8 Causes of Shoulder Joint Pain: Trauma, Arthritis, Sprain, Tendonitis, Bursitis

Shoulder joint pain is common among senior citizens and athletes. The shoulder Joint is one of the largest and complex joint. Shoulder joint links upper arm (humerus) to shoulder blade (scapula). Head of humerus is half ball in shape. Head of the humerus thus fits in a socket of scapula known as glenoid socket. The shoulder joint is thus called a “ball and socket” joint or Glenohumeral joint. The shoulder joint is supported by bony projection of acromion, coracoid process, and clavicle. Shoulder joint is a group of joint that includes Gleno-Humeral joint, Acromio-Coracoid joint, and Acromio-Clavicular joint.

Shoulder joint is supported by rotator cuff, labrum, ligaments, tendon and muscles. Shoulder joint performs wide range of movements. Tendon and ligaments are protected from friction injuries against bone and ligaments by cystic bursa. Bursa contains viscous fluid, which functions as shock absorber.

Shoulder joint pain is common among elderly and athletes. Arthritis is the cause of shoulder joint pain in elderly and injury is the cause among athletes. Most of the study indicates 25% of the patients suffering with shoulder joint pain have painful and restricted shoulder joint movements. ¹

Shoulder joint pain is influenced by following risk factors.

• Smoking
• Genetics
• Hypercholesterolemia
• Type 2 Diabetes²

Following Diseases Can Cause Shoulder Joint Pain:

1. Trauma To The Shoulder Joint
   1. Macro Trauma Resulting in Shoulder Joint Pain
      1. Tendon Tear
      2. Fracture of Shoulder Joint
      3. Dislocation of Shoulder Joint
      4. Rotator Cuff Tear
      5. Labral Tear
      6. SLAP Tear
   2. Micro Trauma Resulting in Shoulder Joint Pain
      1. Partial Tear of The Ligament
      2. Partial Tear of The Tendon
      3. Minor Injury of Labrum
2. Arthritis of The Shoulder Joint
   1. Osteoarthritis of the Shoulder Joint
   2. Rheumatoid Arthritis of the Shoulder Joint
   3. Gout affecting the Shoulder Joint
   4. Pseudo Gout affecting the Shoulder Joint
   5. Septic Arthritis of the Shoulder Joint
3. Shoulder Joint Sprain
4. Frozen Shoulder
5. Tendonitis
6. Bursitis
7. Rotator Cuff Impingement
8. Posterior Joint Capsule Contracture

Most of The Shoulder Joint Pain In Younger Patients And Athletes Are Caused By Injuries.

• Fall
• Sports Injury
• Work Injury
• Auto Accident
• Repeated Movement of The Joint.

Injuries Caused By Shoulder Joint Trauma Are Divided In Micro (Small) Or Macro (Large) Trauma.

Following Are The Injuries To The Shoulder Caused By Macro-Trauma.

• Tendon Tear
• Fracture of Shoulder Joint
• Dislocation of Shoulder Joint
• Rotator Cuff Tear
• Labral Tear
• SLAP Tear

Biceps Tendon Tear And Rotator Cuff Tear Are The Common Tendon Injury Observed In Athletes. Tendon Injuries Are As Follows-

• Tendon Laceration
• Partial Tear
• Complete Tear

Injuries Caused By Direct Impact or Accelerated Forces Often Results In Shoulder Joint Fracture.

Shoulder Joint Fracture May Include-

• Fracture of Humerus- Upper Arm.
• Fracture of Glenoid socket- Scapula.
• Fracture of Scapula- Shoulder Blade.
• Fracture of Clavicle- Collarbone.
• Acromion Process- Section of Scapula.

Dislocation of Shoulder Joint Results in Breaking the Link of the Joint between Following Bones-

• Glenohumeral Joint- Separation of link between humerus and glenoid socket of scapula.
• Acromio-Clavicular Joint- Separation of acromion process and clavicle.
• Coraco-Acromial Joint- Dislocation results in separation of coracoid process and acromion bone.

Rotator cuff tear is extremely painful condition with partial or full thickness tear.

• Full Thickness Tear
• Partial Rotator Cuff Tear
• Rotator Cuff Tear Associated With Tendon Or Ligament Tear.

• Tear Of Rim Of The Capsule
• Tear Of Cartilage Cuff Of Glenohumeral Joint
• Results in Severe Pain And Joint Instability
• Known as Bankart’s Tear.
• Labral Tear When Associated With Biceps Tendon Injury Is Known As SLAP Tear.

• Tear of Labrum
• Tear of Biceps Tendon
• Injury is Very Uncommon
• Injury Rarely Responds To Conservative Treatment
• Surgical Treatment Is Quite Often Preferred.³

SLAP Injuries Are Classified As Follows-

• Superior Labrum Anterior Lesion³– Trauma Causes Injury Of Front (Anterior) Of The Labrum Of Glenohumeral Joint Often Associated With Biceps Tendon Injury.
• Superior Labrum Posterior Lesion³– Trauma Causes Injury Of Back Of The Labrum Of Glenohumeral Joint.

Micro-Trauma Causes Following Injuries, Which Results In Chronic Severe Pain.

• Less Pain At Rest
• Restricted Shoulder Joint Movement
• Severe Pain With Joint Movement

• Less Pain At Rest
• Severe Pain With Joint Movement
• Shoulder Joint Stiffness
• Results in Tendonitis

• Superior Labrum Anterior Lesion³
• Superior Labrum Posterior Lesion³

• Inflammatory Disease
• Joint Capsule Inflammation
• Joint Cartilage Inflammation
• Wear and Tear of Joint Capsule and Cartilage
• Inflammation of Ligaments
• Associated with Tendonitis
• Osteoarthritis is mostly seen in older population.

• Inflammatory Autoimmune Disease
• Inflammation of Synovial Membrane
• Inflammation of Capsule
• Severe Pain
• Secretes Excessive Viscous Synovial Fluid
• Joint Effusion And Swelling
• Advanced Shoulder Joint Rheumatoid Arthritis– The joint cartilages and tendons are also inflamed resulting in severe pain at rest and with activities.
• Shoulder Joint Subluxation
• Disruption of the ligament resulting in partial dislocation (subluxation) of the shoulder joint.

• Gout is an inflammatory shoulder joint disease.
• Inflammation is triggered by uric acid deposit in the joint.
• Shoulder joint gout is less common than foot and ankle joint gout.

• Shoulder Joint Pseudogout is rare.
• Pseudogout is caused by calcium deposit in joint and soft tissue surrounding joint.
• Calcium deposits triggers inflammation resulting in severe pain and joint swelling.

• Septic arthritis is caused by infection of shoulder joint.
• Infection could be blood borne or caused by local spread following penetrating deep tissue wound.
• Penetrating wound into shoulder joint exposes joint to external source of infection.
• Septic shoulder joint arthritis is a rare disease which results in collection of pus in the shoulder joint.

• Shoulder Joint Sprain Is Caused By:
  1. Ligamental Tear
  2. Inflammation of the Ligament
  3. Partial or Complete Tear
• Partial Ligamental Tear- Treated with medication and physical therapy.
• Total or Complete Tear Often Needs Surgical Treatment.

• Severe Pain
• Severe Restricted Joint
• Extremely Stiff Joint
• Progressive Disease
• Triggered By Systemic Disorder
• Prognosis Depends On Early Treatment With Anti-Inflammatory Medications And Aggressive Physical Therapy.
• Early Aggressive Improvement Of Joint Mobility Prevents Joint Stiffness And Muscle Atrophy.

• Tendon is a Thick Bundle of Tough Fibrous Tissue.
• Both the Ends Of Muscles Continue As A Tendon.
• Tendon is attached to Bones on One Side and Muscle on Other Side.
• Tendonitis is Inflammatory Condition of Tendon.
• Tendonitis May Result From Tendon Injury. Tendon injury causes laceration, partial tear or complete tear of tendon.
• Lacerated or Injured Tendon Become Inflamed And Results In Tendonitis.
• Tendonitis is Also Often Seen with Degenerative Joint Disease.
• Degenerative Shoulder Joint Disease Triggers Inflammation of Soft Tissue like Tendon, Synovial Membrane and Ligaments.
• Tendonitis Caused By Degenerative Joint Disease Often Results in Tendon Tear.
• Tendonitis is observed in Workers Involved with Repeated Physical Work. Repetition of shoulder joint movement results in minor tendon injuries.
• Athletes Involved In Repeated Joint Movement Such As Playing Tennis Or Throwing Baseball Often Develop Tendonitis Of Shoulder Joint.
• Most Common Tendonitis of Shoulder Joint Involves Is Rotator Cuff Tendonitis and Bicep Tendonitis.

• Bursa is a Soft Cystic Sac Filled with Viscous Fluid. Bursa Lies between Tendon, Ligaments and Bones.
• Inflammation of Bursa is known as Bursitis.
• Several Bursas are observed in Shoulder Joint.
• Bursa Cushions and Prevents Frictions between Tendon, Ligament and Bones.
• Bursitis Causes Severe Pain with Joint Movement As Well As Movements Of Tendon And Ligament. Inflammation Stimulates Sensory Nerve Fibers Resulting In Severe Pain.

• Rotator Cuff is formed by Several Tendons and Muscles of Shoulder Joint.
• Rotator Cuff Participates In Complex Shoulder Joint Movement.
• Rotator Cuff Impingement Is Caused By Squeeze Of The Rotator Cuff During Upper Arm Abduction (Lifting Arm Outward And Up) At Shoulder Joint.
• Rotator Cuff Is Squeezed Against Acromion Bone.
• Rotator Cuff Impingement May Result In Bursitis And Tendonitis When Bursa Or Tendon Is Part Of The Pinch.

• Selective Contracture Of Capsule At Posterior Side Is Very Rare And Known As Posterior Joint Capsule Contracture (PJCC).
• PJCC or Posterior Joint Capsule Contracture Alters Joint Mechanics.
• Injury is Seen in Athletes Involved with Repeated Forward Forceful Movements of the Shoulder Joint.
• Injury is Caused by Forward Tensile Force Pulling the Posterior Joint Capsule as in Baseball Pitcher and Tennis Player.
• PJCC is also Observed In Non-Athletes and the Cause is Unknown.
• In Non-Athletes a Forceful Forward Joint Movement May Trigger PJCC During Act of Fall or Slip.
• The Pain is Observed with Certain Joint Movements Involving Posterior Capsule.
• Movement Such as Rotation and Abduction is Extremely Painful.

Also Read: Diagnosis Guide for Shoulder Joint Pain.

Also Read: Complete Treatment Options for Shoulder Joint Pain.

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