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What to do if I have shoulder pain?

Most frequent causes of shoulder pain Repetitive movements and lack of ergonomics are two of the causes that can lead to shoulder pain, whether at work, at home or in sports. Direct trauma to the joint itself can also be another of the most relevant causes.

Except for fractures and dislocations secondary to trauma and we focus on shoulder pain without a history of blow or obvious effort, the most common problems are:

In younger people, under 30-40 years of age, especially the most athletic, the most common are glenoid labrum problems. Pain is more limited with intense physical activity or repetitive movements. The lesion of the labrum in the superior region is called the ‘SLAP lesion’ and is especially frequent because the long portion of the bicep’s tendon inserts right there. Sometimes these patients have a history of shoulder instability, i.e., their shoulder “pops” out of place (partially or completely) and they end up further injuring the labrum and ligaments that hold the joint in place.

From the age of 50 to 75 years, it is most common the pathology of the rotator cuff, which when damaged produces pain in the lateral aspect of the shoulder and very often nocturnal pain. The tendons can be simply inflamed (tendinitis), present calcifications (calcifying tendinitis), or reach a rupture that can be partial or complete. When there is a complete rupture of one or more tendons and when conservative treatment (rehabilitation, anti-inflammatory drugs, and corticosteroid injections) is not effective for months, and the person remains very limited and in pain, the best option is often arthroscopic surgery performed by a shoulder specialist, who will be able to offer the best results depending on our injury. The long biceps tendon is also frequently damaged in these patients but can be treated at the same time as the other tendons during surgery.

Patients over 75 years of age are usually diagnosed with primary osteoarthritis, for no apparent reason other than the passage of time, or secondary to a long-standing rupture of the aforementioned tendons. If the patient is very limited, and conservative treatments are not effective, the shoulder prosthesis offers excellent results and a clear improvement in quality of life.

Sports and postural habits

Sport and intense physical work, where the shoulder joint is predominantly involved, can clearly trigger problems in the medium to long term. In young people, throwing, contact or wrestling sports often produce labral problems or inflammation and wear of the rotator cuff, which require an intervention to repair these structures if the sport is to be continued at a high level of intensity.

However, the same injury in the patient who is not very active or who decides to reduce the intensity and frequency of the physical or sporting activity is usually well tolerated and does not require more than rehabilitation treatment and observation over time. It is different when there is a complete rupture of one or several tendons of the rotator cuff. In these cases, the younger the patient is, especially under 55-60 years of age, the greater the recommendation for reconstructive surgery because with time the lesion becomes larger and the prognosis of the surgery, which initially tends to be very favorable, worsens if the lesion is treated too late.

Although postural habits do not really cause shoulder injuries, what often happens is that an already damaged shoulder, when we lean on it or subject it to certain positions, the pain intensifies. This is very characteristic in people with rotator cuff problems; night pain prevents them from resting and is very frustrating due to the impossibility of resting properly. Also, those professionals who make repetitive efforts, always in the same position, raising their arms or throwing them forward, can eventually damage the shoulder tendons by always overloading the same structures and because there is friction of the tendons against the acromion.

Some experts point out that both circumstances can lead to shoulder injuries.

What to do when shoulder pain appears?

The first thing to do is to differentiate whether it has been an acute injury triggered by an effort or fall or whether it is an injury that has appeared progressively. In the most incapacitating traumatic injuries, at least an X-ray should be performed and it is usually advisable to have a nuclear magnetic resonance or, failing that, an ultrasound to rule out bone fractures, dislocations, tendon, ligament or labral injuries, among others.

If the pain has appeared progressively, but is not very limiting, the simple fact of lowering the pace, non-steroidal anti-inflammatory drugs and gentle mobility and strength exercises may be sufficient. Rehabilitation and/or physiotherapy is of great help in these patients and the recommended exercises should be maintained for three to six months before considering that conservative treatment is not working.

Infiltrations can be very effective in milder cases of tendon inflammation, but less so when there is a complete rupture of a tendon or labrum, in which case the ultimate solution will be surgery.

In any case, it is important to keep in mind that there are many causes of shoulder pain and that some of them are not easy to identify. It is advisable to consult a specialist to obtain an accurate diagnosis.

Tips to prevent shoulder pain

In general, it is recommended to avoid, as far as possible, repetitive movements, handling excessive loads, promote ergonomics and a good postural attitude, and when in doubt, ask a professional specialist.

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