SLAP injury to the shoulder joint. Injuries to the labrum (including SLAP injuries) Slap injury to the shoulder

Damage to the biceps tendon in the area of its transition to the labrum is quite common. However, this pathology is very difficult to diagnose and is very often detected directly during surgery. Often, natural wear and tear in this area, which occurs in patients after 40 years of age, can be mistakenly regarded as damage.

If there is persistent pain, limited movement, and the presence of clicks in the shoulder joint, especially if the patient has previously engaged in sports related to swimming or throwing, damage to the SLAP can be suspected.

ANATOMY OF THE SHOULDER JOINT

The shoulder joint is made up of three bones: the clavicle, the scapula and the humerus. The head of the humerus is placed in a small socket of the scapula compared to its size.

A soft tissue lip surrounds the edges of the glenoid cavity; it increases the depth of the glenoid cavity, which allows it to more closely match the shape of the head of the humerus.

The joint is also surrounded by dense connective tissue called the capsule. A strong capsule, strong ligaments, tendons and muscles surrounding the joint hold the head of the humerus in the center of the socket.

The rotator cuff is formed from the tendons of four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) and connects the humerus and scapula.

Tendons connect muscles to bones. The muscle moves the bone by pulling on the tendon. The rotator cuff tendons help lift and rotate the arm. The rotator cuff also centers the head of the humerus in the center of the scapula (glenoid) during movement.

The labrum can become impinged between the humeral head and the glenoid during movement. As a result, the upper parts of the labrum begin to tear off. Over time, the size of the damage increases, the torn lip can move into the joint cavity and become pinched between the head of the humerus and the glenoid (SLAP injury).

The result is pain when moving. Also, when the labrum is torn off, stability in the joint decreases.

CAUSES OF SLAP DAMAGE

Injuries to the superior labrum are often caused by direct trauma, such as a fall on an outstretched arm. Often, with prolonged participation in throwing sports or weightlifting, gradual damage to the labrum can occur. In some cases, a SLAP injury may result from a dislocated shoulder.

SYMPTOMS OF SLAP

The main symptoms of SLAP injury are pain in the anterior regions of the shoulder, clicking and cracking sounds when moving the shoulder joint. Against the background of pain, a decrease in the range of active movements, especially above the head, progresses, and subsequently stiffness in the joint develops. When the labrum is damaged, some patients may experience instability in the shoulder joint with certain movements.

SLAP DIAGNOSTICS

Your doctor may suspect a labral injury based on your history and clinical examination. During a clinical examination, the doctor conducts special stress tests, identifying symptoms characteristic of this disease. MRI and radiography of the shoulder joint are not highly sensitive to damage to the labrum.

In this connection, the diagnosis of damage to the labrum is significantly difficult. Arthroscopy may be used to confirm the diagnosis. An arthroscope is a small optical device connected to a video camera and monitor, which is inserted into the joint cavity through a skin puncture.

During the operation, the joint cavity can be examined, damage to the labrum can be diagnosed, and reconstruction can be performed.

TREATMENT OF SLAP DAMAGE

Treatment usually begins with conservative measures. The main goal is to reduce pain and inflammation in the joint. Therapy is also a priority, mainly physical therapy aimed at preventing stiffness in the joint. Your doctor may prescribe cortisone injections into the joint cavity. Cortisone is a very strong anti-inflammatory drug that, when injected into a joint, significantly reduces pain. However, it is worth noting that pain relief is only temporary. If conservative treatment is not effective within 3-4 months, the pain syndrome is not relieved, and the range of motion in the joint progressively decreases, surgery may be considered.

Arthroscopy is currently used for the surgical treatment of labral injuries, including SLAP injuries.

If the area of the damaged lip is small and does not affect its entire thickness, the lip is not pinched between the head and the glenoid, during movements you can limit yourself to debridement. Debridement is performed with special arthroscopic mechanical instruments or with the help of cold plasma (cold plasma ablation). As a result of debridement, irregularities are smoothed out, as well as areas of fiber disintegration of the articular labrum. With debridement, it is possible to resect marginal and partially torn fragments of the labrum and biceps tendon, which, when moving in the shoulder joint, “wear away” the articular cartilage and contribute to chronic inflammation.

If the labrum tear is significant and instability is detected in the shoulder joint, it may require refixation rather than simple removal.

During arthroscopy, the site of damage is visualized, channels are drilled into the bone in the projection of the avulsion, and special anchors (anchors) are inserted into them, to which the articular labrum is fixed with heavy-duty threads. The operation may require multiple anchors.

Anchors (anchors) can be made of metal or special absorbable material. After some time, the labrum grows to the bone. There is no need to remove the anchor clamps later.

In some cases, if there is significant damage to the biceps tendon, tenodesis is performed.

Tenodesis is an operation of cutting the biceps tendon from the scapula and fixing it to a new place in the area of the proximal humerus.

With tenodesis, the relief of the shoulder muscles does not suffer. The operation leads to a sharp reduction in pain in the shoulder joint.

There are many options for arthroscopic biceps tendon tenodesis.

Anchors or special screws can be used to fix the tendon to the bone.

The advantage of arthroscopic tenodesis is the reduction of damage to the intact tissue surrounding the joint, which leads to faster healing and recovery.

REHABILITATION AFTER SURGERY

After the operation of tenodesis and refixation of the labrum, a special orthotic bandage is prescribed; most often, passive movements in the elbow and shoulder joint are allowed immediately after the operation.

However, active movements of the operated arm are limited to one and a half months after the operation. More aggressive rehabilitation may result in avulsion of the biceps tendon and labrum from the refixation site to the bone. You can usually return to sports 4-6 months after surgery.

Debridement surgery involves more active rehabilitation, which begins immediately after the operation. Skin sutures after arthroscopic surgery on the shoulder joint are usually removed on the 10th day.

WHY SHOULD YOU BE TREATED WITH US?

In our clinic, we widely use arthroscopy and other minimally invasive methods of treating shoulder joint pathologies. Operations are carried out on cutting-edge medical equipment using high-quality and proven consumables, fixtures and implants from major global manufacturers.

Establishing a diagnosis

Purpose of treatment

Repeated consultation with a traumatologist-orthopedist, Ph.D. - for free

Analysis of the results of studies prescribed during the initial consultation
Making a diagnosis
Purpose of treatment

Arthroscopic SLAP reconstruction – 79,000 rubles

Stay at the clinic
Anesthesia
Surgery: Shoulder arthroscopy with SLAP reconstruction
Consumables
Implants (Smith and Nephew, Mitek)

Arthroscopic tenodesis of the biceps tendon - 49,000 rubles

Stay at the clinic
Anesthesia
Surgery: Shoulder arthroscopy with biceps tenodesis
Consumables
Implants (Smith and Nephew anchor, Mitek)

* Tests for surgery are not included in the price.

Intra- and periarticular administration, “blockade” with glucocorticoids (without the cost of the drug) - 1000 rubles

Local anesthesia
Local administration of glucocorticoid solution (Diprospan)

Appointment with a traumatologist - orthopedist, Ph.D. after surgery - free of charge

Clinical examination after surgery
View and interpret the results of radiographs, MRI, CT after surgery
Recommendations for further recovery and rehabilitation
Intra-articular injection of hyaluronic acid (if necessary)
Dressings, removal of postoperative sutures

SLAP shoulder injury is a common condition that occurs more often in people over the age of 40. Due to the anatomical features of the shoulder, this type of traumatic or pathological injury is difficult to diagnose and requires the use of arthroscopy.

Development mechanism

The shoulder joint is a complex anatomical structure. It is formed by the articular surfaces of the scapula, the clavicle, which forms the cavity, and the head of the humerus. To increase the range of movements, soft tissue lips are formed along the edges of the articular cavity, increasing its depth.

SLAP injury involves a violation of the anatomical integrity of the lip, mainly its upper part, of varying degrees of severity, up to separation. This leads to a decrease in the depth of the socket, which causes instability of the joint with the subsequent development of shoulder dislocation (this factor is one of the reasons for the development of habitual shoulder dislocation, which brings significant discomfort and reduces a person’s quality of life).

The long tendon of the biceps muscle (biceps muscle) can be wedged into the area of violation of anatomical integrity, with a sharp limitation in the range of active and passive movements in the shoulder.

Reasons

This type of damage in most cases is of traumatic origin. Violation of the anatomical integrity of the lip of the glenoid cavity of the shoulder occurs with a direct blow or fall on an outstretched arm. Also, quite often, such an injury occurs in people involved in certain sports (shot throw, javelin, weightlifting), in which the load on the shoulder increases significantly.

Often a SLAP injury develops as a result of a shoulder dislocation. This pathology can be provoked by a congenital decrease in the strength of lip tissues or the development of a degenerative-dystrophic process in them.

SLAP syndrome has a clinical picture characterized by the development of several manifestations. These include:

If there is a significant violation of the integrity of the lip of the glenoid cavity, patients subjectively feel the appearance of instability in the joint. Long-term damage to the labrum of the shoulder is often accompanied by habitual dislocation.

Diagnostics

Since SLAP disease has nonspecific clinical symptoms, additional research techniques aimed at visualizing the internal structures of the shoulder are used to reliably diagnose it. These include:

Radiography.
Computer or magnetic resonance imaging.
Arthroscopy.

In terms of determining the severity and exact localization of a violation of the anatomical integrity of the lip of the glenoid cavity of the shoulder, radiography and tomography (magnetic resonance or computer) are of little information. Therefore, in modern clinics, reliable diagnosis is carried out using arthroscopy.

The essence of this technique is to insert a flexible tube, which is equipped with a video camera and a light source, into the joint cavity through minimal incisions. The camera is connected to a monitor on which the doctor can visually assess the condition of the internal structures of the shoulder. With the help of arthroscopy, various manipulations are also performed using inserted microinstruments and manipulators.

SLAP injury of the shoulder joint - treatment

Treatment of this pathological process is complex and step-by-step. It includes the implementation of conservative measures, surgical reconstruction of damaged structures, followed by rehabilitation.

The duration of treatment, as well as the necessary therapeutic measures, are determined by the doctor based on an objective diagnosis, taking into account the individual characteristics of the patient’s body.

Conservative therapy

Conservative therapy is the primary stage of complex treatment of SLAP syndrome. It includes the use of drugs of various pharmacological groups.

To reduce the severity of the inflammatory process, non-steroidal anti-inflammatory drugs are used. Reducing the severity of degenerative-dystrophic processes in the cartilaginous structures of the shoulder is achieved through the use of chondroprotective drugs.

With the development of a chronic inflammatory reaction, as well as to strengthen the structures of the shoulder, physiotherapeutic measures are used, which include electrophoresis with anti-inflammatory drugs, magnetic therapy, mud baths, and ozokerite. Physiotherapy may also be prescribed during rehabilitation activities.

Surgical reconstruction

Restoring the anatomical integrity of the lips of the glenoid cavity of the shoulder is possible only through surgical intervention. The type of operation is determined by the severity of the damage.

Modern clinics use arthroscopic treatment of SLAP injuries. The essence of the operation is to introduce an arthroscope with microinstruments and manipulators into the joint cavity. Under visual control on the monitor screen, the doctor performs the necessary manipulations for plastic surgery and restoration of the anatomical integrity of the structures of the shoulder joint.

The main advantage of a predominantly arthroscopic operation is low tissue trauma, since small incisions are made in the tissue and capsule to insert the arthroscope. Due to this, the recovery period and the length of the patient’s stay in the medical center are significantly reduced. The likelihood of complications (bleeding, secondary bacterial infection) is also minimized.

In case of combined damage to the labrum and other structures of the shoulder, open surgery can be performed. To carry it out, wide incisions are made in the skin, subcutaneous tissue and capsule, which leads to high trauma to the structures followed by a longer recovery period. Surgical treatment methods are used only after a course of conservative therapy.

Rehabilitation

After completing the main stage of therapeutic measures and surgical intervention, the doctor prescribes rehabilitation measures.

The early postoperative period includes procedures aimed at preventing the development of complications. If necessary, anti-inflammatory, hemostatic drugs and antibiotics are prescribed. Subsequent rehabilitation measures include performing special gymnastic exercises with a gradual increase in the functional load on the shoulder.

Rehabilitation measures in the early postoperative period are usually carried out in a medical hospital, then on an outpatient basis.

Recovery duration

The period of time required to restore the functional activity of the shoulder joint can be different and vary from several months to six months. The duration of rehabilitation depends on:

degree of severity of damage to the labrum;
type of surgical intervention (open access surgery or arthroscopy);
age and individual characteristics of the patient’s body.

After open surgery, a longer rehabilitation period is usually required.

It is important to understand: when the shoulder crunches and the crunch is accompanied by pain, this is not a diagnosis, but only a symptom that may manifest a disease. Therefore, there is no point in eliminating the manifestation without establishing the real cause.

Which specialist should you contact when your shoulder joint hurts and cracks? What measures can you take on your own, and under what circumstances should you immediately go to the hospital? What diseases are characterized by such manifestations?

Reasons

In order to try to alleviate the condition, it is necessary to understand its cause.

Injuries and damage to joints and muscles

What caused:

bruises;
dislocations;
sprains;
awkward movements;
lifting weights.

Who is treating? Traumatologist.

Diagnostics:

inspection;
X-ray, ultrasound, arthroscopy;
laboratory research.

applying a cast, wearing a corset or bandage;

anti-inflammatory drugs;

physiotherapy, massage;

neuromodulation.

Shoulder arthrosis

What caused it? The disease occurs infrequently, but its rapid progression is dangerous. With arthrosis, the synovial bursa becomes inflamed, the bones and cartilage are dystrophically changed.

Nature of pain. Usually - aching, pulling, when raising the hand - sharp. It radiates to the elbow, sometimes the whole limb ache. If left untreated, the joint gradually deteriorates.

Diagnostics. A specialist will help you make a diagnosis:

X-ray;

physical therapy;
physiotherapeutic procedures;
anti-inflammatory agents: external and internal;
chondroprotectors;
in severe cases - surgery.

Arthritis

What caused it? Arthritis is an inflammatory disease, which has many causes: from infection to allergies.

Nature of pain. The onset of the disease is characterized by slight pain and crunching in the shoulder joint. Next is constant pain in the affected area, which subsequently becomes unbearable. The joint does not move well, the temperature may rise, and swelling may occur. Severe pain at night, leading to insomnia.

Who is treating? The therapist can order an examination and, based on its results, refer to:

rheumatologist;
orthopedist;
surgeon;
traumatologist;
arthrologist.

Diagnostics:

x-rays;
tests.

Additional research methods may be prescribed.

NSAIDs;
physiotherapy;
chondroprotectors;
sometimes - endoprosthetics.

Osteochondrosis

What caused it? Crunching and pain in the shoulder joints also occur with osteochondrosis - degenerative changes in the intervertebral discs.

Nature of pain. Intense at night, constant discomfort in the shoulder joint and neck, pain occurs when trying to spread the arms. Additional symptoms of shoulder osteochondrosis:

swelling of the hand;
cyanosis;
soreness from touching;
sweating;
cold skin;
numbness of the limb.

Diagnostics:

X-ray in several projections;
in case of circulatory disorders - rheoencephalogram.

anti-inflammatory;
pain reliever;
psychotropic;
chondroprotective.

Collision Syndrome

What caused it? When the arm moves upward, the humerus rests against the “roof”, which is formed by the coracoid and acromial processes of the scapula. Frequent and prolonged raising of the arm to perform any action causes microtrauma to the synovial bursae. This is the “collision” syndrome or the disease of artists.

Nature of pain. Sharp pain when moving. It is stronger at night and pain relief is ineffective. There is swelling and decreased strength in the affected arm.

Diagnostics:

inspection, testing;
radiography;

load limitation;
non-steroidal anti-inflammatory drugs;
glucocorticosteroids;
physiotherapy;

Tendenitis

What caused it? With prolonged stress on the shoulder, injuries, infections, the tendons become inflamed. This is called tendinitis.

Nature of pain. Sharp pain and crunching in the shoulder joint. The progression of the disease makes it impossible to move the limb. The skin of the shoulder turns red and becomes hotter than in neighboring areas. The pain can be so severe that touching the joint is unbearable. Intensifies in the evening.

Who is treating? If the shoulder joint hurts and crunches, you should urgently consult with an orthopedist, rheumatologist or traumatologist.

Diagnostics:

examination, tests, palpation;
MRI or x-ray;
computer arthrography.

To be sure, your doctor may prescribe an injection of anesthetic into the bursa. Relief of pain after the procedure confirms the diagnosis.

In parallel they carry out:

shock wave treatment;
anti-inflammatory;
blockade with corticosteroids.

Bursitis

What caused it? When the periarticular bursa of the shoulder becomes inflamed, pain and stiffness appear when moving. This condition is called bursitis.

Nature of pain. Acute pain when performing any activity is accompanied by swelling and numbness of the hand. At first they are mild, the only concern is swelling, which does not affect the range of motion. Advanced cases are characterized by severe pain and fever.

Who is treating? If you have shoulder pain, you can consult a traumatologist or orthopedist. If the infectious genesis of the disease is established, the patient is referred to a rheumatologist, venereologist, or phthisiatrician.

Diagnostics. Bursitis can only be effectively diagnosed using MRI and ultrasound of the shoulder.

Treatment. Bursitis is treated with:

medicines;
physiotherapy;
massage.

Biceps tendinitis

What caused it? The shoulder joint hurts and clicks with biceps tendonitis. Overload of the biceps muscle during work or sports training causes inflammation of the shoulder tendons. The disease may also be accompanied by other problems, such as shoulder impingement or rotator cuff damage.

Nature of pain. Localization of pain with tendinitis is the front surface of the arm, biceps. The shoulder aches, the pain is accompanied by clicking sounds. It goes away if the load is reduced, so many patients consider rest to be a sufficient measure to combat pain. However, if tendinitis is left untreated, the biceps tendon may simply tear off. The patient hears a sharp click, the pain intensity quickly decreases. The deformation becomes noticeable: the biceps moves down towards the elbow.

Who is treating? If appropriate symptoms are detected, you can contact a traumatologist, who will prescribe an examination and, if necessary, refer to other specialists.

Diagnostics:

examination, questioning, motor tests;
X-ray;
arthroscopy.

complete elimination of loads;
anti-inflammatory drugs;
steroid injections;
physiotherapy, exercise therapy.

Common shoulder dislocation

What caused it? If the primary dislocation of the shoulder joint was treated without diagnosis or the rules of rehabilitation were violated, habitual (recurrent) dislocations may occur.

Nature of the pain: at the moment of dislocation, sharp, impossibility of any shoulder movements, even passive ones. Deformation occurs and the fingers go numb. The patient involuntarily presses his hand to his body to relieve the condition. With repeated dislocations, pain may be almost not felt.

Diagnostics:

x-ray in two projections;
ultrasound examination;
MRI, CT.

reduction of dislocation under local anesthesia;
surgical operation: arthroscopic or open, which aims to fix the torn labrum of the joint.

Increased sports loads

What caused it? Injuries to the shoulder joint during intense sports training occur due to violations of the technique of performing certain exercises and exceeding the permissible loads.

Nature of pain. Pain depends on the type of injury and can be mild, more pronounced or sharp, occurring suddenly. In addition, constant excess load on the shoulder causes diseases such as:

tendonitis;
impingement syndrome;
bursitis;
SLAP syndrome;
Bankrate damage;
arthrosis.

Each of these diseases occurs differently, so the symptoms are different:

crunching in the shoulder joint with sharp pain;
weak, but increasing as the load increases;
aching, dull pain.

Diagnostics. X-ray. Additional studies may be required to clarify the diagnosis:

tests;
arthroscopy.

Treatment. In each individual case, treatment methods differ. Thus, for inflammation, NSAIDs are first prescribed; for minor injuries, it is often enough to reduce the load on the affected joint.

Diseases of internal organs

What caused it? Many diseases of internal organs can radiate pain to the shoulder joint. It is impossible to ignore them: they interfere with basic movements and manipulations.

Nature of pain:

aching due to diseases of the lungs, digestive organs, heart;
acute for inflammation, neck injuries.

Prolonged, dull pain in the shoulder and at the same time sharp, stabbing pain in the chest can be a sign of angina pectoris.

Who is treating? Therapist.

Diagnostics: examination of internal organs, tests.

Humeroscapular periarthritis

What caused it? With glenohumeral periarthritis, the tissues surrounding the joint are affected. It usually occurs due to physical overload.

Nature of pain. Pain when moving your arm, worse at night. Lack of treatment leads to the progression of the disease, the pain becomes severe, radiating to the neck and arm. In the acute phase - insomnia, low-grade fever. The shoulder gradually immobilizes, the muscles atrophy.

Who treats:

rheumatologist;
neurologist;
traumatologist;
surgeon;
orthopedist.

Diagnostics:

X-ray;
blood tests.

Complex treatment:

NSAIDs in the form of tablets, ointments, injections;
physiotherapy;
blockade with corticosteroids.

When should you see a doctor immediately?

The causes of shoulder pain are different, including minor ones: awkward movement, slight overload. In these cases, independent attempts at treatment are acceptable:

taking painkillers;
rubbing the shoulder with anti-inflammatory ointment;
provide peace.

However, there are situations when urgent consultation with a specialist is necessary:

the shoulder began to hurt after any injury;
fever, skin rashes;
analgesics do not help;
unrelenting pain accompanied by crunching sounds.

First aid: how to relieve pain?

First of all, you need to provide first aid to the victim:

If there is a bruise, apply ice;
in case of swelling, raise your arm above your head and secure it in this position;
in case of a fracture, very carefully apply a splint or bandage the victim’s arm to the body;
in case of dislocation, make a scarf bandage to fix the shoulder.

In addition, you need to give painkillers: analgin, no-shpu.

Conclusion

The shoulder joint is a complex mechanism. Only an experienced doctor can understand what exactly is the cause of shoulder pain through research. Sometimes such conditions require immediate surgery. Therefore, it is so important to establish a diagnosis in time and begin therapy.

Be sure to watch the next video

What is shoulder impingement syndrome and how to treat it

The shoulder joint has a complex structure that ensures its mobility. But this is also a factor in the instability of such a joint, which often leads to dysfunction and pain. One of the common causes of pain is impingement syndrome of the shoulder joint.

Causes and mechanism of development of the disease

The joints are formed by the clavicle, scapula and humerus. In the articular cavity located on the scapula, there is the head of the humerus, which is limited from above by the acromion - the process of the scapula. All these structures are secured by ligaments and muscles that form the rotator cuff. Thanks to this, the head of the humerus is fixed in place during movement in the joint when the arm is abducted.

The most vulnerable muscle is located under the acromion. Due to various circumstances, it can be injured, resulting in a corresponding clinical picture.

The following reasons contribute to this:

some features of the acromion process: hook-shaped or curved shape, bone thickenings;
bone growths - osteophytes - at the junction of the acromion and clavicle;
conditions after injury to the tubercle of the humerus or process of the scapula;
rupture of the ligamentous apparatus and muscles;
paralysis and muscle weakness;
thickening of the rotator cuff and intra-articular bursa as a result of chronic inflammation;
congenital ligament weakness;
wrinkling of the posterior joint capsule.

When the arms are raised, especially during work, the acromion moves as close as possible to the humerus and causes compression of the rotator cuff. First, it becomes irritated, then injured, with possible rupture of the tendon. This is especially true for people in certain professions: builders, plasterers, painters, carpenters, installers. A similar problem may also occur among athletes who are actively involved in sports such as boxing, tennis, volleyball, and martial arts.

Clinical manifestations

The main symptoms of impingement syndrome:

Pain in the joint. At first, the pain is dull, aching, and intensifies with movement, especially when raising the arm. Later, the pain syndrome begins to bother you even at night, preventing you from getting a full night’s sleep. Acute pain may occur if the hand is pulled back too far in an attempt to reach the back pocket of the trousers while zipping up the dress.
Limitation of movement in the joint due to severe pain.
Clicking in the joint when lowering the arm.
Over time, atrophy occurs in the muscles surrounding the joint and participating in its formation.
Pain is noted on palpation.

What needs to be done to clarify the diagnosis

To establish a diagnosis, various research methods are required. A special role here is played by a correctly collected anamnesis, complaints and examination data. This is often enough for experienced surgeons and traumatologists. But accurate diagnosis is based on the use of the achievements of modern medicine:

MRI – magnetic resonance imaging – is the most informative;
radiography of the shoulder joint;
Ultrasound of the joint is used less frequently;
arthroscopy – visual assessment using an apparatus of the state of intra-articular structures;
Neer diagnostic impingement test – when Lidocaine is injected into the subacromial bursa, a significant reduction in pain occurs.

What to do if diagnosed

Effective treatment is possible using a whole range of measures. All recommendations should be given by a doctor after assessing the condition and capabilities of the body.

Conservative therapy

It is necessary to provide rest to the affected joint.
Anti-inflammatory drugs that also have an analgesic effect - NSAIDs - are prescribed. They are taken orally or topically.
Blockades using corticosteroids – hormonal agents – are effective. This may be diprospan or hydrocortisone. They are used no more than once a week. No more than three procedures are allowed.
Exercise therapy - physical therapy - can be prescribed in the absence of severe pain. There should be no pain during the exercises. Loads increase gradually.
Physiotherapy methods - UHF, ultrasound with hydrocortisone, laser therapy.

Surgical intervention

If the effect of conservative measures does not occur within a period of three to four months, then they resort to surgical intervention - subacromial decompression of the shoulder joint. Another name for this operation is acromioplasty. Today there are two approaches: open and using an arthroscope. The second method is preferable, since it causes less injury to the joint tissue and is much more effective.

During the operation, two punctures are made. The first is necessary to introduce a device that allows you to visually assess the condition of the joint and identify the immediate cause of pain. The second puncture is intended for a tool that can be used to remove bone growths and other formations that interfere with the normal functioning of the shoulder joint. If a tendon rupture is detected, the edges are sutured or sutured to the bone during surgery.

Reasons

In order to try to alleviate the condition, it is necessary to understand its cause.

Injuries and damage to joints and muscles

What caused:

bruises;
dislocations;
sprains;
awkward movements;
lifting weights.

Who is treating? Traumatologist.

Diagnostics:

inspection;
X-ray, ultrasound, arthroscopy;
laboratory research.

applying a cast, wearing a corset or bandage;

anti-inflammatory drugs;

physiotherapy, massage;

neuromodulation.

Shoulder arthrosis

What caused it? The disease occurs infrequently, but its rapid progression is dangerous. With arthrosis, the synovial bursa becomes inflamed, the bones and cartilage are dystrophically changed.

Nature of pain. Usually - aching, pulling, when raising the hand - sharp. It radiates to the elbow, sometimes the whole limb ache. If left untreated, the joint gradually deteriorates.

Diagnostics. A specialist will help you make a diagnosis:

X-ray;

physical therapy;
physiotherapeutic procedures;
anti-inflammatory agents: external and internal;
chondroprotectors;
in severe cases - surgery.

Arthritis

What caused it? Arthritis is an inflammatory disease, which has many causes: from infection to allergies.

Who is treating? The therapist can order an examination and, based on its results, refer to:

rheumatologist;
orthopedist;
surgeon;
traumatologist;
arthrologist.

Diagnostics:

x-rays;
tests.

Additional research methods may be prescribed.

NSAIDs;
physiotherapy;
chondroprotectors;
sometimes - endoprosthetics.

Osteochondrosis

What caused it? Crunching and pain in the shoulder joints also occur with osteochondrosis - degenerative changes in the intervertebral discs.

Nature of pain. Intense at night, constant discomfort in the shoulder joint and neck, pain occurs when trying to spread the arms. Additional symptoms of shoulder osteochondrosis:

swelling of the hand;
cyanosis;
soreness from touching;
sweating;
cold skin;
numbness of the limb.

Diagnostics:

X-ray in several projections;
in case of circulatory disorders - rheoencephalogram.

anti-inflammatory;
pain reliever;
psychotropic;
chondroprotective.

Collision Syndrome

Nature of pain. Sharp pain when moving. It is stronger at night and pain relief is ineffective. There is swelling and decreased strength in the affected arm.

Diagnostics:

inspection, testing;
radiography;

load limitation;
non-steroidal anti-inflammatory drugs;
glucocorticosteroids;
physiotherapy;

Tendenitis

What caused it? With prolonged stress on the shoulder, injuries, infections, the tendons become inflamed. This is called tendinitis.

Who is treating? If the shoulder joint hurts and crunches, you should urgently consult with an orthopedist, rheumatologist or traumatologist.

Diagnostics:

examination, tests, palpation;
MRI or x-ray;
computer arthrography.

To be sure, your doctor may prescribe an injection of anesthetic into the bursa. Relief of pain after the procedure confirms the diagnosis.

In parallel they carry out:

shock wave treatment;
anti-inflammatory;
blockade with corticosteroids.

Bursitis

What caused it? When the periarticular bursa of the shoulder becomes inflamed, pain and stiffness appear when moving. This condition is called bursitis.

Diagnostics. Bursitis can only be effectively diagnosed using MRI and ultrasound of the shoulder.

Treatment. Bursitis is treated with:

medicines;
physiotherapy;
massage.

Biceps tendinitis

Who is treating? If appropriate symptoms are detected, you can contact a traumatologist, who will prescribe an examination and, if necessary, refer to other specialists.

Diagnostics:

examination, questioning, motor tests;
X-ray;
arthroscopy.

complete elimination of loads;
anti-inflammatory drugs;
steroid injections;
physiotherapy, exercise therapy.

Common shoulder dislocation

What caused it? If the primary dislocation of the shoulder joint was treated without diagnosis or the rules of rehabilitation were violated, habitual (recurrent) dislocations may occur.

Diagnostics:

x-ray in two projections;
ultrasound examination;
MRI, CT.

reduction of dislocation under local anesthesia;
surgical operation: arthroscopic or open, which aims to fix the torn labrum of the joint.

Increased sports loads

What caused it? Injuries to the shoulder joint during intense sports training occur due to violations of the technique of performing certain exercises and exceeding the permissible loads.

Nature of pain. Pain depends on the type of injury and can be mild, more pronounced or sharp, occurring suddenly. In addition, constant excess load on the shoulder causes diseases such as:

tendonitis;
impingement syndrome;
bursitis;
SLAP syndrome;
Bankrate damage;
arthrosis.

Each of these diseases occurs differently, so the symptoms are different:

crunching in the shoulder joint with sharp pain;
weak, but increasing as the load increases;
aching, dull pain.

Diagnostics. X-ray. Additional studies may be required to clarify the diagnosis:

tests;
arthroscopy.

Treatment. In each individual case, treatment methods differ. Thus, for inflammation, NSAIDs are first prescribed; for minor injuries, it is often enough to reduce the load on the affected joint.

Diseases of internal organs

What caused it? Many diseases of internal organs can radiate pain to the shoulder joint. It is impossible to ignore them: they interfere with basic movements and manipulations.

Nature of pain:

aching due to diseases of the lungs, digestive organs, heart;
acute for inflammation, neck injuries.

Prolonged, dull pain in the shoulder and at the same time sharp, stabbing pain in the chest can be a sign of angina pectoris.

Who is treating? Therapist.

Diagnostics: examination of internal organs, tests.

Humeroscapular periarthritis

What caused it? With glenohumeral periarthritis, the tissues surrounding the joint are affected. It usually occurs due to physical overload.

Who treats:

rheumatologist;
neurologist;
traumatologist;
surgeon;
orthopedist.

Diagnostics:

X-ray;
blood tests.

Complex treatment:

NSAIDs in the form of tablets, ointments, injections;
physiotherapy;
blockade with corticosteroids.

When should you see a doctor immediately?

The causes of shoulder pain are different, including minor ones: awkward movement, slight overload. In these cases, independent attempts at treatment are acceptable:

taking painkillers;
rubbing the shoulder with anti-inflammatory ointment;
provide peace.

However, there are situations when urgent consultation with a specialist is necessary:

the shoulder began to hurt after any injury;
fever, skin rashes;
analgesics do not help;
unrelenting pain accompanied by crunching sounds.

First aid: how to relieve pain?

First of all, you need to provide first aid to the victim:

If there is a bruise, apply ice;
in case of swelling, raise your arm above your head and secure it in this position;
in case of a fracture, very carefully apply a splint or bandage the victim’s arm to the body;
in case of dislocation, make a scarf bandage to fix the shoulder.

In addition, you need to give painkillers: analgin, no-shpu.

Conclusion

Be sure to watch the next video

One common upper extremity injury is a Bankart injury of the shoulder joint.

With proper treatment and a full course of rehabilitation, in the first year you can completely restore the functions of your hand and return to a full life. Let's look at this problem in more detail.

The shoulder joint differs from other joints in its structure, especially considering its size. It consists of two main parts: the scapula and the head of the humerus. It is shaped like a ball and quite large in size.

The ratio of the dimensions of the humeral head and the glenoid cavity is unequal - the bone enters it approximately 25 - 30%. The rest would remain loose, making the joint extremely unstable, if not for a special system of cartilage, joints and ligaments.

Along the edge of the cavity there is a cartilaginous growth, the so-called articular lip, which additionally fixes the head.

There is also a system of muscle tendons:

small round;
scapular;
infraspinatus;
supraspinatus.

All together forms a strong joint capsule and a stable system that ensures safe movement of the arm. If the rotator cuff of the shoulder joint is damaged, lifting and abduction of the limb, its rotation, and force tension will become inaccessible.

This anatomical complex is carefully thought out by nature itself, but still it remains vulnerable, which is why Bankart injuries are quite common.

Causes of damage

SLAP injury to the shoulder joint can be caused primarily by external factors, although some internal processes can also contribute to this.

The risk of injury increases in the following cases:

osteoporosis;
tendinitis;
arthritis.

The main reasons for violating the integrity of the articular cuff are:

sudden movements of the hand with a large amplitude of its abduction or rotation;
falling on a straight limb;
exposure to intense load, for example, when suddenly lifting a load;
a blow to the shoulder with great force.

The risk group includes people whose profession or hobbies involve long periods of holding their hands above their heads, rotating movements, or jerking. For example, labral tears are a common injury among athletes: shot putters, golfers, tennis players, etc.

As a result of such an impact, a partial tear or complete separation of the articular labrum occurs. As a result, the shoulder joint loses stability, which is reflected in a significant increase in the likelihood of dislocation, cracks and fractures of the articulation elements. It is dislocations that in most cases accompany SLAP injury.

Symptoms and signs

The main signs characterizing damage to the rotator cuff of the shoulder joint are pain and impaired motor ability. The intensity of their manifestation depends on the severity of the injury.

General symptoms are expressed as follows:

pain that gets worse when moving the limb;
swelling;
characteristic clicks when trying to bend your arm;
a noticeable decrease in strength and mobility of the injured arm;
inability to make abduction movements;
when attempting to perform a rotational movement, dislocation is highly likely;
loss of ability to work.

Important! With minor tissue tears, symptoms may appear mildly, so a person may not pay attention to them. However, if appropriate measures are not taken and the injury is allowed to age, negative consequences may occur, such as continued joint instability.

Types of damage

There is a classification of injuries to the shoulder joint of this type.

There are three types of Bankart injury:

Classic type. The pain manifests itself from the moment of injury, arm movements are difficult. It is characterized by a complete separation of the articular labrum at the junction with the scapular cavity. The moment you receive damage is accompanied by a special click.
Second type. In this case, the damage is minor, a complete rupture does not occur, so the discomfort in the joint is not so pronounced. This leads to ignoring the problem, which can ultimately provoke the development of serious complications.
Extreme type. This is a particularly severe type of injury, since a rupture of the labrum is accompanied by cracks or fractures of the bone. The victim requires immediate medical attention.

The extent of damage and the intensity of symptoms are directly related to the presence of a specific type of shoulder injury. Treatment is selected accordingly.

Diagnostic measures

Even an experienced doctor will not be able to make an accurate diagnosis without hardware tests. Although the symptoms are very specific, some types of damage can be similar to other diseases. If a dislocation is present, it is important to evaluate the soft tissue and bone to identify associated injuries.

The condition of the shoulder joint can be assessed using special motor tests, but in any case additional diagnostics are required.

The most informative research methods include:

MRI. This diagnostic option allows you to examine structural changes in all tissues of the joint, including cartilage and tendons, muscles and bones. Any type of damage in all elements of the joint and adjacent structures will not go unnoticed by the doctor.
CT. In this case, computed tomography is performed using a contrast agent. It is first infused into the joint cavity, due to which the capsule ruptures become visualized in more detail.
Arthroscopy. Through small incisions in the shoulder, a miniature camera - an arthroscope - is inserted into the joint cavity. A saline solution is first pumped inside to open the capsule for a clearer examination of the condition of the tissues. The image from the camera is displayed on the monitor.

X-ray in this case is ineffective, since it allows us to examine only the displacement and violation of the integrity of bone formations. After determining the type of injury and all the necessary associated aspects, appropriate treatment is prescribed.

Treatment methods

To eliminate Bankart lesions, surgical treatment methods are used in most cases. Conservative therapy is possible only for minor tears.

Instructions for this approach include the following activities:

Immobilization. It is necessary to completely immobilize the injured limb to avoid further damage.
Taking medications. Painkillers and non-steroidal anti-inflammatory drugs are used. Additionally, chondroprotectors and vitamin-mineral complexes are recommended.
Physiotherapy. Various procedures, the price of which is quite affordable, stimulate regenerative processes, relieve pain and improve blood circulation.
Folk remedies. They are used only as auxiliary measures to alleviate symptoms and speed up recovery.
Exercise therapy. After fusion of the labrum, you need to carefully develop the limb, gradually increasing the load and range of motion.

Surgical intervention

Shoulder injuries with rotator cuff tears most often require surgical treatment. Surgical intervention is performed in the least traumatic way - through arthroscopy.

In case of old injuries, first of all it is necessary to clean the edges of the tear, so to speak, to refresh the wound. To restore the integrity of the articular labrum, special anchors are required to secure it around the scapular cavity. Holes are carefully drilled in its bottom, where the fixing elements are inserted. With their help, the lip is pulled to the bone and stitched.

Such measures provide optimal conditions for the healing of damaged tissues. Suture threads are used from both titanium alloys and polylactic acid. The dimensions of the clamps in diameter range on average from 1.2 to 3.5 mm.

Rehabilitation

The rehabilitation period takes on average 3 - 6 months. In particularly severe cases, recovery may take more than 1 year. To make the process as easy and quick as possible, you must follow certain rules. First of all, immobilization of the limb is ensured using special orthoses. As prescribed by your doctor, you need to attend physiotherapeutic procedures.

Exercise therapy is of particular importance.

The load on the shoulder joint is distributed into 3 stages, for which the following exercises are used:

Title and photo	Brief description
Stage 1 (1 - 4 weeks)
Muscle tension	Passive muscle contraction prepares the joint for future stress.
Rotation with brush	Activate the muscles of the limb, prevent stagnation of blood and lymph.
Flexion-extension of fingers	It also helps prevent the occurrence of congestion.
Stage 2 (4 - 8 weeks)
Raising hands	Place your arms straight forward, slowly spread them to the sides and bring them back. You can change the position of your palms relative to each other.
Raising your arms above your head	If discomfort occurs, reduce your range of motion.
Rotation of the arm bent at the elbow	Bend your arm at the elbow, with your forearm parallel to the floor. Use a rotational motion to bring your forearm into a perpendicular position.
Stage 3 (8 - 12 weeks)
Rotation at the shoulder	Place your palms on your shoulders and slowly rotate them with the joint.
Straight arm rotations	Perform rotational movements with straightened arms.
Abduction of arms with dumbbells	Hands along your body, carefully lift them up, holding light dumbbells.
Overcoming Resistance	Bend your affected arm at the elbow and clasp your palms together. Pull the injured limb with your healthy hand, contracting the muscles for resistance.

After 3 months, if the dynamics are positive, the usual load with weight lifting can be introduced.

Prevention

In order to prevent injury to the limb in the area of the rotator cuff and to avoid relapses if the labrum is previously damaged, it is necessary to take care to prevent such problems.

To do this, you must follow the following recommendations:

group yourself correctly when falling, the arm put forward is almost always injured in the joints;
perform sports exercises correctly;
avoid sudden movements of the hand, especially with load on the shoulder joint;
do not overload the limb;
Seek prompt medical attention after injuries or if suspicious symptoms appear.

For more information about Bankart injury of the shoulder, watch the video in this article.