Shoulder Pain


What is Shoulder Pain?

Shoulder pain can be a result of injury or disease of the shoulder joint and is a common problem with a number of different causes. Injury can affect any of the ligaments, bursae, or tendons surrounding the shoulder joint. Injury can also affect the ligaments, cartilage, meniscus, and bones of the joint. The design of the shoulder joint sacrifices stability for mobility; due to the fact that an extremely mobile joint means you are at higher risk of a shoulder injury.

Furthermore, common injuries of the shoulder can lead to inflammation of bursitis or tendons and as a result in a torn rotator cuff with dysfunction, impingement, as well as instability and frozen shoulder. Labral tears can be torn from cartilage; fracture of the bones of the shoulder such as biking falls can cause intense shoulder pain. Pain in the shoulder can also occur from current diseases such as arthritis with bone spurs i.e. osteoarthritis or degenerative arthritis. The soft tissues and bone surrounding the shoulder, or the nerves that supply sensation to the shoulder area.


What is a Frozen Shoulder?

A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only for the patient but also when the doctor attempts to move the joint whilst the patient is fully relaxed. The main cause of this is inflammation, scarring, thickening and shrinkage of the capsule surrounding the normal shoulder joint.


What is Bursitis?

This is a fluid filled sac that cushions an area of friction between tissues, such as the tendon and the bone. This reduces friction between moving parts of the body such as around the joints of the shoulder, elbow. The main causes of this are repetitive motions such as repeated throwing of a ball, carrying heavy objects repeatedly, trauma, hitting your shoulder on the table, infection etc.


What is a Rotator Cuff?

The rotator cuff is the group of four tendons which stabilise the shoulder joint. The tendons hook up to the four muscles which move the shoulder in various directions. The four muscles include the subscapularis muscle (moves the arm by turning it inwards); the supraspinatus muscle (responsible for elevating the arm and moving it away from the body); the infraspinatus muscle (assists the lifting of the arm during the arm outward); and the teres minor muscle (also helps the outward turning of the arm).


What is a Hyper Mobility Joint?

This is a condition which features the joints that move easily beyond the normal range expected for a particular joint. Hyper mobile joints are sometimes referred to as loose joints and the most common cause is inheritance from a specific gene which is passed on from parents to children.

shoulder painfrozen shoulderperson with shoulder pain

 


What are the Causes of Shoulder Pain?

• Frozen shoulder- painful persistent stiffness of the shoulder joint making it difficult to carry out the full range of normal shoulder movements.

• Rotator cuff disorders

• Shoulder instability- The shoulder joint is a ball and socket joint. The top of your upper arm bone is the ball, which fits into the socket of your shoulder blade. This occurs when the ball part of the shoulder joint does not move correctly in the socket.

• A broken arm or broken collarbone

• Joint disorders such as osteoarthritis

• Tearing muscle- a torn muscle or tendon causes severe pain and possible weakness in your arm and shoulder area. More likely to develop when you get older people aged 40 and over due to your tendons becoming weaker, however can occur at any age especially if affected by an accident.

• Bad posture can also lead to shoulder pain when using a computer or doing repetitive manual work over a long period of time.

frozen shoulder diagramrotator cuff diagramshoulder instability diagrambad posture


 What are the Symptoms of Shoulder Pain? 

• Swelling

• Weakness

• Numbness

• Tingling

• Bruising (Discoloration)

• Difficulty with everyday tasks such as dressing, bathing, driving, sleeping uncomfortably due to frozen shoulder

• Shoulder pain feels worse during activities that involve arm being above shoulder level, for example, brushing your hair, carrying objects

• Pain when you move your arm in an arch away from your body

• Pain on the front and side of your shoulder

• Shoulder Pain at night

• Severe pain in arm and shoulder

• Stiffness of the shoulder

• Shoulder fatigue

• Dislocated- severe pain, arm being visibly out of position, muscles spasms where the muscles contract painfully, limited movement

• Pain on the joint

• Pain on the top of the shoulder

• Limited shoulder joint movement

• Shoulder instability- This can range from a slipping or catching feeling in your shoulder, to a full shoulder dislocation where the balls come completely out of the socket. The main types include, traumatic(the shoulder is forced out of place by sudden impact mainly caused by an accident/injury/trauma), atraumatic(the shoulder gradually moves out of place over time mainly caused by repetitive arm movements such as throwing, carrying, certain sports etc.)

shoulder pain at nightfatigue shoulder pain shoulder dislocation diagram


How is Shoulder Pain Diagnosed? 

• Go see your GP to diagnose the cause of your shoulder pain by identifying the main symptoms, examining your shoulder. Your GP will need to know whether you have had any recent injuries, anything that makes the shoulder pain feel better or worse, if the shoulder pain is worst at night, if the shoulder pain comes on gradually or suddenly, if the shoulder pain affects your everyday life, if you have any other symptoms.

• Physical examination- The way in which this will work is your GP will compare your shoulders, check for any redness, swelling or bruising, check whether your joint is dislocated, feel your shoulder bones and joints to see whether this causes any pain. Your GP may also ask you to do some specific arm movements to help determine the cause of your shoulder pain further.

• X-Ray- This will test will be specifically on the shoulder if the inside of your shoulder joint needs to be examined to rule out other damage. This radiation will help to detect any problems with your bones located in your shoulder area.

• MRI- Strong magnetic fields and radio waves producing detailed images of soft tissues like tendons and ligaments.

• Ultrasound scan- Can be used to diagnose problems with joints, ligaments, and tendons.


How can you Prevent Shoulder Pain? 

• Stay active and gently move your shoulder

• Try exercises for shoulder pain- for around six to eight weeks to stop the shoulder pain from returning

• Stand up straight with your shoulders gently back

• Sit with a cushion behind your lower back

• Rest your arm on a cushion on your lap

• Use ice packs in affected shoulder area

• Avoid activities that make your symptoms worse


What Treatments are available for Shoulder Pain?

• Pain relief medications over the counter such as paracetamol, ibuprofen etc.

• Painkillers such as codeine

• Physiotherapy

To find out more information visit https://www.nhs.uk/Conditions/shoulderpain/Pages/Introduction.aspx