The structure of the shoulder joint is by far the most complex joint of the body. It is extremely susceptible to injuries and diseases due to the fact that it allows movement in six directions. As a physiatry specialist, we encounter painful shoulder cases frequently in our daily practice.

What are the causes of shoulder pain?

Shoulder pain may be caused by the shoulder joint itself, or it may be pain that is reflected in the shoulder from another area. It is the most common cause of shoulder pain caused by external shoulder joints. When the nerves leading to the arm are squeezed due to the neck stiffness, the patient may feel pain in his shoulder. With a good examination it is easy to see whether shoulder pain is caused by the shoulder joint itself or from another area.

One of the most important causes of pain reflected on the shoulder is the heart attack. The possibility of a heart attack should not be forgotten especially in middle-aged and elderly patients with newly started left shoulder pain.

We can collect the pain that arises from the shoulder itself under two headings. 1- Pain from shoulder soft tissues. 2- Bone and joint-derived pain. More than 95% of the shoulder pain is caused by soft tissues of the shoulder. In other words, muscle, tendon and bursa injured tissue. Few of the shoulder problems are bone and joint.

Which Expert Should Patient With Shoulder Pain Could Apply?

Referral to a physiotherapy rehabilitation specialist for a shoulder pain patient will prevent unnecessary time and money loss and ensure that the correct diagnosis is made as soon as possible. Because physical therapy expertise has a unique expertise that has enough knowledge about all possible causes of cervical canal, tendon rupture, muscle pain, calcifications and shoulder pain.

''Physiatry (Physical Medicine and Rehabilitation) is the only specialty branch that has authority in the diagnosis and treatment of spine and joint pain''

 What Should Be Examinations Like Shoulder Pain?

Although the shoulder joint has a good x-ray of the bone, the majority of the shoulder pain is soft tissue. For this reason, X-ray film is preferred in older patients who are more likely to be calcified. The best way to assess shoulder is magnetic resonance imaging (MRI) of the shoulder. It shows bone and soft tissues on the shoulder very well. EMG examination may be needed in patients with nerve injury. In recent years, in parallel with the developments in ultrasonic technology, the ultrasonics have been placed in the first row when the shoulder pain has been diagnosed.

''The joint ultrasound in diagnosing shoulder problems is effective and sufficient when applied by an experienced specialist''

Which treatments are applied in shoulder pain?

In acute severe shoulder pain, resting and applying ice is extremely important. Here, rest is meant to use the shoulder as little as possible. Most of the acute shoulder pain is relieved by pain relief and ice application for 3-5 times a day for 15 minutes. The shoulder strap can be used on traumatic shoulders in patients with severe pain that can not carry the arm. The length of the hanger should be kept as short as possible. Otherwise, your shoulder joint will freeze.

If the treatment result is unsuccessful, evaluation with MR is necessary. In the case of problems such as brucellosis, tendinitis, tendon rupture, tendon compression, the next stage is usually physical therapy applications. Ten to fifteen sessions of physical therapy are often sufficient. Sometimes applying cortisone injections can give good results.

In chronic shoulder pain treatment approach is different. At this stage, physical therapy applications are extremely important. Exercise exercises to increase joint range of motion and muscle strength are also commonly used with physical therapy applications. Sodium Hyalurinate in the shoulder limbs can be made with needles (known as the common rooster). Again, cortisone injections can be applied very successfully in any chronic soft tissue rheumatism of the shoulder.

Is Shoulder Injection Cortisone Injury?

Cortical injection of the shoulder can be done in several different regions. It is not a problem to make the same region twice a year by not registering more than once. Diet and salt restriction should be considered in hypertensive and diabetic patients.

Cortisone injection can be done in two different ways. In the first method we apply an estimated region of the needle between the bones without any auxiliary means. In this classical method, the success rate is about 50%. In the second and last years, we prefer to use the ultrasonic device to follow the tip of the needle. With this method, we can make the region where the needle should be done with accuracy up to 100% and our success rate is from 90% to 50%.