Shoulder pain is classified according to cause, location, and course:

1. By location:
   • Anterior shoulder pain: Pain in the area of the shoulder head or biceps tendon.
   • Posterior shoulder pain: Discomfort in the area of the shoulder blade.
   • Lateral shoulder pain: Pain on the outside of the shoulder, often due to rotator cuff problems.
2. By cause:
   • Acute shoulder pain: Sudden onset, usually due to injuries or overuse.
   • Chronic shoulder pain: Long-lasting discomfort, often due to degenerative or inflammatory processes.
3. By origin:
   • Muscle and tendon-related: Problems of the rotator cuff or biceps tendon attachment.
   • Joint-related: Osteoarthritis, instability, or shoulder dislocations.
   • Nerve-related: Nerve irritations or compressions, e.g., due to an impingement syndrome.

The causes of shoulder pain are diverse and range from mechanical problems to systemic diseases:

• Injuries:
  • Rotator cuff injuries: Partial or complete tears of the tendons.
  • Shoulder dislocation: Dislocation of the joint due to trauma.
  • Fractures: Bone fractures, e.g., of the humeral head or clavicle.
• Degenerative changes:
  • Shoulder osteoarthritis: Wear and tear of the joint cartilage.
  • Tendon degeneration: Wear or calcification of the tendons.
• Inflammatory diseases:
  • Bursitis: Inflammation of the subacromial bursa.
  • Frozen Shoulder (Capsulitis): Inflammation of the joint capsule with movement restrictions.
• Mechanical overload:
  • Repeated overhead movements or heavy physical work.
• Nerve problems:
  • Compression of the brachial plexus or the suprascapular nerve.
• Systemic diseases:
  • Rheumatoid arthritis, gout, or infections.

The symptoms depend on the underlying cause, but often include:

• Localized pain: Pain in the shoulder area that increases with movement or exertion.
• Radiating pain: Discomfort that radiates into the arm or neck.
• Movement restrictions: Difficulty lifting the arm or performing overhead work.
• Loss of strength: Weakness in the affected arm, especially during rotational movements.
• Grinding or rubbing: Noises in the joint that indicate wear or tendon damage.
• Swelling and redness: Signs of inflammation, especially in bursitis or arthritis.
• Night pain: Pain that makes it difficult to lie on the affected side.

The diagnosis is made through a thorough medical history, clinical examination, and supportive imaging techniques:

- Medical history:

- Collection of the duration of symptoms, possible triggers, and accompanying symptoms.

- Physical examination:

- Tests to check mobility, strength, and pain localization, e.g., the Hawkins test or Neer test.

- Palpation of the shoulder for tenderness or swelling.

- Imaging:

- X-ray: Visualization of bony changes or osteoarthritis.

- MRI: Detailed assessment of soft tissue damage such as rotator cuff tears.

- Ultrasound: Detection of inflammation or fluid accumulation.

- Laboratory tests: To rule out systemic or inflammatory diseases.

Conservative Therapy

Most shoulder pain can be treated without surgical intervention:

• Immobilization: Resting the shoulder with the help of bandages or slings.
• Medication Therapy:
  • NSAIDs: For pain relief and anti-inflammatory effects.
  • Corticosteroid injections for severe inflammation.
• Physiotherapy:
  • Exercises to strengthen muscles and improve mobility.
  • Manual therapy to relieve tendons and muscles.
• Alternative Methods:
  • Acupuncture, shock wave therapy, or heat treatments.
• Pain Management: Application of cold or heat packs.

Surgical Therapy

Surgery is necessary for persistent or severe symptoms:

• Arthroscopy: Minimally invasive procedures to remove inflamed tissue or repair tendon tears.
• Prosthesis Implantation: For advanced osteoarthritis of the shoulder joint.
• Stabilization: Treatment of instabilities or recurrent dislocations.

To prevent shoulder pain and support joint health, the following measures are recommended:

1. Ergonomic movements: Avoid overhead work and incorrect posture.
2. Muscle strengthening: Targeted training of the rotator cuff and shoulder muscles.
3. Regular breaks: Relieve the shoulder during longer activities.
4. Avoid overloading: Limit repetitive movements, especially in sports.
5. Early treatment: At the first signs of discomfort, a doctor should be consulted as soon as possible.