilaginous lip. It completely covers the head of the humerus and is fixed around the anatomical neck of the humerus. The capsule itself is quite spacious and loosely stretched, and has different thicknesses.
The upper and outer parts of the capsule are the most strengthened, since in this place the connective tissue fibers of the shoulder muscles are woven into it. The thinnest and most vulnerable part of the capsule from an anatomical point of view is its anterior surface.
During movements, the tendons of the muscles that are attached to the capsule pull it back and prevent it from being pinched between the bones.
The shoulder joint and its capsule are strengthened by the following ligaments:
Ligaments and capsule of the shoulder joint
There are several synovial bursae near the shoulder joint. They ensure smooth movements in the joint, easy sliding of the tendons of the shoulder muscles and protect the capsule from sprains.
You should know that the number of such bursae is not constant and can vary significantly from person to person. The most common bursae are:
Possible options for synovial bursae of the shoulder are indicated in blue.
Each of these synovial bursae can become inflamed and cause the development of bursitis, which is often part of a pathology such as glenohumeral periarthritis.
The muscles in the shoulder area play a major role in strengthening and protecting the joint. They form the so-called rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor), which provides the main range of motion in the joint. Their tendons are woven into the capsule, strengthening it, and muscle fibers protect the joint from the outside.
The rotator cuff of the shoulder provides not only movement in the joint, but also strengthens it due to the tendons of the individual muscles that make it up
The deltoid muscle is the largest muscle structure of the upper limb girdle. It covers the shoulder joint from all sides. She abducts the arm to its maximum angle and flexes the upper limb at the shoulder.
The teres major muscle takes part in the extension of the shoulder, rotates it inward and leads it to the body.
The deltoid muscle creates an excellent protective frame for the shoulder joint
As already mentioned, the shoulder joint is the most mobile of all joints in the human body. Movements in it are carried out due to several factors: shape and structure, the presence of ligaments and muscles, capsule and synovial bursae. Movement options:
Range of motion in a healthy shoulder joint
Conventionally, all pathologies of the shoulder joint can be divided into 4 groups:
Let's consider the diseases that are most often encountered in practice.
This is a disease that belongs to the group of degenerative-dystrophic lesions of the musculoskeletal system and is accompanied by the slow but steady destruction of hyaline cartilage, corresponding symptoms and consequences.
The disease can have many causes. Most often, there is a connection between a shoulder injury, the presence of metabolic and endocrine diseases, and a genetic predisposition to arthrosis.
Shoulder pain - the main symptoms of all arthrosis
As a rule, shoulder arthrosis is only one of the manifestations of a generalized pathological process, which is combined with damage to the knee, hip, ankle joints, small joints of the feet and hands. Much less often, arthrosis of the shoulder occurs in an isolated form and is usually caused by injury (post-traumatic).
Symptoms that suggest arthrosis:
The prognosis of the disease is completely individual and depends on the cause of the pathology, the age of the patient, the presence of concomitant pathology, and the treatment program. Thanks to modern medications and the development of reconstructive surgery, in most cases it is possible to maintain the functionality of the joint, but sometimes complete ankylosis develops and the limb loses its function.
This is not a separate disease, but a whole group of lesions of the periarticular tissues of the shoulder, which are characterized by very similar symptoms. The main signs of periarthritis or periarthrosis (this name can also be often found) are chronic pain in the shoulder and limitation of the amplitude of normal movements. Pathology can develop due to damage to the joint capsule, synovial bursae, tendons and muscles of the shoulder.
The most common cause of glenohumeral periarthritis is damage to the tendons of the shoulder girdle muscles.
List of individual nosological forms that are included in the group of glenohumeral periarthrosis (they account for 80% of all cases of pain in the shoulder):
This is a lesion of the shoulder joint of an inflammatory nature. The main causes of arthritis are rheumatism, metabolic disorders due to gout, infections (reactive and purulent arthritis), rheumatoid arthritis, damage to the shoulder joint due to systemic autoimmune diseases, allergic reactions, traumatic injury.
X-rays will help determine the exact cause of pain in the shoulder joint.
Among the symptoms of arthritis, the most common are pain, dysfunction of the joint, redness and swelling of the shoulder area, general symptoms of the disease are possible - fever, general malaise, rash, etc. (depending on the cause of the inflammation).
To summarize, it should be said that the shoulder joint is a unique joint in the human body, which allows you to perform even the most complex and elaborate movements with your arms. But due to its anatomical and physiological characteristics, this joint is subject to an increased risk of injuries and various diseases, so every person should be attentive to their health and listen to their sensations in the shoulders in order to identify and treat a possible disease in time.
Injuries to the shoulder joint are quite common in sports such as gymnastics, acrobatics, throwing, water polo, volleyball, basketball, and wrestling.
The occurrence of shoulder injuries is provoked in special cases: when unusual movements are performed in the joint over a wide amplitude, when performing sudden movements, at the time of a collision with an opponent, during a fall, after a strong blow to the shoulder, while performing a backswing, when performing stresses disproportionate to the the athlete's capabilities. Shoulder joint rehabilitation as one of the treatment methods often begins right at the site of injury.
Rehabilitation of the shoulder joint after surgery and injuries - modern perspectives
The shoulder joint is a movable articulating formation that connects the upper limb with the body and gives it all its functionality. Any previous injuries, inflammatory diseases and surgical interventions on the shoulder joint require certain rehabilitation treatment, since there is a high probability of complications that will be much more difficult to get rid of, and it is hardly possible to work and live normally with them.
It is for this reason that this same rehabilitation of the shoulder joint after surgery is recommended by traumatologists and general surgeons. There is no need to think that, on the one hand, this is a long process, universal for everyone, and it can be completely postponed until more favorable times for the patient. Rehabilitation must begin immediately after the operation, literally from the first days, and after a week it can be continued calmly at home for an hour at a time, for example.
There are a variety of injuries: dislocations, fractures, rotator cuff damage, SLAP syndrome, bursitis, etc. Many of them require surgery, but there are also cases where conservative treatment can be used and surgery can be avoided. To ensure a speedy restoration of the functions of the shoulder joint, it is necessary to carry out rehabilitation measures in full.
Shoulder rehabilitation generally consists of two stages: passive and active rehabilitation.
Passive stage of rehabilitation
In order to prepare the joint and muscles for the active phase of rehabilitation, we carry out a set of physiotherapeutic procedures, which allows us to get rid of such phenomena as swelling, pain, inflammation, and muscle atrophy. In parallel, we use massage and kinesiotherapy.
After the end of the first (passive) stage of the recovery period, we conduct a routine examination; if the dynamics are positive, the patient moves on to the next stage, the stage of active rehabilitation of the shoulder joint (PT).
Physical exercise is a powerful stimulator of all vital functions of the human body; it accelerates the process of forming compensation - temporary or permanent. By performing physical exercises, the muscles restore their tone, thanks to which the patient learns to regain control of his movements (muscle control). Moreover, through exercise, a muscle corset is formed, which subsequently minimizes the risk of re-injury! Sports activities are allowed 2.5-4 months after surgery, depending on the type of injury, age and concomitant diseases.
It is also important to note that the lack of full rehabilitation entails a consequence in the form of persistent contracture (“frozen shoulder”), getting rid of which costs a lot of mental and physical strength for both the patient and the rehabilitator. It is very important to begin rehabilitation measures immediately after surgery or a serious injury in order to significantly reduce recovery time.
Rehabilitation after shoulder arthroscopy
Many publications on the Internet, scientific papers and monographs are devoted to a new therapeutic and diagnostic method - arthroscopic operations in traumatology and orthopedics. However, complications often arise, and the consequences of the underlying disease itself, even after successful manipulation, do not always go away immediately and without a trace. According to modern standards of care , rehabilitation after arthroscopy of the shoulder joint is indicated, given that anatomically there are large cavities inside that serve as potential sources of infection. It is necessary to understand that we are talking about short-term sessions that do not force the patient to go on sick leave again.
Rehabilitation after shoulder arthroplasty
Shoulder joint replacement is a complex operation aimed at artificially replacing a damaged joint, which would not be so noticeably inferior in its biomechanical characteristics to the natural one. Thus, the patient again has a chance to return to previous active movements. Technically, the operation is complex , and not all specialized institutions perform it, which, of course, will be resolved as technological progress develops. However, rehabilitation after shoulder arthroplasty, if one has been performed, is indicated not only for absolutely everyone, but also without fail. There is no real chance of a second opportunity to correct the shortcomings, to make some kind of correction, unlike knee and pelvic endoprostheses. Therefore, the patient is required to follow long-term and strict compliance with all recommendations for rehabilitation and treatment.
I would like to express my gratitude to the entire team of the New Step center for the warm welcome and attention paid to me. Very friendly administrators Yana and Natalya! Special thanks to Ivan Vladimirovich, Artem and Rufat for their desire to help their son restore the function of his hand!
I would like to thank the massage therapist Olga for the excellent work. After her massage I want to fly! Thank you! Good luck in your hard work. Sosnovsky I.N.
Many thanks to the sports center and staff! Doctor Temir Evgenievich and also the nurses for their attention to me. Thanks for your work!
I express my gratitude to Artem Andreevich for an excellent massage. He is a real “pro” in his field!
The structure of the shoulder joint is one of the most complex in the human body. Due to evolutionary changes, this joint has become very mobile. The shoulder joint allows the arm to move in different planes. However, due to such mobility and complex structure, the joint is very vulnerable to injuries of various kinds.
The shoulder joint is the most mobile ball-and-socket joint in the human body. The uniqueness of the shoulder joint is that this joint can provide multidirectional movements of the upper limbs. The anatomical structure of the human shoulder joint involves movements that can describe a hemisphere. It is worth noting that in animals the above joint is less mobile, but is more reliably strengthened by ligaments and muscle fascia.
Features of the anatomical structure of the human shoulder joint
The main task of the presented connection in animals is to provide support function. Therefore, the shoulder girdle in animals is connected to the body by powerful muscles that cover the joint in its thickness.
During the process of evolution, the anatomy of the shoulder joint in Homo sapiens has changed somewhat. This is due to the vertical position of the body. In modern man, the main function of the shoulder joint is not supporting, but motor. All these transformations contributed to a decrease in the strength of this joint .
Important! In the shoulder girdle, joints connect the collarbone and sternum to the scapula, thereby forming the acromioclavicular and sternoclavicular joints.
The laying of limbs occurs on days 26-28 of embryonic ontogenesis. The ectoderm serves as the beginning for the skin and its derivatives. Mesoderm is used to form bone, loose and dense connective tissue. In the fifth week of embryonic ontogenesis, the rudiments of the limbs are visible. In an embryo only 14 mm long, prototypes of limbs are found. Until the 9th week of embryonic development, joint spaces are formed .
By the time the baby is born, his locomotor system is fully formed. The final development of the human skeleton ends by the age of twenty-five.
Embryo in the ninth week of embryonic development
The shoulder is a significant component of the human locomotor system. The anatomy of the shoulder joint in pictures visually seems very simple, but this is far from the case. To ensure maximum joint motility, nature made the articular fossa softer and sacrificed the strength of the articulation. The variety of movements of the joint is expanded due to the huge number of muscles and tendons.
Anatomy of the shoulder joint
The morphology of the joints of the shoulder girdle, as can be seen in the photo, is quite complex. The shoulder joint itself is formed by the humerus and scapula bones. Periarticular tissues and muscles play a huge role in the functioning of the joint.
The scapula has the shape of a triangle and is located on the caudal side of the body. This bone is easily felt by palpation. It has a glenoid fossa to which the humerus attaches. The articular surfaces of the bones are covered with hyaline cartilage, which allows the bones to glide easily during arm movements.
The supraspinatus and infraspinatus muscles are attached to the lateral side of the scapula.
Note. The collarbone plays an important role in the functioning of the shoulder girdle. Although it does not enter the shoulder joint, it is attached to the scapula in close proximity to it. Without this small tubular bone, the shoulder joint cannot function effectively.
Magnetic resonance imaging helps to study the structure of the joint, determine the condition of not only bones, but also soft tissues
The most common pathologies of the shoulder joint include:
The shoulder joint is surrounded by three basic structures: the joint capsule, the cartilaginous plate and ligaments. All of the listed tissues differ from each other in structure, origin and functions. Thanks to the coordinated action of these structures, maximum mobility of the upper limbs is ensured. It is also worth noting that the periarticular tissues perform a protective function, while reducing the risk of possible damage.
Periarticular tissues of the shoulder joint
The main function of the cartilaginous plate (“labrum”) is to smooth out the difference in size between the head of the humerus and the glenoid cavity of the scapula . This structure softens minor shocks and shocks, but can become deformed under strong physical impact.
The ligament system of the shoulder joint fixes the head of the ball-and-socket joint in an anatomically correct position . The ligamentous material is firmly fused with the thin articular capsule of the shoulder joint. Its microtexture and thickness are heterogeneous. The thickest layer is on the lateral side of the shell. The coracohumeral ligament is attached to this part. It performs a fixing function, that is, it prevents excessive extension of the joint on the outside of the shoulder. This bundle is very strong. Other areas of the articulation fix less developed glenohumeral ligaments. They strengthen the articulation along the frontal surface.
Excessive physical activity and infectious agents can provoke a number of diseases associated with damage to the ligamentous-muscular system:
Optimal gliding of the articular surfaces is ensured by the articular bursae. The inner surface of these formations synthesizes joint fluid, synovium . The number of joint “bags” depends on the individual characteristics of each person:
Possible locations of articular bursae in the shoulder joint
Important! Each of the listed bursae can become a site of localization of bursitis, and then, with the aggravation of the pathological process, periarthritis.
The muscles of the shoulder region strengthen and protect the joint. They form the muscle capsule, or rotator cuff, which allows basic movement. Their tendons are tightly woven into the connective tissue capsule of the joint, strengthening it, and bundles of muscle fibers protect the joint from the outside.
The muscle capsule strengthens the joint through tendons and individual muscle groups
The muscles of the shoulder joint are responsible for flexion, extension, abduction, adduction and rotation of the limb. When muscles are injured, the anatomical structure of the human shoulder joint is disrupted, which can lead to partial or complete immobilization of the arm. Professional athletes are at risk for shoulder injuries.
Muscles of the shoulder girdle and shoulder
The deltoid muscle is one of the largest in the muscular framework of the upper limb. The muscle fibers of this muscle surround the shoulder joint on all sides. He is responsible for bending the arm at the shoulder and abducting it to the maximum angle.
The teres major muscle provides shoulder extension and produces inward rotational movements.
The deltoid muscle forms a reliable muscle frame to protect the joint
As mentioned above, the shoulder joint has a complex structure. Movements in it arise due to several factors:
Arm span and range of motion in a healthy shoulder joint