Pathology of inflammation around the shoulder joint

2021-01-26 12:00 AM

Pain in the shoulder, in the V-groove of the delta muscle, sometimes spreading down the forearm, even the forearms, the back of the arms


Perioral arthritis is a disease that includes pain and limited mobility of the shoulder joint, and damage to the soft around the joint is mainly tendons, muscles, ligaments and wraps. There was no damage to the bone head, sun joint or synovial membrane.

Pure shoulder joint pain

The most common manifestation is mainly pain.


Injuries: Severe injury to the shoulder area, or injuries caused by occupation, habit or sport in young people.

Tendonitis, degeneration, soft calcification is common in people over 50 years old.

Weather related: cold and humid.

In some cases, no cause is found.



May appear spontaneous, but often due to excessive shoulder joint movement or repeated shoulder injury.

Pain in the shoulder, in the V-groove of the delta muscle, sometimes spreading down the forearm, even the forearms, the back of the arms. Mechanical pain, increased when doing some shoulder movements, difficult to lie down, especially when leaning on the shoulder.

Pain increases with shoulder lift, which can limit discreet movement due to pain.


There are no restrictions on active and passive movement.

No muscle loss

When doing the opposing arm contraction, the pain increases.

Signs of inflammation of the muscles on the spikes:

There is a sharp pain point below the apex with outer shoulder or just in front of the tip of the shoulder, corresponding to the site of the tendon injury.

Making arm resistance movements, pain increases.

Pain when extending from 70 to 90 degrees.

Signs of tendonitis under the spine:

Painful spot when pressed under the ledge with the back, outer shoulder.

Pain increases when turning around.

Signs of tendonitis of the biceps:

When pressing into the binocular groove, pain in the upper - inner part of the front arm.

Pain when folding forearm on opposing arm, or when stretched or or brought forward.

Progression can lead to tendon rupture.


X-ray images should be compared side-by-side, based on straight film of the outward, internal and intermediate positions.

The shoulder joint is generally normal, with one or more points of calcification in the tendons.

The most commonly seen calcification is in the lower mantle - large nodule.


Advantages: In general, there is benign progression, most of them gradually decrease and then go away after a few weeks to a few months, this time can be faster with treatment, may recur.

Not going well or going badly:

Turns into acute shoulder pain, even stiffness in the shoulder joint.

Especially when pain symptoms persist despite treatment, it is necessary to suspect a rupture of the short spins, usually after 50 years of age. Confirms diagnosis by contrast, and if feasible to be demonstrated during surgical resumption.

The degenerative tendon increases without treatment, leading to the aging shoulder joint, characterized by:

Clinical: in addition to pain when moving, also limit movement when lifting active arms.

X-rays with typical signs:

Broken forehead - arm.

The transfer tab is soft and has small cavities.

The same snout-forearms.

Thorns bones.

Narrow drive slot - Arm.

Bleeding old shoulder joint: is a rare complication of the rupture of the rotational tendons due to old age, with bleeding in the joint cavity and the subarachnoid serosa -delta. Sudden pain in the shoulder, completely inactive, and a bruise in the arm is very suggestive. Aspiration blood, confirm diagnosis.

Paralysis of the shoulder joint

Presented by pseudo-delta muscle paralysis due to sudden, clear, acute rupture, purulent spinal tendons.

Elderly (> 50 years old): After a poor posture, shoulder joint injury, or after exertion, the spinal tendons have degenerated.

In young people: Rarely, playing sports, after a strong injury.

Long cut of the biceps occurs only after age 50, after exertion on a tendon has degenerated.

Mechanical symptoms

Severe pain sometimes accompanied by a crackling sound when abruptly breaking the pus of the rotating tendons.

The bruise may appear a few days later, on the front of the arm.

Pain associated with restriction of movement, loss of arm active form (a sign of tendon rupture on the spine) is always associated with a lower tendon rupture, resulting in a loss of active outward rotation of the arm.

Pain goes away spontaneously or with treatment, but is not reversible

movement. This eliminates the possibility of pain-induced sedation.


Normal nerve markers can rule out true paralysis.

Loss of active shoulder lift, while passive movement is perfectly normal. This is a very suggestive objective mark.

In case of long tendon rupture of the biceps, muscle tendon rupture was found in the anterior underarm, when folding forearm had antagonism.


On shoulder joint scans there may be indirect markings of older shoulder joints.

A CT shoulder joint scan with contrast showed a purulent rupture of the spinal tendons, due to a common contrast between the joint cavity and the subarachnoid serosa - delta muscle.

Joint scanner can see the associated lesions.

Shoulder joint stiffness

Manifestations of spasms (constrictive bursitis), thick bursae reduce the movement of the hip-arm joints.

This spasticity of the sheath is due to diffuse nutritional neurological disorders involving bones, muscles, blood vessels and skin, resulting in a painful condition caused by reflex neurodegeneration in the upper extremities.


Common after 40 years of age, in people with nervous stress:

Lesions caused by shoulder joint injuries, prolonged cast immobilization.

Myocardial infarction, severe angina, pericarditis.

Lung tuberculosis, lung cancer.

Paralysis, Parkinson's disease, brain tumour.

Nerve pain - arm, neck shingles - arm.

Hyperthyroidism, diabetes mellitus, goutte.

Drugs: Phenobarbital, INH, Ethionamide, synthetic anti-thyroid, Iode131.

Shoulder joint stiffness is sometimes associated with pain caused by hand dystrophy: pain, oedema, skin changes with increased haemorrhage, stiffness, and muscle associated with hand shoulder syndrome.



Mechanical shoulder pain onset, with increased exam at night.

Gradually over a few weeks, the pain subsided, while the stiffening of the shoulders was mainly an arm and an outward rotation.


Limit movement of the shoulder joint, both active and passive.

Restricting all movements but more clearly the form and rotation.

If you try to move, you will feel a mechanical resistance and cause pain, movements can also be done thanks to the role of the shoulder blade - chest.

Pain points may be seen before or below the apex of the shoulder, but no signs of inflammation.


Normal film: Normal or seen osteoporosis, socket-socket joint - normal arm.

Joint scan with contrast: will show cavity narrowing:

Only 5 - 10ml while the normal is 30 - 35ml.

Reduced joint contrast, sacs and synovial membranes disappear.


Treatment of pure shoulder joint pain

Quits spontaneously after a few weeks to months, may recur.

It can speed up the healing process through treatment:

Mainly thanks to local corticosteroid injection: injected under the muzzle and the outer shoulder against the tendon of the muscle on the spine, up to 3 times, 15 days apart.

For analgesics, nonsteroid anti-inflammatory drugs can be used.

To rest the damaged tendons, simple physical therapy such as shortwave, ultrasound can be combined.

Progression can deteriorate into acute shoulder pain, or even stiffness in the shoulder joint.

Especially when pain symptoms persist for a long time, despite local injection, it is necessary to suspect purulent rupture of short spun tendons, which is very common anatomically, after the age of 50, the lesions gradually increase. This explains the natural feature of poor symptoms, which, as opposed to the illness of shoulder joint paralysis, show signs of sudden, sudden and recent tendon rupture.

This purulent rupture is usually determined by contrast imaging, and if it can be demonstrated by surgical re-stitching.

When left untreated, tendons degenerate gradually, leading to aging shoulder joints (or rupture of the tendons of the short-spun muscles due to old age) characterized by: in addition to pain with moderate and unstable movement, there is a limit Mechanism when lifting active arms.

Treatment of shoulder joint paralysis

Pus rupture of the spinal muscles.

In young people: Pus expected is a problem of surgical treatment: suture of the cut.

In the elderly:

Surgical indication is very delicate, due to degenerative damage to neighbouring tendons. So, first of all medical treatment, including:

Temporarily immobilize your hand in a pose.

For pain relievers and nonsteroid anti-inflammatory drugs, try to avoid topical corticosteroids as much as possible, as this will increase tendon necrosis.

Rehabilitation: active therapy, heat therapy. Surgical treatment may be indicated when medical treatment has failed.

Tendonitis of the biceps: There are no surgical indications except in special cases.

Treatment of shoulder stiffness

Usually resolves spontaneously after 1-2 years.

This process can be shortened with treatment.

Nonsteroid analgesic and anti-inflammatory drug treatment.

Therapy when the pain has begun to stop: gentle passive movement combined with active movement.

Treatment of dystrophy pain: Beta bloquant, calcitonin, Griseofulvin are less effective.

Surgical treatment: