What is Shoulder Pain?
The shoulder joint is a joint in the body, which can be called as the most movable joint. For this reason, pain in the shoulder joint is the commonest musculoskeletal problem. Considering the range of motion this joint permits, it is the most unstable joint. This instability makes the shoulder joint more susceptible to injury, degenerative processes, etc. Shoulder pain can be localized or it can be passed on to the surrounding areas of the shoulder. Sometimes pain due to other medical problems such as liver or heart disease, or cervical spine disease etc. can be mistaken as coming from the shoulder.
The shoulder is made of three bones: The clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) along with their associated muscles, tendons, and ligaments. The articulations between these bones make up the shoulder joint. Shoulder joint is used in almost everything that a person does like it is used in head movements, hand movements, lifting arms, rotating the body etc. Shoulder also supports other functions in the body and therefore is an important part of the body. This is why when there is pain in the shoulders it becomes difficult for a person to perform normal functions.
People experience difficulty in doing even simple tasks such as brushing teeth, getting dressed, cooking, etc. because of pain and discomfort in the shoulder joint. Shoulder pain can be present in one or both shoulders. The pain varies with cause. It can be sharp and stabbing. It can be dull and achy or it can be a harsh type of pain. Sometimes, the shoulder pain goes away with conservative treatments such as rest, ice/heat application, physical therapy etc. Medications such as NSAIDs are also required. For fractures or dislocations, surgery can be required.
Causes and Risk Factors of Shoulder Pain
There are many reasons for shoulder pain. Usually most of the shoulder pain felt is not a cause for worry and it can be treated with conservative measures.
Some Of The Common Causes For Shoulder Pain Are:
- Bursitis Resulting in Shoulder Pain: Bursitis is one of the most common reasons for shoulder pain. It is an inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Symptoms are pain, tenderness, stiffness, swelling, warmth or redness over the joint. It can be treated with NSAIDs such as ibuprofen for pain and inflammation. Physical therapy may also help.
- Shoulder Arthritis: Arthritis can affect any joint. Symptoms are cause pain and stiffness, and may get worse over time and should be treated immediately.
- Shoulder Pain Due To Rotator Cuff Damage: This is the ball and socket joint of the shoulder itself. If the tendon present there is damaged or torn, it results in extreme pain in the shoulder. Symptoms are difficulty in moving the shoulder, popping or clicking noises, or difficulty in raising the arm over the head.
- Shoulder Pain from a Sports Injury: Injuries to the shoulder are very common, especially in people who are active in sports. Some injuries aggravate the muscles and tendons surrounding the shoulder and straining or overuse of these muscles make the shoulder sore.
- Frozen Shoulder: This is also referred to as adhesive capsulitis. It is a condition where it causes stiffness of the joint. Physical therapy and stretching the joints help in this type of shoulder pain and stiffness.
- Calcific Tendinitis is a result of calcium deposits within the tendon (generally rotator cuff tendons) and this can cause pain in the shoulder.
- Shoulder Instability: Loosening of the joint due to dislocation from trauma.
- Shoulder Dislocation: This condition occurs when the top of the humerus is disconnected from the scapula.
- Shoulder Separation Causing Pain: Also known as AC separation, the results in injury of the acromioclavicular joint.
- Labral Tear Causing Pain in Shoulder: There are many forms of torn labrum causing shoulder pain.
- Shoulder Pain from a SLAP Lesion: This is a form of labral tear commonly caused when someone falls onto an outstretched hand.
- Biceps Tendon Rupture Resulting In Shoulder Pain: This condition occurs when the bicep ruptures near the joint of the shoulder.
Pathophysiology of Shoulder Pain
Shoulder pain is a condition which is quite common. It usually has an underlying pathology due to multiple factors. There can be many reasons for shoulder pain. Continuous shoulder pain can be due to bursitis, tendinitis, tear of the rotator cuff, adhesive capsulitis, avascular necrosis, impingement syndrome, glenohumeral osteoarthritis (OA), or from trauma or accident. It also be a combination of all these conditions.
Common causes of persistent shoulder pain are adhesive capsulitis, glenohumeral osteoarthritis, and/or rotator cuff disorders. These three conditions have complex etiologies; however, they can be diagnosed through medical history, focused physical examination, and x-rays.
Signs and Symptoms of Shoulder Pain
Any injury or disease to the shoulder joint can cause shoulder pain. The injury can occur in ligaments, bursa, tendons surrounding the shoulder joint, ligaments, cartilage, menisci, and bones of the joint. This is an extremely mobile joint and is always at risk for increased injury.
Common Symptoms Accompanying Shoulder Pain Are:
- Joint pain.
- Tenderness around the joint.
- Achiness upon movement of the joint.
- Swelling over the joint.
Serious Symptoms Accompanying Shoulder Pain Are:
- Difficulty in carrying objects.
- Difficulty in using the arm.
- Trauma causing deformity of the joint.
- Shoulder pain at rest or at night when sleeping.
- Persistent shoulder pain.
- Inability to raise the arm.
- Swelling in or around the shoulder joint or arm.
- Bruising around the shoulder joint or arm.
- Signs of infection such as fever, redness etc.
- Weakness in the shoulder and arm.
- Other unusual symptoms.
Tests to Diagnose Shoulder Pain
Medical history and physical examination:
- MRI (Magnetic Resonance Imaging).
Watch 3D Video of Shoulder Joint Arthroscopy (Diagnostic) To Identify The Cause of Shoulder Pain.
Treatment for Shoulder Pain
Treatment of the shoulder pain depends on the cause of shoulder pain, whether it’s due to an injury, degenerative condition, dislocation, infection etc. and on the severity of condition.
Some Of The Common Treatments For Shoulder Pain Are:
- Rest: Resting the shoulder joint helps in reducing the swelling and pain.
- Heat and ice can also be used to help reduce swelling and pain in a shoulder injury.
- Physical therapy helps in recovery from shoulder pain by increasing the strength, mobility, and help patients in returning to their previous activity level.
- Stretching muscles and tendons that surround the shoulder joint help with some causes of shoulder pain and in relieving the pain.
- Some exercises also strengthen the muscles around the joint and relieve pain.
- Nonsteroidal antiinflammatories are the most commonly prescribed medications for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.
- Cortisone injections are quite helpful in relieving inflammation for shoulder pain.
- Dislocation is treated by a procedure called Manipulation and Reduction, which is done by placing the head of the humerus back into the socket joint of the scapula. An x-ray is then taken to ensure that the procedure did not fracture the bones that are surrounding it. The arm is then placed in an immobilizer for several days. After pain and swelling are reduced, the patient is enrolled in a rehabilitation program for restoration of range of motion of the shoulder and to strengthen the muscles to prevent future dislocations.
- A shoulder which has been dislocated previously is more prone to reinjury, especially in active individuals. Occasionally, a physician may perform a surgery in which a small incision is made through which a small scope called arthroscope is inserted to explore the inside of the joint. This procedure is called as arthroscopic surgery. After this, the shoulder is put in a sling and restrained for three to six weeks. Healing may take several months. Arthroscopic surgery of the shoulder is a relatively new technique.
Other Complementary Treatment Options Are:
- Capsaicin cream.
- Massages are helpful in shoulder pain resulting from stress.
- Yoga and Pilates.
- OrthoInfo. (2021). Shoulder Pain and Common Shoulder Problems. American Academy of Orthopaedic Surgeons https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems
- MedlinePlus. (2021). Shoulder Pain. U.S. National Library of Medicine https://medlineplus.gov/ency/article/003171.htm
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