SHOULDER PAIN

What is Shoulder Pain?

There is a joint cover that we call capsule surrounding the shoulder joint. If there is a situation that causes adhesion in the capsule, frozen shoulder disease is encountered.

There are ligaments connecting the joint, which we call ligament , on the capsule. Excessive strain or looseness in these will cause half or full shoulder dislocations in the shoulder joint.

On these ligaments are muscle beams . These tendons are responsible for the movement of the shoulder. There are four important rotator tendons in the shoulder called the rototor cuff. Tearing them can also cause pain.

There is one of the biggest sacs (bursa) of the body called subacromial, which allows the joint to move more easily. This may also cause rheumatic inflammation.

Finally, on top of all this is the deltoid muscle, one of the strongest muscles to shape the shoulder.

Causes such as injury, strain, tearing and trauma in one or more of these structures will cause shoulder pain as well as other complaints.

The area between the humerus, which is the upper arm bone, the scapula, which is the scapula, and the clavicle, which is called the collarbone, is the area where the shoulder joint is located. The shoulder joint is a very mobile joint that can move in four directions.

Although shoulder pain is caused by the shoulder joint, there may also be pain reflected on the shoulder from other regions. The most common example of this is neck hernia.

Shoulder pain can be caused by abnormal reasons that may occur in one or more of all the components described above.

What Causes Shoulder Pain?

The most common causes of shoulder pain are those caused by their own anatomical structure. The most common causes are compression of the shoulder tendons, frozen shoulder, calcific tendinitis caused by calcium accumulation in the tendons, shoulder laxity or shoulder dislocations, and strain of the muscles around the shoulder called myofascial pain. Another important reason is shoulder pain caused by strokes.

Less common causes are usually off the shoulder. Inflammatory rheumatism, upper lung cancers, liver, gall bladder, spleen problems and neck hernias are the most common in this group.

• Shoulder blows, traumas
• Collarbone fracture
• Bursitis, fibrositis, myositis, tendinitis
• Shoulder fractures and dislocations
• Lying on your side and in the wrong position constantly
• Spine injuries
• Activities such as lifting heavy loads, wiping windows
• Impingement syndrome
• Shoulder pain can also be seen in cases such as cardiovascular diseases, chronic lung disease, diabetes, and neck diseases.
• Stroke (half paralysis)

What Are The Symptoms Seen With Shoulder Pain?

Although the complaint is usually pain, they may present with symptoms such as sensitivity in the shoulder, increased warmth, redness, decrease in shoulder movements, epaulette finding in shoulder dislocations, stiffness or mass in the shoulder.

How Should Shoulder Pain Be Diagnosed?

The diagnosis will usually be made by the history to be taken from the patient and especially by a good shoulder examination. Most of the shoulder pain is caused by soft tissue. Since calcifications are seen in older ages, they may not be seen in normal plain films. Tomogrophy is rarely required. The best method to evaluate the shoulder is the MR technique. It shows bone and soft tissues extremely well. EMG may be required in patients with suspected nerve injury.

How Should Shoulder Pain Be Treated?

Shoulder pain, which often occurs after muscle strain and wrong movements, heals spontaneously in a short time. Emergency intervention may be required in shoulder injuries due to trauma.

The causes of shoulder pain are varied. It is observed in a wide range from tumors to traumas. For this reason, first of all, tumors and infections should be considered and should be distinguished in cases of fever, shoulder pain at night, weight loss, shoulder pain that does not change with arm movements and does not respond to painkillers. After other reasons are ruled out, treatment should be planned by focusing on the main cause. Physical therapy is used in most of the pathologies that cause shoulder pain.

Ice application is extremely beneficial in acute pain. The shoulder should be rested as much as possible, used sparingly and anti-inflammatory drugs should be used. Very good results are obtained with ice treatment to be applied for 15 minutes, 3-5 times a day.

A shoulder sling should be used in patients with severe pain that cannot carry their arm or people who have been traumatized. Suspension time should be kept as short as possible.

Treatment approach is different in chronic pain. At this stage, physical therapy methods have an important place. ESWT can be useful in combination with exercise practices to increase range of motion and muscle strength.

NEURAL THERAPY

What is Neural Therapy?

Neural therapy is a treatment method that emerged about a century ago as a result of two German physicians, named Huneke, who started to use a method that was previously applied but was almost forgotten, and observed some coincidences well.

Neural therapy is a treatment method designed to use our autonomic nervous system with low dose local anesthetic injection. The electrical potential of healthy cells decreases with infections, trauma and surgical incision. If severe, intense and continuous stimuli continue, cells cannot recover. Unless the person has an anatomical and genetic disorder, deficiency, and advanced degeneration, the injection applied to the skin with neural therapy can reverse and treat the formation processes of some diseases.

Neural therapy is a field of application that regulates OSS (autonomic nervous system) and neutralizes negative stimuli in disruptive areas.

How Does Neural Therapy Work?

The neurovegetative system, which we call the autonomic nervous system, is a part of our nervous system that covers the whole body and has effects at the cellular level. Bioelectrical damage in OSS underlies our diseases and persistent pain. Infections, surgeries, accidents, physical and psychological traumas that we have experienced throughout our lives cause the formation of bioelectrically problematic areas in our body. These problem areas are called “interference fields”. Bioelectrical damages in these regions can be permanent for life. This electrical communication disorder can be corrected by the injection to be applied to the skin part of these regions, also called interference areas.

“Interference field” is the deterioration of the basic bioelectrical structure of the cells. In a healthy cell, there is an electrical difference inside and outside the cell, with the effect of electrolytes in our body. This difference, which is approximately -40 / -90 millivolts, is called the membrane electrical potential.

Negative warnings from the diseased area spread to the whole body. Some of these are repaired by the body, but some cannot be repaired. Life-long external factors (infections, trauma, operations-like interventions to the body) have the potential to create disruptive areas. Stimuli originating from these areas (primary focus), which are the source of the problem, may affect the message network of the OSS and form a focus in another region (secondary affected area). Today’s medicine tries to treat this secondary focus. For this reason, there are problems in treatment.

The potential of past infection foci, traumas, operations and all dental treatments that are not performed well to create disruptive areas is high. Especially the head and neck area is dense in terms of disturbing areas.

The electrical potential of the cell is increased with repeated injections of local anesthetic in neural therapy. Procaine and lidocaine, the short-acting anesthetic agents used, contain a potential of about -290 millivolts. With the application, the cell almost hyperpolarizes. Each injection made will leave some electrical potential in the cell until the cell reaches its normal potential of -40 / -90 millivolts. Upon reaching these levels, the diseased cell will turn into a healthy cell. Thus, the electrical potential of the cells in the interference field will have increased to the required levels. Cell membrane stabilization will be provided and the negative effects of disruptive areas on OSS will be eliminated.

OSS has a wide network structure extending to the intercellular fluid. This fluid is also called matrix. There are metabolic, biochemical, biophysical processes in the matrix, and intercellular and intracellular substance exchanges take place.

How Is Neural Therapy Applied?

Neural therapy may be perceived as an injection therapy, but the purpose is not to infuse drugs. The most important therapeutic feature here is that the physician finds the source of the disease with the interference field approach.

In neural therapy, local anesthetic is administered by injection. Application areas are subcutaneous, muscle tissue, surgery and scars on the body, intra-articular and painful points. Injection into the nerve is not applied.

The most important issue in neural therapy is the determination of the area where the local anesthetic will be applied by needle. This area detection is the most important feature that distinguishes neural therapy from other standard local anesthetic injection applications and similar treatments.

Neural therapy treatment is applied in sessions, and it is recommended that at least three days pass between two sessions. It is recommended to use local anesthetics and lidocaine and procaine in neural therapy. It is recommended to use reduced doses (such as 0.5% – 1%) of drugs due to the danger of high doses and possible side effects.

In Which Diseases Is Neural Therapy Applied?

The main domain of neural therapy is the treatment of orthopedic and muscular nerve diseases.

• All headaches, regional musculoskeletal pain, chronic pelvic pain
• Fibromyalgia, tendonitis, sports injuries
• Carpal tunnel syndrome, chronic inflammation and inflammations
• Spinal arthritis pains
• Chronic elbow, shoulder, knee, waist, back and neck pains, waist and cervical disc hernias
• Facial paralysis, neuropathic pains, nerve injuries

Since the factors that cause pain in patients are eliminated in neural therapy, time is given to the body to renew and repair itself. During this repair period, there will be returns, body functions will improve and complaints will return to normal.

In Which Circumstances Neural Therapy Is Not Applicable?

• Second and third degree atrioventricular blocks, bradycardia
• Patients with an acute surgical indication
• Decompensated heart failure
• Myasthenia gravis.
• Those using anticoagulant drugs
• Malignancies and sepsis

Are There Any Side Effects of Neural Therapy?

1. Neural therapy is not a drug-applied treatment method.
2. It is benefited from the stimulation created by the short-acting local anesthetic substances in the autonomic nervous system.
3. As soon as the needle is inserted into the skin, this stimulus spreads in the neural network and the old nerve damage is corrected bioelectrically.
4. In most other needle treatments, drugs are given to the tissue, while neural therapy is applied to the skin.
5. In neural therapy, only procaine and lidocaine substances are used as drugs. Here, these drugs are preferred not because of their local anesthetic properties, but because of their bioelectrical effects.
6. No side effects have been encountered in this treatment method, which has been used frequently in the west for more than eighty years.

NECK PAIN

Our neck is the part of the spine that provides the connection between the head and the body and at the same time plays an important role in maintaining our balance by bearing the weight of the head. The neck is the most load-bearing and mobile part of the spine. For this reason, it is one of the sections that are most exposed to trauma.

What is Neck Pain?

Although neck pain is less common than low back pain, it is a health problem encountered in one third of the general population. There are seven vertebrae and five discs in the cervical spine. The fact that the neck carries the weight of the head, being very mobile, carrying excessive load and being in an area open to trauma make it more susceptible to external factors.

Neck pain is a very common health problem that is seen equally in both genders. It is frequently encountered in posture disorders, especially in desk workers and those who use computers intensively. Neck pain increases with the advancement of age. It is more common especially in 40-60 age groups. Tensions in daily life and work stress can also be counted among other factors that can cause neck pain.

What Causes Neck Pain? .

Degenerations in the cervical spine that increase with age, muscle strains (such as excessive use of computers and mobile phones, reading books in bad positions, clenching teeth) can cause muscle spasm and cause neck pain. Joint and cartilage erosion, nerve compression, and general injuries that occur with age can also be considered among other causes of neck pain.

Inflammation and tissue damage may occur as a result of chronic trauma, degeneration and calcification in the cervical spine and surrounding tissues. They can cause neck pain due to spasms and strains in the neck muscle tissues. The regions that can cause the most common neck pain in the cervical spine are usually between C4-C6 (cervical 4th and 6th).

In the type of injury known as Whiplash Syndrome and usually seen after car accidents, the casualty also experiences a mild neck pain at the beginning. However, after a few hours, the pain intensifies and this is accompanied by neck stiffness. This discomfort reaches its highest levels in a few days and resolves spontaneously in about a month.

The most common causes of neck pain are those of the mechanical type at a rate of approximately 95%. The exact cause of neck pain cannot usually be found. In patients;

1. Depending on the bone structure; congenital torticollis, traumas, fractures, slips, calcifications, narrow canal,
2. Rheumatic diseases; ankylosing spondylitis (AS) and rheumatoid arthritis (RA) etc.
3. Tumors, infections
4. Due to soft tissue; posture disorders, fibromiagia etc.
5. Many diseases such as nervous and vascular problems are among the causes.

What Kinds of Symptoms Are Experienced in Neck Pain?

The most common symptom in patients is neck pain that increases with physical activity and relieves with resting and hot compresses. Although the pain is usually blunt, knife-like pain may also occur. Morning stiffness is rare, although it is short-lived.

Pain can spread to the shoulder, back area. It can spread to the back of the head, shoulder circumference, arm and forearm. The pain may be accompanied by dizziness, instability, and numbness in the hands. Over time, problems such as gripping and lifting objects may also arise in patients.

How Should Neck Pain Be Treated?

Although patients benefit greatly from physical therapy, precautions to correct posture disorders must be explained before treatment. In the acute period;

• 1-2 days of short rest
• Pain relievers and muscle relaxants.
• Various physical therapy applications such as tens (transcutaneous electric nerve stimulation), heat application, interference, ultrasound, laser, hil therapy, traction, massage and taping
• Trigger point injections, neural therapy
• Manipulation applications can be made.

Immobilization (fixation) can be applied in the acute period with a soft collar. Neck collar application times should be kept short, it should be applied as short as 1-1.5 hours a day and should not exceed one and a half months as a treatment.