Painful shoulder syndrome

We must start with a brief description of the shoulder joint, the only one of its kind in the entire human body. It is a "flail pond" - I hope, that explains almost everything, especially the association of a range of motion! And it is true. The mobility of the shoulder is enormous in almost all directions and planes. It owes it to a specific structure, i.e.. a shallow and round socket on the shoulder blade, set almost in the vertical plane and the spherical humerus "hanging" vertically. This structure is united and activated by numerous and strong muscles of the shoulder girdle, whose tendons are sticking (they grow up) to different places of the humerus, shoulder blades and bones of the forearm. They are complemented by synovial bursae ("Grease nipples") and very strong ligaments made of connective tissue. The joint itself is tightly wrapped by the joint capsule, creating an articular cavity inside with an axillary recess.

It would be hard to find a job (profession) man not using shoulder actions – no, maybe a philosopher recording his thoughts on a tape recorder. For many, a healthy shoulder is the basis of their profession: miner, hutnik, Builder, farmer, baker… and athletes: weightlifter, basketball player, boxer, swimmer, swordsman, javelin thrower, tennis player, finally… angler! of course – without shoulders (and the entire upper limbs) there would be no fishing. There are many places in the shoulder that can be mechanically damaged as a result of various injuries and repetitive movements exceeding the strength of the materials, which tissues are made of. Especially the same movements repeated many times – so even a slight "jerking" – leads to the phenomenon of "material fatigue" well known in the art. The motion system is subject to many basic laws of physics, even the law of gravity, friction, inertia, as well as the concepts of force distribution, vectors, leverage, blocks, etc.. It is clear then, that the main "weak point" is the attachment of the muscle's tendon to the bone moved by the muscle. This is the main source of shoulder pain (at least at the beginning of trouble), which are also a warning signal to our brain under the slogan: “Don't yank me anymore – I need to rest". There are by far two of the most common pain areas in the shoulder (ok. 90-95% all the shoulder pains) shown in the attached sketch. We will discuss both.

• The supraspinatus of the scapula (along with m. shoulder and 3 others of minor importance) moves the humerus (that is, the arm) sideways and up – is therefore the main culprit of "wing movement". Ramion breakdowns, bending in the elbow with the subsequent turning of the hand up and back is technically called abduction and rotation. It is a type of movement that is carried out continuously for probably all types of fishing! – mainly when casting.
The supraspinatus muscle along with the supporters is a group of very strong muscles, while their attachment to the greater tubercle of the humerus has an area of ​​approx. 0,6-0,8 cm2. For each of us with even a slight technical imagination, the disproportion is obvious, which justifies the relative ease of the phenomenon of overload, damage and finally tearing the trailer (it happens to javelinmen and weightlifters – also a complete breakup). In everyday life, pain occurs when combing, shaving, reaching on the hanger, or hanging your wife's laundry indicates what "got us". On the other hand, the pains at rest prove more damage to the trailer and – in addition to relinquishing the burden – require professional treatment. Our body naturally intervenes at the site of damage (it is so always and everywhere throughout the system). This intervention is based on local repair and restoration processes (hyperemia-edema-proliferation of connective tissue cells leading to tendon thickening and attachment, and sometimes even calcifications), and these processes alone are responsible for the severity of pain. Then it is advisable to use drugs administered directly to the source of pain easily detectable by a doctor's finger (if he knows the anatomy sufficiently). There is easily a needle mounted on a syringe with the appropriate drug (e.g.. Polcortolon, Depo-Medrol, Diprophos, Celeston) conducted by the hand of an orthopedic surgeon or rheumatologist or other knowledgeable person. This treatment is popularly called "blockade", although its goal is not to immediately combat the pain, but a gradual reduction by the healing effect of the administered drug. Such treatment gives the best chance of success provided that the jerking of the damaged trailer is categorically limited, including wearing a hand on the so-called. in a sling or bandaged to the torso for a period of several to several days. In the overwhelming majority of cases, this type of procedure leads to a satisfactory result.

• 2-head muscle of the shoulder (popular "biceps"), in fact, the tendon of the long head of this muscle is the second critical point of the shoulder. It is extremely long, "Working" on the arch in the groove between the greater and minor tubercles of the humerus, also in part inside the joint cavity, sticks to the upper part of the acetabulum also on a small area of ​​approx. 0,5-0,6 cm2. The entire biceps mainly flexes the upper limb at the elbow (a commonly known gesture), but also raises the whole arm forward and upward and is therefore the second most important shoulder muscle. Moving loads in front of you (very unhealthy at all), lifting and holding in front of you, the movements of the traffic policeman, a painter, many athletes and… angler- holding a stick in his hand for hours, leaning on the forearm, but it weighs heavily on the shoulder and elbow. All this weighs down and can overload the attachments of the long head. A little reminder here: we have two kinds of load – static and dynamic.

• Static then occurs, when we apply resistance continuously and steadily to resist e.g.. force of gravity (keeping the fishing rod in the air), dynamic and – when we make multiple movements also overcoming the force of gravity, air resistance or weight of equipment, e.g.. when casting the fishing line, swimming or rowing. The damaging actions of trailers have both types of loads. The essence of the changes taking place in the attachment of the long head of the biceps is, of course, the same as in the supraspinatus, only that. Due to the described anatomical features, the course of the ailments can be much more unpleasant and long-lasting! Especially, when the articular capsule is drawn into the repair and restoration process and it undergoes adhesions. The treatment is the same, i.e.. it is based on injections into the inter-nodular groove and tendon insertion of the aforementioned drugs. Often, it must also be assisted by anti-inflammatory drugs known from previous advice (Butapyrazole, Majamil, Naproxen or others like Metindol, Profenid, Piroxicaim).

Do not forget to limit the burden on the shoulder. Neglect in Painful Shoulder Syndrome can often lead to varying degrees of limitation in shoulder function, including severe invalidity (permanent muscle contractions, adhesions of the articular capsule). Because – after mastering acute, the pain stage of the disease – it is necessary to improve movement without overload, best “calm "swimming.

Comprehensive sanatorium treatment is by all means advisable and has the best prognosis. Rarely, Fortunately, some of them undergo a "freeing" shoulder surgery.

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