Shoulder physical therapy, shoulder pain, disease treatment, Belgrade, Serbia.

The shoulder joint consists of three bones: the upper part of the upper arm (humerus), the scapula and the clavicle. The entire shoulder joint is surrounded by a joint capsule filled with fluid that lubricates the joint and makes it function properly.

If the joint loses its mobility or a part of its mobility, as a consequence there is a reduced secretion of that fluid and further complications (arthrosis, crepitations, frozen shoulder, contractures in the joint itself). The walls of the capsule are made up of ligaments that connect the muscle to the bone.

Dynamic stabilizers of the shoulder are made up of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. They are responsible for the humerus standing firmly in the cup. The shoulder is the most mobile joint in our body, so injuries are very common.

Pain in the shoulder can continue due to calcification, that is, the accumulation of calcium in the tendons of the rotator cuff. Additionally, shoulder pain can be a result of a rotator cuff injury. Ruptures of the rotator cuff occur more often in later life, but they can also occur in younger people, mostly athletes.

This injury occurs in the elderly as a result of falling or straining the shoulder while lifting.

Shoulder pain is one of the most common reasons people seek physical therapy. Pain in the shoulder area very often occurs at night (it is often pain in the area of ​​the biceps brachii tendon on the front of the shoulder, or in the very top of the shoulder of the supraspinatus tendon).

There are several possible symptoms for shoulder pain:

• Shoulder pain, especially at rest and at night
• Pain when raising and lowering the arm, as well as when rotating the shoulder
• Feeling of weakness in arm and shoulder
• Crepitations when performing movements

The classic picture of calcific tendinopathy (calcification in the shoulder) is the presence of intense pain in the shoulder without a clear reason or injury, which leads to a significant reduction in shoulder mobility and impaired functioning.

• Arthrosis - loss and damage of cartilage
• Arthritis - inflammation of the joints
• Crepitations - clicking and scratching from the joints
• Frozen shoulder - inflammation of the shoulder capsule

The cause of shoulder pain itself can be different, and therefore diagnostics in order to discover the cause of the pain is very important.

Inflammation of the tendon in the shoulder or the formation of calcifications in the muscle itself can also be causes of pain. Patients initially ignore the pain and try to relieve it with creams or analgesics. Unfortunately, the pain does not go away if you use creams or analgesics, but even increases over time.

The shoulder joint itself is less mobile due to pain, which is why the joint is not lubricated. This leads to more severe pain in the shoulder during the day and night.

The appearance of calcifications in the shoulder muscle is related to overstrain of that part, and as a consequence, there is a micro-injury of the muscle itself. The calcification looks like a "little ridge" that the patient feels when moving the shoulder.

Repetition of the same movements in athletes or people who perform a certain type of work in which there is a routine load on the shoulder are also causes of shoulder pain.

Poor circulation, most often caused by aging, is also a standard cause of shoulder pain. Over time, the tendons in the shoulder lose their elasticity, that is. the blood supply to the tendons and muscles is reduced, which reduces the body's ability to restore the damaged tendon. People over the age of 40 are at greater risk of rotator cuff tendon tears.

The most common causes of shoulder pain can be:

Inflammation - infection or injury to part of the shoulder. Redness, swelling and pain may appear in a certain part of the shoulder. You feel that part of the shoulder is "hot". These symptoms occur as a natural reaction of the body to an infection or injury.

Trauma (injury) or damage to the muscles and tendons around the shoulder - your posture in the upper body or neck can cause shoulder pain or tension in the muscles between the neck and shoulder. This pain occurs as a result of improper sitting at the computer or standing.

Inflammation of the bursa - a fluid-filled cushion that normally helps muscles and tendons slide smoothly over the bones of the shoulder.

Damage to the bones and cartilage of the shoulder - arthritis is the most common cause of this type of shoulder pain.

It is very important to start shoulder physical therapy as soon as possible when the first symptoms of shoulder pain appear. Please call us as soon as possible when you feel pain in your shoulder that has been bothering you for more than two days.

Treatment of calcifications in the shoulder

Treatment in most cases is non-operative. After a detailed examination of the patient and ultrasound diagnosis, the treatment begins, which consists of the application of various physical therapy techniques. The main goal of physical therapy is to reduce tendon inflammation, and shockwave therapy is mostly used for this goal. After successful treatment, it is necessary to carry out adequate kinesitherapy to restore the full range of motion of the shoulder.

Treatment of rotator cuff tendon tears

The treatment depends on several factors: the age of the patient, the work the patient does and the degree of damage to the shoulder. Treatment aims to reduce pain and restore normal shoulder function. Treatment can be non-operative (rest, cessation of all shoulder activities) or operative (surgery). 

Correctly prescribed physical therapy by a physiatrist is a key factor in the treatment process of shoulder tendon rupture. Physical therapy aims to reduce pain, improve circulation in the shoulder itself, and speed up the healing process of the injury. The rehabilitation itself requires a multidisciplinary approach and constant monitoring of the patient's condition.

Treatment of shoulder pain is most often performed using:

• Shockwave therapy - a very important technique of physical therapy, which uses a shock wave with a radial effect to blood the shoulder and affects the breakdown of calcifications in the shoulder.  This therapy also helps with inflammation of the tendons of the shoulder girdle and certainly shortens the recovery time for complex complaints that patients have.
• Laser therapy - application of a laser as a source of coherent monochromatic light, a highly directed beam affects the faster recovery of the shoulder. The laser represents stimulated radiation where all emitted photons are equal, have the same wavelength, the same direction of movement, so the resulting light is monochromatic, coherent and directional;
• Ultrasound therapy - penetrates deep into tissue and is most absorbed in ligaments and tendons (structures with a high collagen content).
• Kinesitherapy - the application of movement in the treatment of patients. Kinesitherapy is the basis of functional treatment and training of patients after injuries and painful conditions. Treatment of injuries in rehabilitation cannot be imagined without kinesitherapy.
• Electrotherapy - has an analgesic effect on pain, which means it reduces pain by stimulating receptors in the skin and releasing endogenous opioids, as well as improving blood and lymph circulation.
• Cryotherapy – cryomassage of the injured region, cooling of painful tissue and pain relief.