Chronic shoulder joint pain: Principles of diagnosis and treatment

Chronic shoulder pain (CSP) is an urgent problem, mainly due to the high prevalence of this pathology among the population. Until recently, there were no unified approaches to the management of patients with CSP. Currently, such recommendations have been developed by a group of experts, which includes doctors of various specialties. Based on these recommendations, the article presents approaches to diagnosing the causes of CSP, which are quite diverse. The most common causes of pain in the region are syndrome of compression of tendons of muscles rotating the shoulder (SCTMR), calcifying tendinitis (CT), adhesive capsulitis (AС), osteoarthritis of the shoulder joint (OA SJ), osteoarthritis of the acromioclavicular joint (OA ACJ). The article presents the main clinical manifestations of SCTMR, СТ, AС, OA PJ, OA ACJ, describes the necessary laboratory and instrumental research methods necessary to diagnose the specific cause of, as well as to exclude other diseases associated with shoulder pain. Treatment of CSP should be comprehensive and begin only after determining the cause of pain and functional disorders in this area. The first-line drugs are nonsteroidal anti-inflammatory drugs prescribed taking into account the patient’s concomitant diseases. If they are ineffective, local injection therapy (glucocorticosteroids, hyaluronic acid, autologous platelet-rich plasma) should be connected to therapy. In case of OA PJ, OA ACJ, it is advisable to include symptomatic slow-acting antiarthritis drugs in complex therapy. All patients are shown various methods of physiotherapy and rehabilitation. If conservative therapy is ineffective, surgical treatment should be considered.