Dor no ombro: Principais causas e cuidados

本站添加: 2026-06-06

[00:00:00]And it was actually the one who operated on me, who operated on my husband. But look, there are people here from Lisbon, there are people here from Assis, and people from Instagram are here too. Hello, good afternoon, Zote. Thank you so much for accepting this invitation, and it 's very important for us to talk about these health issues in relation to our people who suffer from misinformation, right?

[00:00:35]And you're an expert on the subject, right? Today we're going to talk about shoulder pain.

[00:00:42]OK. I'll start by thanking you for the opportunity to talk to you and your countless social media followers. Actually, it 's a new experience for me. I'm a newbie on social media, but I'm very happy to be here with you, answering your questions, and helping you in any way we can regarding your shoulder. Just to give you some statistical data, the orthopedic pain that people most often seek from an orthopedist is back pain.

[00:01:17]Secondly, there's the shoulder, and particularly nowadays, it's linked to physical activity, which is a very good thing, but it's part of our daily routine here. I felt honored, and it was indeed an honor, to have treated you as a friend, and obviously, as a patient. I'm available, OK? Because, people, whatever you want to ask, let's go, let's make the most of our time there.

[00:01:43]You're the expert on this subject, right? And nowadays people are so used to being glued to screens, to their phones, right? He comes to the office complaining a lot about shoulder pain and back pain, and shoulder pain is becoming more and more frequent, right?

[00:01:58]Shoulder pain. And you, the champion of history, tell us what causes the most pain in the shoulder, what is the shoulder, what is the shoulder, right? Sometimes the shoulder is more than just bone, right?

[00:02:13]There are other things, right?

[00:02:15]So, look, the shoulder is the joint with the greatest mobility in the human body.

[00:02:21]So, the shoulder has a joint, it has a range of motion of 360º.

[00:02:27]At the expense of the shoulder, we place our hand at all points in space. So, this mobility, obviously, comes at a price, in terms of injury, in terms of effort, in terms of pain. Actually, I'm going to grab a template here, let me see if you guys can figure it out. Oh, that's a shoulder. The shoulder is the scapula. Can you see the shoulder from the front? The scapula. That's the clavicle. And here the number is articulated. Therefore, all rotational movement is done at the expense of the rotator cuff. The rotator cuff isn't exactly trendy right now, but people are familiar with it today. They know that when the rotator cuff hurts, it tears, it sprains, and in some cases people need surgery.

[00:03:25]What is the rotator cuff? The rotator cuff consists of four tendons that cover the head of the humerus.

[00:03:33]Their number and name are irrelevant here. But basically, every time we perform shoulder elevation and rotation movements, these tendons are working.

[00:03:45]In specific situations, such as physical activity, manual labor, or people who use their arm in a position above 90º, there is a medical term for impingement, where there is an impingement of the rotator cuff against the acromion. So this impact movement here is the cause of old tendinitis, of old mursitis, which today we know as pathology, as rotator cuff injuries. So basically, that's it. The shoulder pays a price, doesn't it? The rotator cuff suffers from compression during elevation and rotation movements. This, broadly speaking, is the cause of shoulder pain.

[00:04:28]So there you have it, it's very important, right?

[00:04:32]Since the shoulder is the most mobile part of the body, that's another reason for us to take care of ourselves, to prevent this disease, because over time, of course, as time goes by, the years go by, and obviously all the joints suffer from this problem of aging.

[00:04:55]So, how can we prevent this shoulder pain?

[00:05:03]So, Roque, look, the best medicine, you know this in your field, this is fundamental, is prevention.

[00:05:10]Well, from the point of view of joint pain, and here I include the shoulder, knee, spine, hand, all the joints, mobility and movement are fundamental.

[00:05:23]In the case of the upper limb, the joints of the upper limb have mobility, but they do not bear weight or load. This is a function of the spine, hip, knee, and ankle. So, what do we have to do? Maintaining flexibility, specifically in the shoulder or all joints, stretching, elasticity, and avoiding muscle contractures is fundamental.

[00:05:51]So, on one hand, we prevent injuries through good, guided physical activity with stretching, and on the other hand, we prevent muscle injury. In the old days, we used to say, "My muscle is weak."

[00:06:05]Today we call this sarcopenia.

[00:06:08]Therefore, all muscular activity, at any point in our lives and at any time, is geared towards building muscle strength. We have balance, we have a sense of where our body is spatially, we know. And strengthening. This strengthening is achieved specifically through exercise and often through everyday activities.

[00:06:32]Look, I always tell my patients, shifting the focus a little bit from the shoulder, that the person has back pain.

[00:06:38]Obviously, only the mailman works on the move. We all work sitting down.

[00:06:43]The person sits there, gets up, it's been 40 minutes, an hour, gets up, goes to the kitchen, drinks a glass of water, leaves the office, goes to the other room. This mobility, this movement, is already sufficient, or at least helps to maintain very good orthopedic and joint health.

[00:07:02]It's because many people, sometimes you see them in the office, you say: "Look, you need to walk, you need to move around."

[00:07:08]But then he says, "But doctor, when I walk, when I move my arm, that's when I teach you what you taught me, right?" Those physical therapy exercises for arm mobility. And I say: "No, but it hurts, of course, if you stay still, if you become sedentary, that's when you get pain, right? Is n't that true? No, look at Rock. And particularly the shoulder, it has a very bad characteristic in terms of pain. Normally, people in the early stages of the degenerative wear and tear process during the day are fine, completely pain-free. And the complaint of nighttime pain is very common. Look, I go to bed, I wake up every day at 2 am, a specific time, with shoulder pain. So, the shoulder has a very particular and very bad characteristic for the patient. Most, a large part of patients have nighttime pain. It bothers them at night. Why does the shoulder bother them at night? During the day, the act of sitting or standing, the muscles take advantage again of our little model. Uh, everything is an impact, it's the beating. During the day, the arm, this space between the scapula, is more open, further away. And at night there is an impact, there is the rotator cuff."

[00:08:36]It hurts, exactly, it hurts, and regardless of whether the person sleeps on their shoulder or not, it hurts. And getting a little into your part, when a person lies down, their cardiac output decreases. And with lower cardiac output, the "cleaning," so to speak, of the rotator cuff joint, the catabolites, the substances that cause pain, they have less chance of being eliminated due to the decreased cardiac output, due to the person's rest.

[00:09:07]And then the person has pain and can't sleep, right? That's the problem.

[00:09:11]They can sleep. Rock, it's a common complaint here in couples.

[00:09:16]Uh, either the man or the woman has shoulder pain and this disturbs the sleep of their partner, right, the other side of the couple.

[00:09:24]So, night pain is a characteristic of the shoulder, uh, and it's part of this biological aging process and part of the inflammatory process.

[00:09:38]And the advice I sometimes give to patients who have night pain, which is bothering them before more specific, definitive treatment, is: Before going to bed, do some stretching. Stretch, stretch that capsule, that joint, which probably... Your sleep quality, your rest will be better, right? The pain, the rotator cuff won't wake you up during the night.

[00:10:05]Yes, but there are situations where there's no way around it, right? There's no way around it. And there are many people who are reluctant to adopt surgical therapy, right? For example, I see it myself, because when I had to have it done, I had a lesion in my spine, in my hip, and surgery was indicated.

[00:10:29]Even our friend Suzuki, Itiroo, and I was reluctant, I said: "Ah, wait a little, wait, wait, wait." But there comes a time when you have the surgery, then you regret having spent so much time suffering. It's the same thing with the shoulder, isn't it? Rock, that's a constant.

[00:10:53]Uh, the patient, what leads, what motivates the patient to any type of treatment, uh, focusing here on the orthopedic side, is pain. Pain, secondly, comes the lack of mobility, whether in the upper or lower limb. And the person only gets surgery, in quotes, they wait, they keep postponing the surgery for a long time. From the orthopedist's point of view, obviously the decision to have surgery is always the patient's. Now, from the point of view of recovery, recovering a hip, a knee, a shoulder that has little muscle atrophy, where the muscles still work, is very different from that of a person who has had shoulder or hip pain for years and opts for surgery after some time.

[00:11:42]Obviously, the pain improves, the surgical pain obviously hurts, after a while the pain goes away, but the recovery, the rehabilitation is slower due to lack of use. The person has muscle atrophy there, muscles that no longer work, in the case of the shoulder they can no longer lift their arm, almost in the case of the hip, the person can no longer walk.

[00:12:04]So all this has to be taken into account in the treatment plan and in the patient's choice to have surgery.

[00:12:13]Here, normally it's the patient who decides when, right? But sometimes there's a very big taboo, right? Ah, I'll put "So, a bionic shoulder here, how's it going to be? Everything else, but the results are good, right? Isn't that right? They're very good. They're very good. Uh, look at the surgery where the shoulder has two lesions. In younger people, in young people, in boys, in girls, then the shoulder comes out of place, shoulder dislocation. This is something common in youth, 15, 20, 25 years old. And there are degenerative lesions where, between the rotator cuff and the arthrosis, normally the rotator cuff is stitched, it's sutured, a stitching surgery is performed. And when there is a lot of wear and tear, whether in the hip, knee, or shoulder, then the option is a prosthesis, an arthroplasty. And the results, [clearing throat] excuse me, are usually good. The results are good in terms of mobility, in terms of pain, in terms of quality of life.

[00:13:18]Today we talk a lot about quality of life, without a doubt, because longevity is increasing, right? People are living longer, but there are..." "Having quality of life is important. And the fact that we live longer means more muscle injuries, joint injuries, it's all part of aging. Now, how do we prevent this? What you just said? Exactly that. I mean, by preventing muscle loss, because sarcopenia starts around age 40, right? That is, muscle loss.

[00:13:53]Now, if you exercise correctly, if you do physical exercise, if you have proper nutrition, if you sleep well, then obviously any procedure you do will have better results, right?

[00:14:11]Without a doubt. I think the focus today on longevity is allowing us to age with quality.

[00:14:20]And this quality is linked to everything you said: nutrition, physical and mental well-being. And the physical aspect also comes into play. The orthopedist, the cardiologist, we keep asking them, begging them, because they have physical activity. Today we have a mentality that people do physical activity." Physical activity, but I see the other side of the coin here, those who push themselves too hard, those who exercise too much. And then there's the injury from exercise, either done incorrectly or excessively in terms of repetitions and weight. So, as in life, everything in medical treatment has to be very well-balanced. Physical activity has to be well-balanced and well-guided.

[00:15:14]Because you're absolutely right, because I'm only thinking about the patient who arrives, who is of a certain age, who can't move, who... now there's the opposite, right?

[00:15:27]Really, I have a 60-year-old patient who started doing CrossFit.

[00:15:34]Obviously, he's going to get injured, right?

[00:15:36]CrossFit is those violent, fast, intense exercises, right? I mean, it's obvious that there will be injuries. And as you said, right? I mean, really, because of the physical activity that's so widely promoted today, problems in this sense are starting to arise, right?

[00:15:55]Tendon rupture and more, right?

[00:15:58]Uh, I think that people need to know... Respecting one's own limits in all physical activities is very important. The body always warns you, you know that, Roque, we are old doctors, experienced doctors. The body gives signals. And the signal it gives in relation to orthopedics is pain, just like it does in the heart, of course.

[00:16:24]So, respect the pain. It's rare for someone to experience pain during exercise. If they do, something is definitely wrong. Now, you exercise, and the next day your shoulder, your knee, your elbow hurts.

[00:16:42]Something is wrong. Respect your body, turn on the alert, the red light to tell you that it's good to have pain during exercise, right? That pain stimulates hypertrophy, so be careful in that sense too, right?

[00:17:01]Exactly. Look, physical activity releases endorphins. Endorphins are the hormones that give well-being.

[00:17:10]Normally, these endorphins increase the pain threshold. The pain will present itself in a much greater way. But respect it. You specifically mentioned it.

[00:17:20]Crossfit is a very intense activity, with a lot of weight, the person goes to the limit and this limit sometimes causes serious injuries, injuries that the orthopedist will have to intervene in, both from the point of view of non- surgical treatments and sometimes also surgical ones. Then they have to operate on the knee, ankle, biceps. The person tears their biceps, lifts, does a lot of bench presses. Things sometimes happen. That 's it.

[00:17:56]When you do, for example, you overdo that dumbbell fly, and it always happens, right?

[00:18:06]And today people are using anabolic steroids, right? Testosterone, I mean, that really complicates things even more, right?

[00:18:16]Uh, no. And they say, you... one situation that I see a lot here in the shoulder and elbow area is a biceps rupture, both at the top of the shoulder and at the elbow. The biceps flexes, it comes from the shoulder to the elbow.

[00:18:34]Then the person, you know, I was doing curls with, I don't know, 20 kg, 30 kg. And, bam, it bursts. Do you take anabolic steroids? No, I don't take just amino acids. So the advice I give, especially to younger people, is to be careful with what is offered to you in terms of medication, in terms of gaining more muscle mass. A normal muscle or tendon can rupture. If the tendon ruptures, it has something wrong, or it's something mechanical from an orthopedic point of view, sometimes it's something metabolic. So, be very careful with these dietary supplements, right, Roque?

[00:19:20]I think the internet froze there, Roque.

[00:19:28]Hello everyone, good afternoon. Draico, I think there was some problem with Dr. Rock's internet. I'll try to call him so we can get back to you, okay?

[00:19:39]No, okay. I'll wait here. If you have any questions, if you want me to add anything, Katinha, feel free to ask.

[00:19:46]Okay, we can. Look, someone here, Roberto, asked if there are any specific exercises to strengthen the rotator cuff. Strengthened. I also had another question here that I thought was interesting, which you can develop further: why does the shoulder become unstable when performing circular movements, and what can be done to improve this? Well, basically, strengthening the rotator cuff exercises— all of them, I'll stand here just to show you—are done with the elbow in this position.

[00:20:27]So, those elastic bands are used, right? The elastic bands are used, and they are done without raising the arm, always at 45º.

[00:20:37]These are isometric exercises. I say: "Look, do external rotation, count mentally 1 2 3 4 5, do it." There are several series, internal rotator, internal rotator, all of them. So, all these [snoring] exercises protect the rotator cuff, and most of them are done with the arm not elevated.

[00:21:03]When Rock, Rock came back now, the main advice I give to people is, don't lift weights, don't do exercises behind the shoulder, that is, for each exercise I have, I even show you here, I have one in my office, literally, it's a broom handle. This is a broom handle. Whatever you do here in front of us, everything is valid. Be careful with exercises where you pull the weight behind your head.

[00:21:34]This puts a lot of strain on the rotator cuff.

[00:21:35][snoring] So, exercises done behind the head put a lot of strain on the rotator cuff. So here in the front, obviously, with all the care, with all the maintenance of strength and resistance, they are much healthier. They're healthy, right? The ones behind.

[00:21:57]Yes, but that's a good explanation. I was off-air for a bit because there was a power outage here at home, in the neighborhood, but I really think this kind of information you're giving is extremely important, you know? Because the physicist, the physical education teacher, sometimes he ends up pressuring us, you know? No, because you have to do this, it's strong, this is this, this is that, stimulating. And sometimes we push ourselves beyond our limits, you know? Because you get stuck in that pile, in that whole thing, and it increases the weight, it increases that. Look, you're so old, and the guy next to you is half your age and doesn't lift as much weight, right?

[00:22:45]In other words, you keep stimulating yourself and that leads to injury. He has an injury.

[00:22:50]That's the big problem. And as you well know, physical performance is not a continuous upward curve.

[00:22:58]We repeat the same series. One day it will be upper limb, one day lower limb. There are days when we do the series, right? There, physical conditioning is much easier. There are days when it's much harder.

[00:23:10]Well, it's the same person, the same trainer, the same exercises, and the human body responds. Sometimes he just flies off, but other times they should respect him. So, your rhythm, right, your cycle of strength, exercise, elasticity, all that... You have to respect your body, you said, right? The signals that the body gives us, which we have to learn.

[00:23:34]And I like to pass this on to the people, all these people who follow us, which, thank God, is growing more and more, but that's why we want to bring correct information to people. There's a lot to it because this whole thing about you going online and seeing someone doing this, that, and the other thing... Hey Roque, we know that medical treatment, physical treatment, it's not a one-size-fits-all solution, it's not something you tell everyone, whether they're 20 or 80, to repeat the series of doses with 3 kg. So, medical treatment, rehabilitation, physical conditioning, it's all directed.

[00:24:26]Each person has a different profile, each person has a different level of resilience.

[00:24:30]That's without taking that into account. Sometimes the person has an associated illness, like high blood pressure, and they can't do much cardiac work because they have some limitation from a cardiocirculatory standpoint.

[00:24:41]So I say, sometimes I talk a lot, when the person has surgery or is going to have treatment, I say: "Ask your physiotherapist, whoever is going to guide you, to call me, it can even be the physical education teacher." And then we talked, and I said: "Look, do it respecting the physical aspects, both my physical condition and the patient's physical condition. Sometimes the patient doesn't have the cardiocirculatory conditions to do what you specifically think should be done.

[00:25:12]Yes, I think it's extremely important when you start a type of exercise, a gym, whatever, if you have a physical education professional, you have to be guided by your doctor, by the orthopedist, by the cardiologist. I always like to guide people in the sense of looking for the correct exercise, you know? The physical education professional understands this, but they have to know the patient's clinical side and have to follow the orthopedist's guidelines, right?

[00:25:44]Uh-huh. Hey Roque, I see a lot here in the office, uh, the patient comes here with an injury, so okay. You have an orthopedic injury X, Y, Z. Uh, what's your exercise routine like?

[00:25:57]Oh, no. I wake up at 6 am, go to the gym, stay there for 40 minutes, take a shower and go to work. No, but tell me."

[00:26:03]How do you get there? You warm up, you cycle a little, you go on the treadmill for 15, 20 minutes, you stretch before doing the exercises, and afterward, you stretch to keep the muscles working without contracture. So, physical activity is fundamental, but the way that physical activity is done is also important. So, stretching, cardiovascular condition, preparation, and routine must be respected. There are people who go to the gym six times a week and work out like crazy, which is absurd. So, all of that has to be taken into consideration.

[00:26:46]And then it's no use, right? Some people go to the gym for an hour, work out like crazy, but then they sit down all day afterward, right? It's not just about the end, right?

[00:26:55]Exactly. I think common sense prevails. A person does some sets of, I've had patients here who suffered serious injuries with very high loads, with a 200 kg leg press, with a 120 kg bench press.

[00:27:13]The body wasn't made for that. So, or So, the person arrives at 6 am, exercises until 7 am, and spends the whole day sitting with enormous stress.

[00:27:26]Yeah.

[00:27:26]And then things get a little different.

[00:27:31]Good morning. Well, we're almost at the end.

[00:27:36]I'd like to first thank you and apologize for all the problems we've had online and everything else, but unfortunately, that happens, right? But I want to thank you for your availability, and please, pass on to everyone your recommendations for having a healthy shoulder, I mean, healthy aging, with a good quality of life, right? And the shoulder, keep the shoulder looking good, right?

[00:28:12]Look at the recommendation: Physical activity.

[00:28:15]Guided physical activity, done well, whether it's stretching.

[00:28:20]Stretch and respect the load.

[00:28:23]Preferably, don't do exercises where the arm, where the shoulder goes beyond 90º. Remember the rotator cuff; when it's raised, it has an impact on injury.

[00:28:34]So, these precautions are important.

[00:28:37]Now, there are physical activities where you use the shoulder above 90º. Those who play... Volleyball, swimming, tennis – the shoulder is pushed to its limit, up to 90 degrees. So, anyone who does these activities needs specific rotator cuff strengthening.

[00:28:55]There are various programs, various protocols. Each protocol is designed for people who do a certain type of exercise, right?

[00:29:06]Professionals do it one way, amateur athletes do it another way.

[00:29:11]Our generation here, and older people also do it in a more directed way, but get guidance, exercise, stretch, stretch the anterior capsule, the posterior capsule – that thing that's also done for the whole human body – and maintain a healthy joint. Respect the pain and exercise.

[00:29:35]Well, thank you very much, Zop. I hope to see you tomorrow morning at Mass, because, look, 7 o'clock, Zop is part of our Sunday Mass and liturgical holidays, right? 7:30 in the morning, Sunday. That's it. So, until tomorrow.

[00:29:58]Thank you very much. Thank you very much for the opportunity. Hugs to everyone. I'm available if you need anything later on Dr. Rock's social media, I'm available, okay? OK.