Shoulder Pain

The Shoulder Joint

The shoulder joint is one of the most mobile and complex joints in the human body. It is a ball-and-socket joint that allows a wide range of movement, including flexion, extension, abduction, adduction, internal rotation, and external rotation. The shoulder joint is formed by the articulation between the head of the humerus (the upper arm bone) and the glenoid cavity of the scapula (shoulder blade). The upper arm bone, together with the shoulder blade forms the glenohumeral joint.

The stability of the shoulder joint is primarily maintained by a group of muscles and tendons called the rotator cuff. The rotator cuff includes the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. These muscles help to stabilize the joint and rotate the upper arm.

The shoulder is susceptible to various injuries and conditions, such as dislocation, instability, rotator cuff tears, bursitis, and arthritis. Treatment for shoulder problems can range from conservative approaches, such as rest, physical therapy, and medications, to surgical interventions, depending on the severity and nature of the condition.

Shoulder Pain

There are many cases of shoulder pain from injury to chronic overuse, or to underlying medical conditions. The shoulder is a complex joint being very mobile making it vulnerable to injury or overuse. The shoulder can be injured through a fall or from contact in sport. Repeated throwing in some sports can cause traumatic injury to the shoulder. The most common case for us to treat shoulder pain is due to a rotator cuff problem and are the largest causes of shoulder pain.

Shoulder pain through Injury

Shoulder pain can be caused by injury, ranging from injuries to underlying medical conditions. Here are some common causes of shoulder pain:

Rotator cuff injury:

The rotator cuff is a group of muscles and tendons that stabilise the shoulder and move the upper arm. Injuries including a rotator cuff tear or strain, can cause pain. A torn rotator cuff often results from sudden overuse or trauma. It is important to note that rotator cuff tears are a normal part of ageing and do not always cause pain.

Shoulder dislocation:

A shoulder dislocation happens when the humerus (upper arm bone) is forced out of its socket in the shoulder blade. This can occur due to a traumatic injury or excessive force applied to the joint. Dislocation causes is not a fun injury and requires immediate medical attention. If initially left untreated or unmanaged, it may result in recurrent dislocations/subluxations or shoulder problems.

Rotator cuff Tendinitis/Tendinopathy:

Inflammation of a tendon can occur in the shoulder due to repetitive overhead motions or overuse. this is called rotator cuff tendinitis. It often affects the rotator cuff tendons and can cause pain, swelling, and difficulty with certain movements. Rotator cuff tendinitis is not always the problem and often, the rotator cuff tenon can be irritated from overuse or weakness rather than inflammation, in this case “Tendinopathy” is a more appropriate descriptor.

Fractures and trauma:

Fractures of the collarbone, upper arm bone, or shoulder blade can be a significant cause of shoulder pain. Traumatic injuries, such as falls or accidents, can result in fractures or other injuries to the shoulder. This can also occur as a secondary outcome from shoulder dislocation.

Shoulder Pain Without Injury: Overuse Causes

A shoulder problem can occur without a specific injury, and there are several common causes for such pain. Here are six possible causes of shoulder pain without trauma:

Shoulder Impingement Syndrome:

Shoulder impingement syndrome can develop due to repetitive overhead movements or poor shoulder mechanics. It involves the compression or impingement of the muscles and tendons between the acromion (top of the shoulder blade) and the humerus, such as the rotator cuff. This can result in shoulder pain, weakness, and limited range of movement. Often imaging may show bone spurs, however we know that these are usually not the cause of impingement symptoms.

Bursitis:

Bursitis is the inflammation of the bursae, which is a small fluid filled sac that cushion and reduce friction between tendons, muscles, and bones in the shoulder. Overuse, repetitive motions, or certain medical conditions can cause bursitis, leading to pain, swelling, and discomfort.

Tendinopathy:

Tendinopathy refers to pathology of the rotator cuff tendons. In the shoulder, tendinopathy commonly affects the tendons of the rotator cuff. It can develop gradually over time due to repetitive motions or as a result of age-related changes.

Frozen Shoulder (Adhesive Capsulitis):

Frozen shoulder is a condition characterized by stiffness, pain, and a gross reduction in range of motion in the shoulder. It typically develops gradually and progresses through three stages: freezing, frozen, and thawing. The exact cause of frozen shoulder is not well understood, but it occurs when strong connective tissue forms around the joint capsule. It may be associated with hormonal imbalances, diabetes, or previous shoulder injuries.

Osteoarthritis:

Osteoarthritis is a degenerative joint disease that can affect the joint. It occurs when the cartilage on the ends of the bones wears down over time, leading to pain, stiffness, and reduced range of motion. Arthritis pain commonly affects older individuals or those with a history of injuries of the shoulder joints.

It is important to note that these causes are not exclusive, and other factors or conditions could contribute to shoulder pain without an apparent injury. If you are experiencing persistent or worsening shoulder pain, it is advisable to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Signs and symptoms of shoulder pain

Shoulder pain can manifest in various ways and may be accompanied by other symptoms. Here are some common signs and symptoms associated with shoulder pain:

Pain: The primary symptom of shoulder pain is discomfort or pain in the shoulder which may travel into the upper arm, called referred pain.

Limited range of movement: This may be caused by weakness in the muscles and tendons, or a restriction of the joint, or possibly from pain inhibition.

Swelling and inflammation: Inflammation of the shoulder can cause swelling or tenderness in the affected area. The shoulder may appear visibly swollen or feel warm to the touch.

Weakness: Pain may be accompanied by muscle weakness, making it challenging to perform certain tasks or activities that involve the use of the shoulder. This may be a secondary symptom stemming from a new rotator cuff tear.

Shoulder instability: Some individuals with shoulder pain may experience a sensation of the joint being loose or unstable. This feeling can occur due to damage to the ligaments or tendons that support the shoulder. This is far more common in those who have dislocated their shoulder.

Clicking or popping sounds: In some cases, shoulder pain may be associated with audible clicking, popping, or grinding noises when moving the shoulder. On occasion this may indicate pathology but are usually not considered significant without associated pain.

Numbness or tingling: If a nerve in or around the shoulder is compressed or irritated, you may experience numbness or tingling sensations that radiate into the upper arm or into the fingers.

Difficulty sleeping: Shoulder pain can interfere with your ability to find a comfortable sleeping position, leading to disrupted sleep or difficulty falling asleep.

It’s important to note that these symptoms can vary depending on the underlying cause of the shoulder pain. If you’re experiencing persistent or severe shoulder pain, it’s advisable to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosing shoulder pain

Diagnosing the cause of shoulder pain typically involves a combination of medical history assessment, physical examination, and sometimes imaging tests. Here is an overview of the diagnostic process for shoulder pain:

Medical history:

Your doctor will start by asking you questions about your symptoms, including the location, intensity, and duration of the pain. They will also inquire about any previous injuries, medical conditions, or activities that may have contributed to the pain. Providing detailed information about your symptoms and medical history can help guide the diagnostic process.

Physical exam:

A thorough physical examination of your shoulder will be conducted. The doctor will assess the range of movement, strength, and stability of your shoulder. They may also perform specific tests to evaluate the integrity of the ligaments, tendons, and muscles in the shoulder. Palpation of the shoulder area can help identify areas of tenderness, swelling, or deformity.

Imaging tests:

Depending on the suspected cause of your shoulder pain, your doctor may order imaging tests to get a more detailed view of the shoulder. Common imaging techniques include:

X-rays: X-rays can provide information about the bones in the shoulder, helping to identify fractures, arthritis, or bone spurs.

Magnetic Resonance Imaging (MRI): An MRI uses magnetic fields and radio waves to create detailed images of the soft tissues, including muscles, tendons, and ligaments. It can help detect tears, inflammation, or other soft tissue abnormalities.

Ultrasound: This imaging technique uses sound waves to create real-time images of the shoulder structures. It can be helpful in evaluating tendons, muscles, and fluid accumulation.

Computed Tomography (CT) scan: In some cases, a CT scan may be ordered to provide more detailed images of the bones and soft tissues in the shoulder.

In certain situations, your doctor may recommend a diagnostic injection to investigate shoulder pain, such as a local anaesthetic or corticosteroid, into the shoulder joint. If the injection provides temporary relief of pain, it can help confirm the suspected source of shoulder pain.

Referral to a specialist:

In some cases, shoulder surgery may be warranted. Referral to a specialist needs to come from your GP.

Remember, diagnosing shoulder pain accurately requires a comprehensive evaluation by a healthcare professional. If you are experiencing persistent or severe shoulder pain, it’s important to consult with a medical provider to determine the underlying cause and develop an appropriate treatment plan.

Treatment options for shoulder pain

Treating shoulder pain depends on the underlying cause and severity of the condition. Here are some common treatment approaches that healthcare professionals may recommend for those who feel shoulder pain:

Rest and activity modification: Resting the affected shoulder and avoiding activities that worsen the pain can help promote healing. Limiting repetitive or overhead movements and modifying daily activities can reduce strain on the shoulder muscles.

Ice or heat therapy: Applying ice packs or heat pads to the shoulder can help reduce pain and inflammation. Ice is generally recommended for acute injuries or inflammation, while heat can provide relief for chronic pain or muscle stiffness. It’s important to follow the proper guidelines for applying ice or heat to avoid skin damage.

Pain medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation, but should be discussed first with your GP or Pharmacist.

Physiotherapy: A physiotherapist can design an individualized exercise program to improve shoulder strength, flexibility, and stability. They may incorporate stretching exercises, range-of-motion exercises, and strengthening exercises of the rotator cuff, upper arm and shoulder blade. Manual therapy techniques, such as joint mobilization or manipulation of soft tissues, may also be used.

Steroid injections: In certain cases, corticosteroid injections may be administered directly into the shoulder joint to reduce inflammation and provide temporary pain relief.

Assistive devices: Depending on the condition, your healthcare provider may recommend the use of assistive devices, such as slings, braces, or splints, to support and immobilize the shoulder joint, allowing it to rest and heal.

Surgical intervention: If conservative treatments fail to alleviate the shoulder pain or if there is a structural problem, such as complete rotator cuff tears, surgery may be considered.

Alternative therapies: Some individuals find relief from shoulder pain through alternative therapies such as acupuncture, chiropractic care, or massage. While the evidence for their effectiveness varies, they may be worth exploring in consultation with a qualified practitioner.

It is important to consult with a healthcare professional for an accurate diagnosis and to determine the most appropriate treatment plan for your specific shoulder pain. They can provide personalized recommendations based on your condition and medical history.

Self-management of shoulder pain

In addition to seeking medical advice and treatment, there are several self-management strategies that can help alleviate shoulder pain and promote healing. Here are some self-care tips for managing shoulder pain:

Rest and avoid overuse: Give your shoulder adequate rest and avoid activities that aggravate the pain. Overuse or repetitive movements can further strain the shoulder joint and impede healing. If you find it makes your pain worse, it is best to consult your health professional.

Apply ice or heat: Applying ice packs or heat pads to the affected shoulder can help reduce pain and inflammation. Use ice for acute injuries or inflammation, and heat for chronic pain or muscle stiffness. Remember to follow the recommended guidelines for applying ice or heat to prevent skin damage.

Practice gentle exercises and stretches: Stretch and strengthen the shoulder to promote mobility and flexibility, to help you lift your arm. Avoid any exercises or movements that cause pain or discomfort. Consult with a physical therapist for appropriate exercises that suit your condition.

Maintain good posture: Pay attention to your posture, particularly how your shoulder blades sit. Both during daily activities and while sitting or standing for extended periods. Proper posture can help prevent unnecessary strain on the shoulder joint and muscles.

Use ergonomic equipment: Ensure that your work or daily equipment, such as chairs, desks, and computer setups, are ergonomically designed to support good posture and reduce strain on the shoulder.

Practice relaxation techniques: Stress and tension can increase muscle tightness and worsen shoulder pain. Engage in relaxation techniques such as diaphragmatic breathing, meditation, or gentle yoga to help relax the muscles and reduce stress.

Modify daily activities: Adjust your daily activities to minimize strain on the shoulder. For example, when lifting heavy objects, use your legs and core muscles rather than relying solely on your shoulder. Avoid repetitive overhead motions whenever possible.

Maintain a healthy lifestyle: Adopting a healthy lifestyle can contribute to overall well-being and promote healing. Eat a balanced diet, stay hydrated, get regular exercise, and ensure an adequate amount of sleep.

Avoid activities that worsen the pain: Identify and avoid activities or movements that worsen your shoulder pain. Be mindful of your limitations and modify your activities accordingly.

Remember, while self-management strategies can provide relief for mild shoulder pain, it is important to consult with a healthcare professional if your pain persists, worsens, or is accompanied by other concerning symptoms.

When to be concerned about shoulder pain

While many cases of shoulder pain can be managed with self-care and conservative measures, there are situations where it is important to be concerned and seek medical attention promptly. Here are some signs and symptoms that may indicate a more serious underlying issue and warrant medical attention:

Severe or persistent pain: If your pain is intense, severe, or continues to worsen over time despite rest and self-care measures, it is a cause for concern.

Sudden injury or trauma: If the pain is the result of a sudden injury, such as a fall, car accident, or direct blow to the shoulder, it is important to seek medical evaluation, especially if there is visible deformity, severe swelling, or inability to move the arm.

Shoulder instability: If you experience a sense of your joint being loose, dislocating, or popping out of place when you lift your arm or weight bear. This may indicate a problem with the ligaments, rotator cuff tendons, or structures that stabilize the shoulder.

Inability to move the shoulder or arm: If you are unable to move your shoulder or arm, or there is a significant loss of strength or function, it may suggest a more severe injury or a nerve-related issue that requires medical attention.

Numbness, tingling, or weakness: If you experience numbness, tingling, or weakness that radiates down the arm, it may indicate nerve involvement. This could be due to conditions such as a pinched nerve, cervical spine issues, or brachial plexus injury.

Signs of infection: If you notice signs of infection, such as increased redness, warmth, swelling, or drainage from the shoulder area, along with fever or chills, it is essential to seek immediate medical attention.

History of cancer or unexplained weight loss: If you have a history of cancer or are experiencing unexplained weight loss along with shoulder pain, it is important to get evaluated, as shoulder pain can rarely be a symptom of certain cancers.

Limited range of motion: If your pain is accompanied by a significant decrease in range of motion, making it difficult to perform daily activities or affecting your quality of life, it is advisable to consult with a healthcare professional.

Previous unsuccessful treatment: If you have tried self-care measures, such as rest, ice, or over-the-counter pain medication, without significant improvement, it may be necessary to consult with a healthcare provider for further evaluation and treatment.

Remember, it’s always better to err on the side of caution and seek medical advice if you are concerned about your shoulder pain. An experienced healthcare professional can evaluate your symptoms, conduct a physical examination, order appropriate tests, and provide a proper diagnosis and treatment plan based on your specific situation.

Long-term outlook for shoulder pain

The long-term outlook for shoulder pain depends on various factors, including the underlying cause of the pain, the severity of the condition, and the effectiveness of the treatment. In many cases, shoulder pain can be effectively managed, and individuals can experience significant improvement in their symptoms and overall function. However, in some cases, chronic or recurring shoulder pain may require ongoing management and lifestyle adjustments.

Here are some possible scenarios and outcomes for shoulder pain:

Acute injuries or strains: If the shoulder pain is the result of a recent injury or strain, it may resolve with appropriate rest, and rehabilitation exercises. With proper treatment and adherence to a rehabilitation program, the majority of acute shoulder problems heal well, and individuals can regain full function and be pain-free.

Overuse or repetitive strain injuries: Shoulder pain caused by overuse or repetitive strain injuries, such as rotator cuff tendinitis or bursitis, may require a combination of rest, activity modification, physical therapy, and anti-inflammatory medications.

Chronic conditions: Some conditions, such as chronic rotator cuff tears, frozen shoulder (adhesive capsulitis), or arthritis, can cause chronic or recurring shoulder pain. The long-term outlook for these conditions depends on factors such as the severity of the injury or condition, individual response to treatment, and adherence to rehabilitation and management strategies. While complete resolution may not always be possible, the goal of treatment is often to reduce pain, improve function, and enhance quality of life. A combination of conservative treatments, such as physical therapy, medications, injections, and in some cases, surgery, may be utilized to manage these chronic conditions.

Degenerative conditions: Degenerative conditions, such as osteoarthritis or rheumatoid arthritis may cause progressive shoulder pain over time. While these conditions cannot be fully cured, they can often be managed with a combination of lifestyle modifications, pain management strategies, physical therapy, and possibly surgical interventions, if necessary.

It’s important to note that each individual case is unique, and the long-term outlook for shoulder pain can vary. The key to achieving the best possible outcome is early and accurate diagnosis, appropriate treatment and rehabilitation, and adherence to self-care measures. Working closely with healthcare professionals, such as orthopedic specialists, physiotherapists, and pain management specialists, can help develop an individualized treatment plan and optimize long-term outcomes.