Inflammation of the long head of the biceps treatment. Tendinitis of the shoulder is a disease of the tendons

Shoulder pain affects 5–7% of the population, and the prevalence of such complaints triples by the age of 60. The reason for this is various diseases musculoskeletal and musculoskeletal system, but highest value have .

Muscle tendons, despite their strength, are a rather vulnerable structure of the shoulder. With prolonged exposure to adverse factors, pathological processes develop in the connective tissue, which disrupts the function of the entire joint. Therefore, shoulder tendinitis requires a quick and adequate response not only from the patient, but also from the doctor.

Causes and mechanism of development

The shoulder joint performs an important function in a person's daily life. It provides a wide range of movements, without which it is difficult to imagine professional, sports and domestic activities. Because of this, a significant part of the load falls on the shoulder.

Prolonged exposure to a mechanical factor causes microtraumatization of the tendons passing in rather narrow channels, and the development of an inflammatory process, which is the basis of tendonitis.

First of all, athletes are subject to such influence: javelin (disc, shot) throwers, tennis players, weightlifters. A similar condition is often observed among representatives of working professions (builders, painters).

But the disease can also have a completely different mechanism of development, in which inflammation is of secondary importance. Often come to the fore, which begin to develop after the age of 40. This is facilitated by metabolic-endocrine, vascular disorders, as well as age-related changes in the body. Therefore, in addition to injuries, as possible factors in the development of tendonitis, it is necessary to consider such conditions:

• Diabetes.
• reactive arthritis.
• Infectious diseases.

In most cases, there is a combination of several factors. But whichever of them causes damage to the tendon, the further development of the disease is subject to the same mechanisms.

Tendinitis should be considered as a multifactorial disease, great importance in the development of which is assigned to increased loads on the shoulder.

Symptoms

To make a correct diagnosis, the doctor conducts a clinical examination of the patient. First, he finds out complaints, the circumstances of the pathology, and then examines the place of probable damage. This will help identify specific traits illness.

The function of the shoulder joint is provided by various muscles, the tendons of which can be subject to inflammation. Certain symptoms will also depend on their involvement in the pathological process. But it should still be noted the general signs of tendinitis:

• Pain in the shoulder.
• Restriction of some movements.

Pain first occurs during exercise, and then bother even at rest and at night. They can be sharp or dull, monotonous. On examination, you can see some signs of inflammation: swelling, redness. However, this will not always be the case. Sometimes it is possible to determine soreness at the site of localization of the damaged tendon. Of great importance are special tests, during which the doctor prevents the patient from performing active movements. The appearance of pain at this moment will indicate the defeat of a particular muscle.

Chronic tendonitis can lead to tendon ruptures. They appear not only with a significant load, but even when performing simple movements.

Rotator cuff injury

The first thing to consider is rotator cuff tendinitis. It is formed by the supraspinatus, teres minor, infraspinatus, and subscapularis, and plays an important role in stabilizing the joint during various upward movements of the arm. In this case, pain is characteristic in the outer upper part of the shoulder joint, which can spread to the elbow. They often occur due to unusual loads, especially when working with raised arms for a long time.

Isolated damage to certain rotator cuff structures may occur. The most common traumatization of the supraspinatus muscle, due to its particular vulnerability. The disease is initiated by compression of the tendon between the head of the shoulder and the acromial arch. As a result, pain appears in the middle of the upper part of the joint. A positive test with resistance to shoulder abduction, confirming the defeat of the supraspinatus muscle.

If the pathology affects the infraspinatus and small round muscles, then a test should be performed with resistance to rotation of the shoulder outward. It is difficult for a patient with tendonitis to comb his hair or make similar movements. With inflammation of the tendon of the subscapularis muscle, a test with resistance to internal rotation of the shoulder becomes positive.

Biceps injury

The biceps tendon is also damaged. Tendinitis of the long head of the biceps is characterized by the appearance of pain along the anterior-upper surface of the shoulder joint. As a rule, they occur after lifting weights. A test with resistance to outward rotation of the hand (supination) helps to identify the disease. In addition, there is palpation tenderness at the place where the tendon passes - the intertubercular groove located along the anterior surface of the humerus at its upper edge.

Tendinitis of the biceps and rotator cuff requires differential diagnosis with another pathology in which pain occurs in the shoulder joint: arthritis, arthrosis, injuries.

Diagnostics

To confirm the defeat of the muscle tendons in the shoulder area, it is necessary to use additional means. As a rule, they include instrumental visualization methods that allow you to see a clear picture of the changes taking place. These include the following:

• Magnetic resonance imaging.
• Joint ultrasound.
• Radiography.

To identify violations in the metabolic processes of the body, a biochemical blood test should be carried out. In addition, consultation with a traumatologist is mandatory.

Treatment

Effective treatment of tendinitis of the shoulder joint helps a complex effect on the pathology. In this process, not only medical manipulations are important, but also a deep understanding by the patient of the essence of the disease. As a rule, various methods of treatment are used:

• Medical therapy.
• Physiotherapy.
• Therapeutic gymnastics.
• Massage.
• Operation.

The choice of one method or another is based on the characteristics of the course of the disease and the properties of the body. Therefore, the therapeutic program is developed individually for each patient. At the same time, special attention is paid to unloading the affected shoulder and creating rest. The factors that provoke the appearance of pain should be eliminated as much as possible, up to wearing a scarf bandage. However, prolonged immobilization of the joint is not recommended.

The treatment of tendinitis is based not only on the effects of certain agents, but also requires the active participation of the patient.

Medical therapy

Without the use of medicines, it is difficult to imagine the treatment of any pathology, including tendonitis. The drugs are used to reduce inflammation, relieve pain and swelling, eliminate muscle tension and improve the function of the shoulder joint. Given the great importance of degenerative processes in the development of the disease, one should also include those drugs that will improve metabolic processes in the tendon itself, contributing to its healing. Thus, the following medications are recommended:

• Anti-inflammatory (, Dicloberl).
• Muscle relaxants (Mydocalm).
• Chondroprotectors (Artra, Don).
• Vascular (Solcoseryl).
• Hormones (Diprospan, Kenalog).
• Local anesthetics (Novocain).

The last two groups of drugs are used exclusively for topical use. They are injected into the area of ​​the affected tendon to eliminate pain. Various anti-inflammatory ointments (Dolobene, Diklak) are used as local therapy.

Medicines should be used as prescribed by the doctor. Self-administration of drugs is strictly prohibited due to the possibility of developing unforeseen reactions.

Physiotherapy

With tendinitis of the shoulder, physical methods of influence are actively used. They have an additional positive effect in combination with medicines. In order for the acute symptoms of the disease to pass more quickly, you can use the following procedures:

• Electro- and phonophoresis of novocaine, lidase.
• Ultraviolet irradiation.
• laser treatment.
• wave therapy.
• Mud and paraffin therapy.
• Magnetotherapy.

The course of treatment may consist of several procedures, but it should be completed completely. This will make it possible to obtain a stable therapeutic effect.

Physiotherapy

In case of damage to the tendons of the shoulder, physiotherapy exercises are required. Without it, it is difficult to ensure the restoration of the function of the joint in the previous volume, since it is the movements that should contribute to the work of the muscular-ligamentous system. The following exercises may be prescribed:

• Throwing a towel over the crossbar, grasp its ends, and pull down with a healthy hand, while lifting the patient.
• Holding a gymnastic stick in front of you, describe a circle with it.
• Putting the palm of the affected hand on the opposite shoulder, raise the elbow up, helping with a healthy hand.
• Squeezing the hands into the lock, raise your hands in front of you.
• Swing the affected arm back and forth and to the sides like a pendulum.

It must be remembered that gymnastics can be performed only during the period of remission, when there are no acute signs of the disease. In addition, it is impossible to overload the joint with intensive exercises - it is necessary to develop the shoulder gradually so as not to cause pain and deterioration.

The effectiveness of therapeutic exercises largely depends on the perseverance of the patient and his desire to get a good result.

Massage

We must not forget about the shoulder massage. It is also performed after the elimination of pain. Thanks to massage techniques, muscle relaxation occurs, the delivery of nutrients to the affected area improves, which contributes to the activation of recovery processes. As a rule, 10-15 sessions are recommended.

Operation

If conservative therapy has not shown the desired effect or a tendon rupture has occurred, then tendonitis has to be treated with surgical methods. They mainly perform arthroscopic operations, which are considered minimally invasive and minimally traumatic. With their help, excision of altered tissues, plastic and fixation of the tendon is carried out. After that, rehabilitation treatment is required, which consists of the above conservative methods.

If tendonitis is suspected in the shoulder area, then it is first necessary to establish which muscle is affected. According to the results diagnostic examination the doctor determines further treatment, in which the patient himself must take an active part.

Orthopedists and traumatologists often encounter a specific lesion, which is defined as tendon tenosynovitis. Pathology is characterized by a long latent course, which reduces the likelihood of timely access to a doctor. The disease causes excessive stiffness of the tendons, swelling, pain. Treatment is complicated if the presence of microcrystals of salts in the tendons is confirmed, and they themselves have undergone defibration.

Causes

The active development of the disease is facilitated by infection of adjacent tissues or the penetration of pathogenic microflora into the structure of the tendons. In 80% of cases, this is due to a puncture or other violation of the integrity of the tendons. The main ways of defeat:

1. Existing infections, especially STIs (in 90% of cases of detected infectious tenosynovitis, the patient suffered from gonorrhea).
2. Physical trauma, after which the introduced acute infection is divided into monomicrobial and polymicrobial. Each of them progresses depending on the nature, extent of damage.
3. Physiological aging process (common cause of knee tenosynovitis).
4. Staphylococcus aureus migrating from the epidermis, with which the patient was previously infected.
5. Biting by animals and subsequent suppuration of the bitten wound.
6. Intravenous use of hard drugs (there is a high probability that tenosynovitis of the tendon of the long head of the biceps will occur).
7. Open damage skin, the surface of which was exposed to fresh or salt water with the presence of mycobacteria.

Any of these ways leads to tenosynovitis. Including situations where the patient has not completed the full course of treatment for rheumatoid or reactive arthritis.

Symptoms

The examination is enough for the doctor to make a preliminary diagnosis. And the doctor confirms it with diagnostic methods, determining the nuances of the pathology.

Tenosynovitis of the tendon of the long head of the biceps brachii is a stenosing disease that manifests itself as a specific pain sensation of a pulling nature. In 9 out of 10 cases, the patient complains that an unpleasant sensation covers the shoulder, spreads along the front surface of the arm (along the biceps muscle). Palpation of the affected area gives a painful sensation: its localization is a groove between the tubercles of the humerus and in the direction below, where the tendon is even better accessible to palpation. Against the background of pain, the patient has difficulty abducting the arm.

Tenosynovitis of the hamstring tendon is manifested by such distinctive features:

• increase in pain after slight physical exertion;
• extensive swelling around knee joint;
• visible hyperemia of the skin.

Symptoms can be supplemented depending on the statute of limitations of the lesion.

Diagnostics

Diagnosis of tendon tenosynovitis is difficult only because of premature prescription. antibiotic therapy, which 60% of doctors carry out even before establishing a final diagnosis. Laboratory research regarding the pathology under consideration is secondary.

Methods for detecting tendon pathology are as follows:

1. Laboratory research. An increase in the content of leukocytes, an increase in ESR are established in the blood, as indicators of an active inflammatory process.
2. X-ray examination. The main purpose of the method is to confirm the presence of tenosynovitis and exclude the concomitant development of osteomyelitis, bursitis, arthritis.
3. Research using ultrasound. The method is informative, has advantages over MRI: low price, technical simplicity. Ultrasound does not involve the use of magnetic field energy. The procedure is safer for health, does not affect devices implanted inside the body (heart pacemakers). Ultrasound helps to study the structures of tendons and ligaments in detail, making it possible to differentiate tenosynovitis, including through the use of color Doppler mapping (CDM).
4. MRI. The method provides an image of the entire joint, including the capsule with the glenohumeral ligaments, articular cartilage on the head of the humerus. The muscles and tendons surrounding the joint, synovial bags are also visualized.

MRI and ultrasound of the shoulder or knee joint are not interchangeable diagnostic methods. The implementation of each of them involves specific goals and objectives.

Treatment

Delay in going to the hospital does not promise a positive prognosis - the disease moves to an even more aggravated stage. Then the patient loses the possibility of even self-service, and there is no need to talk about the implementation of labor activity. One of the options for wasting time is the desire to normalize health by unofficial methods. Traditional medicine does not contain a single recipe that can restore the tendon-ligament apparatus. And patients who take decoctions and apply compresses to the body waste time, increasing the risk of developing disability.

conservative

If, according to the diagnostic results, it is confirmed that the existing disorder is tenosynovitis of the tendon of the long head of the biceps, treatment with conservative methods involves the following appointments:

For implementation hormonal treatment use drugs of the glucocorticoid group - Dexamethasone and Prednisolone.

Injection administration hormonal drugs, especially in chronic processes, does not give a complete cure, increases the rate of collagen degradation, negatively affects the production of new collagen (reduces its synthesis by 3 times).

The doctor expands general appointments with the active use of immunomodulating agents, vitamin therapy.

More

During conservative therapy, it is important not to load the affected joint - for this, immobilization with an orthosis is performed. Recommended local application of ointments: Nise, Dolobene, Ketonal.

Physiotherapy

Physiotherapeutic methods help to normalize blood circulation, stop or minimize pain, improve metabolic processes in the affected area. The procedures that are advisable to prescribe if tenosynovitis of the biceps tendon of the shoulder, popliteal fossa or other department is confirmed include magnetic therapy; laser therapy; thermal applications. The use of electrophoresis with novocaine will improve the abduction of the limb, reduce pain.

Recently, radon baths have been actively used.

After the documented recognition of the safety of radon in the treatment of articular pathologies, interest in this gas is growing. The demand for the element is due to its unique therapeutic capabilities.

Radon is an inert gas that is colorless and odorless. It is 7.5 times heavier than air, has 3 isotopes, the most important of them is 222 Yal with a half-life of 3.82 days.

Before conducting radon baths, the doctor makes sure that the patient has no contraindications to medical technology:

Among them:

1. Fever of unknown origin.
2. Oncological processes (confirmed) - the presence of malignant neoplasms, benign tumors with a tendency to grow.
3. All diseases of the blood.
4. Heart rhythm disturbances (atrial fibrillation, extrasystole).
5. Psycho-emotional disorders (epilepsy, neurosis, schizophrenia).
6. Postponed large-focal or multiple small-focal cerebral infarction.
7. Professional activity associated with a long stay in the field of radioactive or electromagnetic radiation.
8. The period of pregnancy and breastfeeding.
9. Violation of functional activity thyroid gland, high predisposition to its hyperfunction.
10. Condition before surgery.
11. Severe gynecological conditions - fibrocystic mastopathy, uterine fibroids, fibroids, adenomyosis, endometriosis.
12. Men have an adenoma of the prostate.
13. Cholelithiasis.
14. The presence of stones in any of the segments of the urinary system.
15. Confirmed retinal detachment.
16. The presence of defects on the skin, areas of weeping dermatitis, pathologies of fungal origin.
17. Confirmed osteoporosis.

To determine the concentration of radon for the procedure, the doctor is guided by the dominant pain manifestations. They perform dry air baths and traditional water baths. The effect of the procedure is to improve the blood supply to the tissues adjacent to the joint; high probability of long-term pain relief (in 90% of cases).

Anton Epifanov about physiotherapy:

Surgery

Surgical intervention is carried out in extreme cases, when it is not possible to restore the limb by conservative methods. Weigh down surgery the patient's age is over 45 years, the presence of an insulin-dependent diabetes and if the etiology of tenosynovitis is the progression of a polymicrobial infection.

Tendon plasty is a multi-stage, delicate operation. It involves a subsequent long-term recovery and is characterized by a high price.

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The introduction of antibiotics a day before the intervention, active intraoperative antibiotic therapy helps to eliminate the risk of complications in the postoperative period.

Features of anesthesia during surgery for tendon tenosynovitis:

• in choosing an anesthetic aid, the short duration of the intervention, the absence of the need for deep relaxation, the presence of adequate hemostatic measures are important;
• modern medicines provide adequate pain relief without a threat to the life of the patient;
• a common complication after the intervention is a short post-narcotic depression. It provides the possibility of early transfer of the patient from the ICU (intensive care unit) with the activation of the patient;
• the depth of immersion in anesthesia is provided by narcotic analgesics. In clinics with high financial support, the most successful combination for anesthesia for short operations is practiced - Diprivan + narcotic analgesics (in 68% of cases). But the high cost of Diprivan limits its use in clinical practice. Less well-funded hospitals use Ketamine for anesthesia. Its difference from Diprivan is specific: as patients recover from anesthesia, they need sedative therapy (carried out with standard dosages). It is important for a specialist to control the main vital indicators - they must be stable during the entire surgical intervention.
• In 23.3% of cases, barbiturates are used for anesthesia, mainly sodium thiopental in standard dosages. If the depth of anesthesia was sufficient, the "management" of anesthesia causes certain difficulties. Prolonged post-narcotic depression is possible, requiring constant monitoring of the patient.

The prognosis for recovery is favorable (subject to early medical attention). However, the patient should be prepared: full recovery will take 3-4 months.

Conclusion

Tenosynovitis of the tendon can be cured only in a hospital, and therefore - by the methods of official medicine. Relying on alternative options is not safe. The most common cause of the development of pathology is chronic damage. Orthopedists and traumatologists deal with the elimination of the disease. If tenosynovitis is of an infectious origin, a venereologist is involved in drawing up a treatment plan.

Each person has experienced stretching of muscles and ligaments. However, few people know that such a harmless injury can develop into nodular tenosynovitis. Athletes are well aware of the dangers of this disease. Indeed, often damage to the ligaments and muscles is accompanied by stretching of the tendons that are nearby. If the injury is not properly treated, then an inflammatory process with severe pain syndrome may develop - tendon tenosynovitis.

Types and causes of the disease

Doctors divide tenosynovitis into the following types:

1. Stenosing. It is also called tenosynovitis of the large joints. Typically, tendons are affected that are responsible for flexion and extension of the arm at the elbow, leg at the knee, and abduction to the side of the fingers. With a joint injury, a person feels pain if he tries to move his limbs. In advanced cases, scars form on the joints and tendons. Interestingly, stenosing tenosynovitis is most commonly seen in women.
2. Tuberculous. This type of disease is diagnosed in adult patients. If the body is affected by a tubercle bacillus, then the carpal tendons are injured first of all. Often pain is not felt, however, the movement of the hand and fingers is limited, and the arm itself swells in the area below the shoulder.
3. Chronic. Often, inflammatory chronic tenosynovitis leads to rheumatoid arthritis. This disease can only be diagnosed by a specialist by conducting the necessary examinations.

There are many reasons for the occurrence and development of tenosynovitis. First of all, doctors distinguish various injuries. Small bruises are not dangerous, as they heal quickly. But if the injury led to injury, then there is a risk of infection. Infection when it enters the wound causes inflammation. The weakened immune system exacerbates the situation. If the body is not able to fight pathogens on its own, then inflammation only intensifies.

Overwork, heavy physical exertion and advanced age can also become the causes of the development of the disease. Usually a person in his everyday activities involves a certain group of muscles. Overloading those tendons that are in constant tension often leads to the development of tenosynovitis.

At risk are the elderly, as their bones and muscles weaken and can no longer withstand the previous loads. If timely examination and treatment is not carried out, then any negative factor can provoke the development of the disease. V rare cases tenosynovitis is a hereditary disease.

Musculoskeletal tissues are closely related to each other. The defeat of one area provokes pathology in other places. Therefore, diseases such as bursitis or rheumatoid arthritis often become the causes of nodular tenosynovitis. In addition, pathogenic organisms are spread through the blood due to diseases such as herpes, syphilis, tuberculosis, etc.

Symptoms of the disease

The sooner tenosynovitis is diagnosed, the easier it is to treat. However, this disease often does not cause any discomfort in humans. Only over time, he begins to feel a slight pain when moving his limbs. Then reddening of the affected area appears, and when pressing on the sore spot, you can feel the tumor. However, specific symptoms depend on the site of inflammation. There are the following localizations:

Sometimes, with the same disease, pain sensations are of a different nature. Some people complain of constant aching pain, while others experience discomfort only when moving their limbs.

However, in any case, when the first symptoms appear, it is necessary to consult a doctor, since neglected tenosynovitis can lead to disability.

Diagnosis and treatment

For a long time, doctors could not give a description of the disease. This happened only in the middle of the last century. Much is now known about the disease, including the fact that tenosynovitis usually affects middle-aged people, and women suffer from it more often than men.

The disease can be diagnosed in several ways. If a tumor is clearly felt during palpation of the affected area, then this is an occasion to immediately go to the hospital. The doctor also examines the patient and prescribes the type of examination. Usually the patient still gives general analysis blood.

Most often used to diagnose the disease ultrasonography. With its help, it is possible to consider the size of tumors, their number and location. X-rays are prescribed when tenosynovitis has caused bone deformity. MRI makes it possible to examine the type of tumor in the most detailed way. A biopsy is performed in cases where it is necessary to distinguish a tumor caused by tenosynovitis from other neoplasms.

Nodular tenosynovitis is treated with medication. However, the lists of drugs will be long, since there is no universal drug that cures the disease. The doctor prescribes a group of drugs that help relieve inflammation, pain, swelling, swelling and redness. These are painkillers and anti-inflammatory drugs, analgesics, antibiotics, drugs that strengthen the immune system and improve metabolism. The course is selected individually, the duration of admission depends on the complexity of the disease.

Only a doctor can determine the course of nodular tenosynovitis. He conducts special studies, selects the method of therapy, prescribes medicines. Therefore, it is better to refuse treatment with folk remedies without consulting an experienced specialist, otherwise there is a risk of aggravating the situation.

Folk recipes will not help to cope with the injury, but they can be used as a prophylactic.

For a speedy recovery, it is better to combine a course of medication with physiotherapy. Massage, magnetotherapy, electrophoresis and other physiotherapeutic methods will help restore the lost functions of the joints and tendons. Only in advanced cases, surgical intervention is required. During the operation, the affected tendon node is removed to the patient. But even surgery does not protect against recurrence.

Tenosynovitis may reappear after a course of treatment. Therefore, it is important to follow all the recommendations of the doctor during the rehabilitation period.

Treatment of humeroscapular periarthritis - long, but simple

The most common "rheumatic" disease of the shoulder, according to modern research, is humeroscapular periarthritis. It occurs in about 80% of cases associated with diseases of the shoulder joint. The reason lies in the fact that the tendons in the shoulder joint are in constant functional tension, which leads to the development of a degenerative process in it.

• Causes of humeroscapular periarthritis
• Symptoms and stages of the disease
• Treatment with traditional methods
• Exercise for sickness

Treatment of humeroscapular periarthritis is quite simple, but the main condition for effective treatment is timely therapy.

Causes of humeroscapular periarthritis

The occurrence of the disease can be provoked by some factors: age after 40 years (women are especially affected by this disease), hypothermia, prolonged exposure to dampness, as well as the presence of diseases - spondylosis, arthrosis, sciatica, neuropsychiatric disorders, congenital malformations of the upper shoulder girdle.

The main etymological factor is macro and microtraumas that may appear as a result of professional or sports activities. However, often the occurrence of humeroscapular periarthritis does not have any apparent cause.

Symptoms and stages of the disease

In the development of humeroscapular periarthritis, several stages and clinical forms of the disease are observed.

A simple or "simple painful shoulder" is initial form the most common disease. With it, isolated inflammation of the tendons of the infraspinatus and supraspinatus muscles occurs, or much less often - tendinitis of the long head of the biceps muscle. A symptom of this stage of the disease is the occurrence of painful sensations or their intensification with certain hand movements.

In this case, the patient usually cannot raise his hand up or cannot touch his spine from behind. The pain is localized in the anteroposterior part of the shoulder, where the tendons of the short rotators attach to the greater tubercle. However, many other movements may not cause pain in the shoulder. X-ray results usually do not reveal pathological abnormalities.

As a result of the treatment of humeroscapular periarthritis at the initial stage, there may be a recovery within a short period (from several days to a week) or a relapse of the disease with a transition to the chronic stage, but without certain restrictions on movements in the shoulder. Also, with the most unfavorable outcome, the disease can go into the stage of acute humeroscapular periarthritis.

Acute or acute painful shoulder - this stage of the disease can occur independently or be a complication from the first initial stage. With it, inflammation of the tendons and the bag in which they are located occurs, which leads to calcification (degeneration) of the affected tissues. Usually the pain appears suddenly, especially after physical exertion on the joint.

It has a growing intensity, gives to the back surface of the hands and to the neck. Pain intensifies at night. Hand movements are sharply limited, however, hand movements forward are almost free. It is more convenient for the patient to keep the diseased hand in a physiological position, i.e. in a bent state and brought to the body.

Localization of pain is different. Pain can be on the anterolateral side of the shoulder (inflamed tendons that attach to the short rotators), and on the outer region (inflammation in the subdeltoid bag), and on the front surface (inflamed tendon of the long head of the biceps brachii muscle).

At this stage, the disease may be accompanied by elevated body temperature and increased ESR. X-ray results reveal tissue degeneration in the subacromial region of the shoulder, supraspinatus tendons, or subscapularis.

An acute painful shoulder can take days or weeks to heal. Chronic ankylosing or blocked shoulder - most often the result of an acute form of the disease. This stage of the disease is characterized by dull pain, which intensifies during movement of the shoulder. The main symptom is progressive stiffness in the shoulder joint. The patient cannot carry out the lateral abduction of the shoulder, because. when fixing the scapula, the scapular-sternal joint does not function.

The condition of the blocked shoulder does not lead to an increase in body temperature and changes in laboratory research. X-rays may reveal salt deposits (calcifications) in affected tendons.

Palpation determines pain in front of and under the acromion, along the groove of the biceps muscle of the head of the shoulder joint, and also at the point of attachment of the deltoid muscle to the joint.

Treatment with traditional methods

The answer to the question: "How to treat humeroscapular periarthritis?" you can start by saying that the most important thing in the treatment of this disease is persistence and duration. Because during all periarthritis, there is a slow resorption of calcifications and foci of degeneration, while the process of microtraumatization of the tendons continues.

The main methods of treatment of periarthritis include:

• unloading of the affected tendons;
• the use of anti-inflammatory and analgesic drugs;
• physical and balneological methods;
• less often - surgical intervention.

The creation of rest of the affected limb is created by immobilizing the diseased tendon. For example, in a mild case, this is done with a support bandage, a simple wooden or wire splint, which limits the mobility of the diseased limb. In the first stage of the disease, recovery may occur after several days of immobilization. In a more severe case, a removable plaster splint is used.

Only after the pain is relieved, cautious movements gradually begin to perform: first more active, then passive. At the same time, the use of analgesics is used - acetylsalicylic acid, analgin, brufen, indocide, butadiene, reopirine, etc. in the usual doses of use.

Pain sensations of increased intensity are relieved by infiltration of the affected tendon with a combination of novocaine and hydrocortisone. It is injected into the subdeltoid or subacromile region with a dose of 50-100 mg.

The injection is repeated after five to ten days until the pain decreases. sharp pain can also be removed by the introduction of corticosteroids inside. For example, triamcinolone or prednisolone 3 tablets per day, gradually reducing the dose to ¼ table. in 5 days.

However, it should be remembered that glucocorticosteroids, while quickly reducing pain and exudative phenomena in the affected tissues, are not able to prevent the development of joint stiffness and therefore their use is advisable only as part of complex treatment humeroscapular periarthritis.

Comprehensive treatment of the disease also involves the use of physical methods. Ultrasound, sinusoidal currents and hydrocortisone phonophoresis improve blood circulation and provide good pain relief. Also, in the case of persistent pain syndrome, doctors recommend the use of X-ray therapy, and in case of chronic protracted development of the disease, general hydrogen sulfide or radon baths.

With humeroscapular periarthritis, the massage procedure is contraindicated. but the best remedy to prevent blockade of the shoulder during chronic humeroscapular periarthritis, therapeutic exercises are performed, which should be performed systematically for several months.

Only in case of ineffectiveness of traditional methods of conservative treatment, surgical intervention is used.

Treatment of the disease with folk remedies

Competent treatment with folk remedies for humeroscapular periarthritis can produce a positive effect. For example, the widely used method of hirudotherapy (treatment with leeches) is able to improve microcirculation in tissues and contribute to a speedy recovery of the patient.

Also, in the treatment of humeroscapular periarthritis, various decoctions and infusions of herbs are used, which have an anti-inflammatory effect. They are used either orally or as a compress on the affected area.

1. 1 st. a spoonful of chopped St. John's wort is poured with a glass of boiling water. The decoction is infused for half an hour. Take it for 1 tbsp. spoon 4 p. in a day.
2. Dried nettles are poured with boiling water and kept in a water bath for 15 minutes. Take 1 tbsp. spoon 3-4 p. in a day.
3. 5 gr. crushed blackcurrant berries are poured with a glass of boiling water and insisted for twenty minutes. Take half a cup 3 r. in a day.
4. Horseradish is ground on a grater, heated, wrapped in cheesecloth and applied warm as a compress to the affected area.
5. 50 gr. calendula flowers are diluted with half a liter of vodka and infused for 15 days. Then used as rubbing in the humeroscapular region of the affected joint.
6. Mint leaves, birch buds, dandelion root and coriander are taken in equal amounts and poured with boiling water. After insisting, they are used for rubbing 3 r. in a day.

listed above folk methods contribute to the removal of pain and inflammation.

Exercise for sickness

Active exercises will help to achieve a quick full recovery of joint function. There are a lot of them, so the choice depends on the recommendations of the doctor and the patient's own capabilities.

1. I.P. (starting position) - Hands on the waist. We make circular movements with the shoulder.
2. I.P. - Hands on the waist. We make shoulder movements forward and backward.
3. I.P. - A sick hand on a healthy shoulder. With a healthy hand, gently pull the other elbow up with a smooth movement.
4. I.P. - Hands clasped behind the back. With a careful movement, we pull the sore hand to the buttocks.

Regular exercise helps to prevent the transition of the disease to the chronic stage. The prognosis for humeroscapular periarthritis is favorable. In the course of treatment, foci of degeneration and calcifications gradually resolve, pain disappears and mobility of the limbs is restored. The basic rule of effective treatment is: in order to prevent serious complications, treatment should be started at the time of the first symptoms.

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Tendinitis of the long head of the biceps

Tendonitis is an inflammation of a tendon that initially occurs in the tendon sheath or tendon sac. In this case, it is an inflammatory process in that part of the tendon that connects the upper part of the biceps muscle to the shoulder. Most often, the disease appears after too much load, when performing a certain type of work or when playing sports.

Clinical features of the disease

There are also cases when tendinitis develops not due to excessive loads, but as a result of muscle wear and injury. With tendonitis in the localization of the long head of the biceps, pain is noted in the upper anterior part of the shoulder girdle.

In order for the tissue layer of the biceps tendon to regenerate, it takes a lot of time. For example, if a person’s professional duties are associated with performing intense and the same exercises with his hands raised above head level, or if he is an athlete (tennis player, basketball player), the tendon part is subjected to regular excessive stress, and normal regeneration is simply not carried out in time. .

When the tendon wears out, its tissue degenerative changes begin, collagen fibers become tangled and very often torn. It becomes apparent that during this process, the tendon loses its strength and becomes inflamed, which can lead to rupture.

Quite often, tendonitis of the long head of the biceps develops after a direct injury. For example, if a person falls on the shoulder, this will lead to the onset of the disease, and the transverse ligament of the shoulder may rupture.

Features of tendinitis

Thanks to this ligament, the formation of connective tissue is located in the bicipital recess, which is located next to the tip of the humerus. When it breaks, the bicep is not held in place and quietly slips out, subsequently it is irritated and inflamed.

The disease can occur if the rotator cuff ruptures, impingement or instability of the shoulder occurs. If the cuff breaks, this will allow the humerus to move freely and act on the connective formation, which, naturally, will lead to its weakened state.

The appearance of the disease is also facilitated by the instability of the shoulder, which occurs when the head of the humerus is excessively mobile inside the socket.

The most important symptom of tendinitis of the long head of the biceps is pain, which is dull in nature. Often, the pain syndrome is localized in the front of the shoulder, but sometimes it goes even lower, to the area where the biceps muscle is located.

Pain is one of the main principles of the disease

Pain increases during movement of the limb, especially if it is raised up. When the limb is at rest, the pain subsides. There is also weakness when turning the forearm and bending the elbow joint.

First, the doctor questions and examines the patient. The patient must give accurate answers about the nature of his work, about possible injuries, if he is an athlete, then about the intensity of training.

During the examination, the doctor pays special attention to how the patient performs certain movements, perhaps they are difficult as a result of muscle weakness and pain. A number of special tests are then performed to determine whether there is damage to the rotator cuff or instability of the shoulder.

If an X-ray examination is not enough to select the most appropriate treatment, then the doctor may refer the patient to an MRI.

Shoulder MRI result

This study can give much more information about the damaged biceps tendon, it makes it possible to see if there is an inflammatory process, if the labrum is damaged, if there are ruptures of the rotator cuff.

In order to determine the presence of other problems with the shoulder joint, the doctor prescribes a diagnostic arthroscopy.

Treatment of this disease can be of two types: conservative and surgical.

The conservative method consists in the complete unloading of the biceps tendons, that is, the patient should exclude the slightest load on this area and provide the tendon with rest. NSAIDs are used to reduce pain and inflammation. Steroid injections are given very carefully because they often further weaken the tendon.

Without fail, the patient should undergo a course of physiotherapy and exercise therapy. Physiotherapy treatment helps to reduce the inflammatory process as soon as possible, and exercise therapy helps to restore muscle mass.

Physiotherapy

If the patient works in a field where there is a risk of shoulder instability and rotator cuff rupture, then he will be advised to change jobs. This will reduce pain and inflammation, and give a person the opportunity to live a full life.

If conservative treatment did not bring any results and the person still suffers from pain, then it is recommended to him surgical treatment. It is also resorted to in case of detection of other problems in the shoulder area. The most common surgical treatment is acromioplasty. During the operation, which surgeons perform using arthroscopy, the anterior lobe of the acromion is removed.

This makes it possible to expand the distance between the acromion and the adjacent head of the humerus, thus reducing pressure on the tendon itself and nearby tissue.

If the patient has severe degenerative changes in the tendon, then biceps tenodesis is performed. This method consists of reattaching the upper lobe of the biceps tendon to a new location. Such surgery gives a good result, but, unfortunately, it is not durable.

After the operation, rehabilitation lasts about six to eight weeks. A positive outcome will largely depend on the patient himself, that is, on his attitude towards a good end result. Doctors do not recommend stale, shortly after the operation, you need to start physiotherapy exercises.

Exercise therapy for tendinitis

The exercise therapy doctor will select a set of exercises and control the process of strengthening the muscles of the shoulder and forearm. Usually a positive trend is observed after two to four weeks.

If the patient conscientiously follows all the recommendations of the attending physician, then the complete recovery of the shoulder and forearm will take three to four months.

In order to avoid tendonitis of the long head of the biceps, you must adhere to the following recommendations. Firstly, before training, do warm-up and warm-up exercises, try not to do the same movements for a long time. Secondly, do not allow physical overload and avoid injury. Change the load regularly, the intensity of the load should increase gradually, and do not forget to take timely rest.

Muscles and tendons are the most important part of the musculoskeletal system, together they provide joint movement. Disruption of the tendon leads to the loss of normal motor function in the affected area, the patient cannot move the shoulder and experiences severe pain.

Biceps tendinitis is an inflammatory disease of the tendon where it attaches to the biceps. Pathology occurs most often in people who perform hard work and in athletes, and requires mandatory treatment under the supervision of a competent specialist.

Biceps tendonitis is accompanied by the following symptoms:

pain occurs in the shoulder, which increases over time, the pain also increases with physical exertion; during movement, cracking of the tendon may appear; sometimes swelling and redness occur in the area of ​​​​inflammation; motor activity of the affected shoulder is disturbed due to pain; with purulent tendinitis, the general body temperature, weakness, nausea and other symptoms of intoxication occur.

The severity of tendonitis symptoms depends on the stage of the disease. Since the pathology develops gradually, there are 3 degrees of pathology:

At the very beginning of the disease, the pain is weak, discomfort occurs only with a sharp movement of the hand and quickly passes. In the second stage, the pain is more pronounced, it occurs during physical exertion and does not go away for a long time. At the last stage, the symptoms are pronounced, pain attacks disturb even at rest .

It is best to start treatment on early stage tendinitis, so even with mild shoulder pain that appears regularly, you should definitely visit a specialist.

Tendinitis is an inflammatory disease that affects the main or long head of the biceps muscle. The disease begins with inflammation of the tendon sheath and tendon bag, and gradually passes to the muscle.

According to the World Organization for the Control of Joint Diseases, 80% of people in the world have joint problems. The worst thing is that joint diseases lead to paralysis and disability. To date, there is one effective remedy, which is different from all previously existing means.

Interestingly, biceps tendonitis is a disease that affects not only people. Pathology is often observed in horses and cattle, tendinitis of the biceps in dogs is also a common occurrence.

Tendonitis of the head of the biceps is associated with increased physical exertion on the shoulder, sharp monotonous movements, in which microtraumas of the tendon occur. Most often, pathology occurs in professional athletes, such as tennis players, swimmers, since during training they perform active shoulder movements.

If the athlete follows the rules of training and gives the shoulder a rest, then the tendon will have time to recover normally, and inflammation will not occur. Otherwise, degenerative disorders and an inflammatory process will occur in the tendon, this condition can lead to its rupture if a person neglects treatment and continues to load the shoulder.

Tendonitis of the biceps of the shoulder can occur not only with great physical exertion, but also with a shoulder injury. In this case, there is a rupture of the transverse ligament, which fixes the tendon. As a result, it is displaced and injured, which leads to the formation of an inflammatory process.

To assign effective treatment tendinitis, you must first correctly diagnose, for this you must definitely consult a doctor. The specialist will take an anamnesis, conduct an external examination and send for an ultrasound. Based on the results of the examination, the correct diagnosis will be established and the doctor will prescribe an effective therapy.

Treatment of tendonitis of the long head of the biceps begins with immobilization of the shoulder. The patient is forbidden to load the affected joint, so as not to injure the tendon even more. Depending on the stage of the pathology, wearing a fixing bandage, orthosis, or even a plaster cast may be indicated.

To relieve pain and inflammation, the patient is prescribed to take non-steroidal anti-inflammatory drugs, and use external agents. A course of physiotherapy, for example, magnetotherapy, electrophoresis with lidase, and other procedures prescribed by a doctor, depending on the stage of the disease, will also help speed up recovery.

After removing the inflammation, physiotherapy exercises and massage are prescribed for tendinitis of the biceps and triceps, these procedures help restore blood circulation in the affected area, and normalize the motor activity of the joint. Massage and exercise therapy are especially effective if the patient has chronic biceps tendinitis.

Treatment of tendonitis of the biceps of the shoulder is not always carried out conservatively; in severe cases, surgical intervention may also be indicated. For purulent tendinitis, the doctor surgical method cleans the tendon from pus. Also, the operation is performed when the tendon is ruptured, in which case the surgeon restores it.

Biceps tendonitis must be treated under the supervision of a specialist, otherwise it can become chronic. In complex therapy, it is allowed to use prescriptions traditional medicine, but it is recommended to consult a doctor before using the remedy.

With tendonitis, the following folk recipes are used:

Compresses from decoctions of herbs are used to relieve inflammation and pain. With tendinitis, comfrey, chamomile, arnica, sage help well. In the acute stage of the disease, it is recommended to do a cold compress to stop the inflammatory process. During the treatment period, it is recommended to eat turmeric, it has an anti-inflammatory effect in tendonitis. Salt compresses also help well. To prepare such a product, it is best to use sea salt, it is dissolved in hot water and moisten gauze folded 3 times with a solution. Wet dressing should be placed in a plastic bag and put in the refrigerator for 20 minutes. Remove the cold gauze from the bag, attach to the shoulder and secure with a bandage on top, hold until completely dry.

The movement and stability of the shoulder joint is possible thanks to the muscles and tendons:

• they provide a true and full range of motion (full range is possible with the participation of the scapula);
• muscles and tendons of the rotator cuff hold the head of the humerus in the articular cavity and maintain the necessary clearances between the surface of the head and cavity, as well as between the superior tubercle of the joint and the acromion of the scapula.

Tendons are soft tissues and are also susceptible to inflammatory diseases. If such a process is observed in the shoulder, then tendonitis of the shoulder joint is diagnosed.

Tendinitis refers to periarticular diseases and can be combined with other similar pathologies:

• enthesitis - inflammation of the tendon at the site of its attachment to the bone;
• tenosynovitis - simultaneous inflammation of both tendons and bags;
• bursitis - inflammation of the joint cavities and bags surrounding the tendons.

Bursitis or synovitis usually precedes tendinitis.

The following types of shoulder tendon pathologies are diagnosed:

• rotator cuff tendonitis:
  • supraspinatus, infraspinatus, round and subscapularis;
• biceps tendonitis (biceps tendonitis);
• calcific tendinitis;
• partial or complete rupture of tendons.

Causes of tendinitis

The development of tendinitis may be preceded by:

1. Chronic increased sports or professional loads: tennis players, volleyball players, baseball players, weightlifters, gymnasts, acrobats, etc.; builders, drivers, loaders, etc.
2. Permanent microtrauma.
3. Reactive, infectious, allergic,.
4. Degenerative changes in bone structures (osteoarthritis).
5. Cervical osteochondrosis.
6. Prolonged immobilization of the shoulder after injury or surgery.
7. Congenital dysplasia of the shoulder joint and other causes.

Shoulder Tendinitis Symptoms

A healthy shoulder joint, thanks to the hinge type, provides a full range of motion in flexion, extension, abduction, adduction and rotation (rotation). The limited angle of movement and the resulting pain indicate inflammation of the tendons, bursa and capsule, as well as damage to the joint itself or its plexus.

How to distinguish inflammation of different tendons

• Symptoms of tendinitis of the supraspinatus tendon and subacromial bursa:
  • When the shoulder is abducted to an angle exceeding the range of 70 - 90 °, painful sensations appear due to the pressing of the shoulder tubercle of the tendon of the supraspinatus muscle to the acromion of the scapula and compression of the subacromial bag.
  • A further increase in the angle of elevation leads to the unlocking of the clutch of the head of the shoulder with the acromion (at this moment a click can be heard), after which the pain disappears.
• Symptoms of tendonitis of the tendons of the infraspinatus and round muscle:
  • Pain during rotational external movements (when trying to get something from the top shelf or comb).
• Symptoms of inflammation of the tendon of the subscapularis muscle:
  • Pain with internal rotation (hand abduction behind the back).
• Biceps tendonitis:
  • Painful sensations at the moment of bending the arm in the elbow joint, associated either with lifting weights or with supination (turning outward) of the forearm, for example, when closing the door with a key.

Calcific tendonitis

Tendon calcification can occur:

• in the advanced stage of arthrosis, when the destruction goes beyond the cartilage;
• in places of microtrauma and damage.

Inflammation begins around the calcium depots in the tendon tissues. Due to the fact that it is impossible to remove calcifications, it is already difficult to cope with such tendinitis, and it becomes chronic.

How to distinguish tendinitis from other pathologies

• Symptoms of damage to the acromioclavicular joint:
  • Abduction of the shoulder to the maximum possible angle of 180° is accompanied by pain.
• Anterior subluxation of the head of the shoulder:
  • Severe pain in the shoulder and a sharp limitation of movement, coupled with a changed contour of the shoulder with a head shifted forward and downward.
• Retractile capsulitis:
  • All movements are limited (both passive and active).
  • There is no inflammatory or degenerative inflammation in the joint itself, but there are signs of capsular fibrosis and regional osteoporosis.
• Thoracic outlet syndrome, plexitis:
  • Pain is not associated with movements, unlike tendonitis, and is caused by:
    • compression of the neurovascular bundle emerging between the clavicle and the first rib;
    • inflammation of the brachial plexus.

Separately, it is worth talking about subacromial syndrome, since it refers to stability disorders in the shoulder joint and can create grounds for tendon deformities and even rupture.

subacromial syndrome

The imbalance of the muscles and tendons of the rotator cuff leads to a decrease in the distance between the acromial process and the head of the shoulder joint. When the shoulder moves, the tendons of the supraspinatus, infraspinatus, subscapularis and round muscles are constantly injured. This is the subacromial syndrome.

There are three degrees of subacromial syndrome in the tendons:

• Inflammation, swelling and hemorrhage.
• Fibrotic changes, thickening, partial tears.
• Complete tears plus degenerative changes in the bones of the joint involving the acromion of the scapula and tubercle of the humerus.

Diagnostics

• Primary diagnosis is made on the basis of a test assessment of pain during movement and palpation.
• Confirmation of the diagnosis can be given by radiography, but it mainly reveals calcium deposits.
• A more accurate examination (MRI, CT) allows you to identify degenerative inflammatory processes in the tendons, as well as microtrauma.

Treatment of inflammatory diseases of the tendons

• At first, restriction of movements is introduced for two to three weeks.
• To relieve pain and inflammation, NSAIDs are prescribed orally:
  • nimesil, ketorol, nurofen.
• Local treatment is also used in the form of ointments and gels - containing NSAIDs and irritating effects:
  • nise, capsaicin.
• With severe pain, glucocorticoid injections are made into the periarticular tissues of the shoulder (the exception is biceps tendonitis).
• Effective methods of physiotherapy:
  • electro- and phonophoresis;
  • magnetotherapy;
  • balneotherapy;
  • cryotherapy;
  • shock wave therapy (SWT) - this method is especially effective for calcifying tendonitis.

Therapeutic exercise and prevention

Exercise therapy is the main treatment for tendinitis. Active movements (rotation of the shoulders, raising the arms above the head, swinging, spreading the arms to the sides) should be used when the pain subsides.

During the period when movements still cause pain, you need to use the following exercises:

• Postisometric relaxation: a combination of tension in the sore shoulder joint followed by relaxation without movement.
• Passive exercises with a sore shoulder using a healthy arm.
• Pulling up a sore arm with the help of improvised means (a rope or a cord thrown over a pipe or a crossbar at the top).
• Abduction of the diseased arm to the side with support on the gymnastic stick.
• Pendulum movements with a sick hand in a relaxed state.

Tendinitis of the shoulder joint will not develop:

1. If you dose the loads, limiting their intensity and duration.
2. Emergency methods are unacceptable with a weak general fitness: they didn’t do anything for a whole year, and then they suddenly wanted to dig up a plot in the country in a day; independently decided to plaster the walls and ceilings, etc.
3. Before any active load, whether it be sports or work, a light warm-up workout is necessary.
4. Make sure to take breaks for rest during prolonged exertion.

Video: Treatment of shoulder tendinitis.