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Shoulder Pain



What causes shoulder pain?

What are the causes of shoulder pain?


Tendon tears

Impingement syndrome

Shoulder instability

Shoulder Arthritis

Shoulder fractures

In which cases should a shoulder fracture be operated?

General principles in shoulder pain

When should a doctor be seen?






What causes shoulder pain?

When there is a complaint of shoulder pain, we first try to understand whether this pain is caused by a stiffness in the back muscles or a hernia in the neck, for example. In this regard, the location, type of pain and the type of pain provide us with the general distinction. After understanding the main origin of the pain with the examination, we focus on this cause. Sometimes in this article you can see the causes of pain caused by the shoulder joint itself.

The shoulder joint is not a single joint. There are 3 main joints that allow us to perform many movements perfectly, from scratching our back to grabbing a ball coming from above, and many ligaments, tendons and muscles that connect them. Thanks to these, we reach a very large area in space and complete a lot of work.

The cost of allowing such a wide range of motion is that it is susceptible to many injuries and diseases.


 What are the causes of shoulder pain?


We can examine shoulder pain in 7 categories:


1. Arthritis



4.Tendon problems (tears, tendinitis, bursitis)

5.Nerve compression or diseases




The most common causes of pain are:



 There are fluid-filled sacs in the shoulder joint that prevent or facilitate the muscles from rubbing against each other or to the bones. Normally, we do not notice these sacs.

These sacs are called 'bursa'.

If these sacs swell and cause pain, we call it 'bursitis'.

To give an example, we also have such a bladder on our elbow bump, and most people realize it only when they get sick and swell.

Excessive pressure on the shoulder or some diseases cause these sacs to swell, causing pain. When it's alone, it's easy to treat. If there is a factor that causes the development of bursitis, it is not enough to treat bursitis only, it is necessary to treat this underlying condition.



Tendons are long, round, white, hard ropes-like structures that connect muscles to bones. They are used to move the bones to which they are attached by the contraction of the muscles. Diseases of the tendons are called tendinitis.

There are 2 types:

1. Sudden or ACUT: tendon swells or tears after a sudden forceful movement

2. Chronic or Chronic: It is the insufficiency of the tendon due to reasons such as bad friction or rheumatic disease. The most common tendonitis muscles are the tendons of the muscle group that we call rotating sheaths that enable us to turn the shoulder.



Often due to aging, tears caused by micro tears and deformations in the tendons are seen over the years. Diabetes and smoking are also effective on tears. These tears can also be seen in athletes or some professions as an occupational disease. It may be necessary to repair these tears, but the main goal is to take measures to increase the quality of the tendon or muscle. With a good diet and exercise program, the repaired tendons are optimized. Now, we can improve the healing quality of tendons with biological injections.



In some cases, for example, when there are certain muscle weaknesses, the tip of the shoulder blade starts to rub against the shoulder blade while lifting our arm up. This can cause bursitis and tendonitis after a while and work can grow until the tendon ruptures. Early treatment prevents this impingement syndrome from causing tears.


The shoulder joint is a shallow joint, which is why it allows us to move our hands easily over a wide area. The structures that hold the shoulder joint in place provide a kind of vacuum in the joint. When there is some kind of tear, this vacuum effect disappears and the shoulder joint is as if it will come out while moving, and sometimes it comes off. Shoulder dislocations are the most common type of dislocation among all joints. If the structures that are torn after dislocation cannot be healed properly, recurrent dislocations continue to occur and the patient tries to move that shoulder in his daily life. In the treatment of most of the cases called instability, where such shoulder structures remain loose, these torn structures must be repaired surgically.



Due to wear and tears in the shoulder joint, the cartilages of the joint face may wear out. These conditions, called osteoarthritis, usually start at the end of middle age and gradually increase towards old age. When it is noticed early, it is possible to slow down and relieve the pain with rehabilitation. It requires prosthetic surgery in its advanced stages.



In the elderly, they fall on the shoulder joint frequently and since bone resorption is effective at that age, shoulder fractures are common. Sometimes, a fracture may develop as a result of an insignificant fall or impact, which seems very simple, and the situation can be understood when a doctor is visited days later. Fractures in teens are usually caused by motor or car accidents. Some of these fractures need to be treated surgically. Since the shoulder joint is not a suitable place to make a plaster cast, bandages (velpau bandages) or slings are usually used if there is no surgery.


In which cases should a shoulder fracture be operated?

Very strong muscles adhere to the shoulder blade bone, when a fracture occurs, these strong muscles pull the broken piece and the broken pieces move away from each other. in this case:

If the slip / divergence between the broken parts is too

If the joint surface cartilage integrity is impaired

If fracture union is predicted to be late and problematic

If early action is required, surgical fixation is safe for healing health.

When shoulder fractures are detected with closed and open surgeries, it is possible to start physical therapy early.


General principles in shoulder pain:

Most shoulder pain starts insidiously. In fact, when there is pain somewhere, we expect it to pass first. Most shoulder pain is related to neck muscles or nerves. The first question that comes to mind about shoulder pain, especially in the elderly, is whether it is related to the heart or not. Yes, pain related to the heart or internal organs can also hit the shoulder area. Even though it is rare, left shoulder pain requires being alert for heart problems in patients at risk. Not only heart, gallbladder or kidney diseases, neck hernias can hit the shoulder area.


There is no need to try to predict this, it is possible to understand the situation with examination.


The pain associated with the shoulder joint itself increases with moving the shoulder joint, increases when lying on the shoulder, and in certain positions, the patient says that he is relaxed. Pain that awakens at night can be seen.

There are 3 separate joints in the shoulder:

1.shoulder joint

Acromioclavicular joint (AC joint) between collarbone and scapula

3. subscapular joint between the shoulder blade and chest wall

During the examination, these 3 joints are examined and tested separately.

If you want to do a quick test at home, try to touch your shoulder blades with your hand, as shown in the picture. If there is a difference between the two sides, if there is pain and restriction while doing this, a doctor's examination is required.


We can understand which joint is problematic by looking at the pain location.

Typically, shoulder pain begins in the shoulder and spreads to the upper arm. Patients generally describe this pain in two ways


The "palm sign" is a typical feature of shoulder joint and bursitis pain; The patient describes the pain by placing the palm of the other hand directly on the area in the picture.


The 'finger mark' here does not refer to the patient's main shoulder joint, but to the 'acromioclavicular' joint between the scapula and collarbone, which is the problem.


Pain character is important. When there is pain in a joint, which positions cause pain, at what time of day or in which movements the character of the pain changes are important information. As a general rule, severe nighttime pains should not be suppressed with painkillers and kept waiting. Especially when children have joint pain, care should be taken immediately, the child's fever should be checked before going to the doctor and what he told should be noted.

Whether there is swelling in the shoulder area can be understood by looking at both sides. Examine the shoulder area from the back and front. If necessary, photos can be taken for follow-up.


Most shoulder pains are muscle tendon or bursa problems that can be cured with short treatments. Important problems may not be understood by the magnitude of the pain. A shoulder pain that lasts for 2 days should be examined by a doctor.


When should a doctor be seen?


After falling on the shoulder in any way, most of us find it appropriate to wait a few times for these pains before going to the doctor. In fact, this is a good strategy for most of us. But it will be bad for some of us. There are some signs that tell you that somehow you will need to see a doctor. Shoulder pain is very common, especially over the age of 50, which can delay serious situations in the future and delay going to the doctor.


Complaints indicating a serious situation after a fall, impact or force:


Night Pain: If you cannot lie on the sore shoulder at night and you wake up from sleep for this reason, it is necessary to see a doctor. In addition, it is better to sleep on a pillow at night in shoulder headaches. Lying prone can be a trigger for shoulder pain.


Weakness in raising the arm: If you feel weakness or weakness while moving the arm, this is a serious finding of muscle tear. The tendon of one of the rotating sheath muscles may be ruptured or torn.


Insecurity and dislocation of the shoulder: The joint may dislocate during a fall or, for example, a sudden shoulder strain. In shoulder dislocation, it can completely come out of the socket of the head and sometimes it can come out and sit back. Some patients say that it comes out and enters during a fall. If you feel such a situation, it is essential to consult a doctor.


If a voice is heard in the shoulder: A sound felt or heard with the pain indicates that something is broken. In this case, an examination is also required.


Swelling and deformity: A swelling in the head or upper part of the shoulder, the ligaments between the shoulder blade and the collarbone may be broken, or the collarbone may be broken. In such swelling cases, it is necessary to see a doactor.

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