Caring & Treating Since 2005
What is Shoulder Pain
The shoulder joint is the most manoeuvrable joint in the body. Its remarkable range of motion allows us to swing from monkey bars and perform cartwheels, but also do everyday tasks that we take for granted, like reaching for an object on the shelf or scratching that itch on the back.
However, because of the wide range of motion allowed, it is also an unstable joint and far more prone to dislocation than other joints.
Damage to the shoulder joint can happen acutely from sport, strenuous lifting, or a bad fall or accident. Shoulder pain may also develop slowly over time as a result of wear and tear or ageing.
Anatomy of the Shoulder
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle).
The head of the humerus fits into a rounded socket in the scapula, known as the glenoid. A combination of muscles and tendons keep the humerus centered in the glenoid.
These tissues are called the rotator cuff. They cover the head of the humerus to form a joint capsule, and attach the humerus to the scapula. In doing so, the rotator cuff act to stabilize the shoulder. The inner layer of the joint capsule secretes synovial fluid, which helps to lubricate the shoulder joint.
Symptoms of Shoulder Pain
The severity and location of shoulder pain may vary based on the different underlying causes. There are also other signs and symptoms that may accompany shoulder pain:
- Decreased range of motion and inability to raise the arm above the head
- Instability and feeling like the shoulder is going to “pop” out anytime
- Numbness or weakness of the arm
What are the Causes of Shoulder Pain?
The following are the common causes of shoulder pain:
Rotator cuff injury
Repetitive overhead arm movements, heavy lifting or other forms of trauma can strain the rotator cuff tendons and lead to tendinitis. Tendinitis can also develop due to chronic degeneration. The pain is felt mainly when raising the arm outwards and upwards from the body. When tendinitis is present, there is an increased risk of a rotator cuff tear occurring. The tear can be partial or complete and results in weakness when trying to raise the arm.
Also known as painful arc, this condition is directly caused by rotator cuff tendinitis. The affected tendons are thickened and inflamed and get squeezed or impinged by the edge of the shoulder blade when moving or raising the arm.
Also known as adhesive capsulitis, this is a condition in which the movement of the shoulder becomes severely restricted due to the growth of abnormal bands of tissue (called adhesions) between joint surfaces and a lack of synovial fluid to lubricate the joint. Frozen shoulder commonly occurs between the ages of 40 to 60 and can occur after a rotator cuff impingement, a tendon tear, or even minor injury. The problem usually resolves on its own, but this can take up to three years.
A shoulder dislocation occurs when the head of the humerus is forced out of the shoulder socket, usually as a result of a sudden injury or from overuse. When the ball of the humerus comes just partially out of the socket, this is called a partial dislocation or subluxation. Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations cause pain and unsteadiness when raising the arm or moving it away from the body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis.
Bursae are small fluid-filled sacs that aid in cushioning pressure points and reducing friction between the bones and ligaments or tendons. Bursitis can cause pain and swell in the affected area, particularly with motion.
OA is the most common form of arthritis and is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones. This causes the bones to rub against each other, causing pain, stiffness and loss of movement in the joint. In the shoulder, OA often occurs after an injury.
A shoulder fracture usually occurs from trauma or a fall. The most commonly fractured areas in the shoulder are the clavicle and the head of the humerus. A shoulder fracture usually causes severe pain and bruising.
Referred pain from the neck
Sometimes, shoulder pain actually originates from the neck. A prolapsed intervertebral disc in the neck, for example, can cause impingement on nerves that travel through the shoulder all the way to the arm and hand.
How to Test for Shoulder Pain?
After a detailed consultation and physical examination of the shoulder, the following tests may be performed to aid in diagnosis:
This provides two-dimensional views of the shoulder joint and is a cheap and reliable way to diagnose many shoulder issues.
Computed tomography (CT) scan
This provides three-dimensional views of the shoulder joint and is more detailed than traditional X-ray, and gives an excellent visualisation of the bones and some of the soft tissues.
This test is able to offer good visualisation of the soft tissues and is thus particularly useful for diagnosing soft tissue injuries.
Magnetic resonance imaging (MRI) scan
This test shows the various rotator cuff muscles, tendons, blood vessels, nerves and other soft tissues in the highest detail.
Blood tests such as full blood count, inflammatory markers, or rheumatoid factor.
How to Treat Shoulder Pain?
Treatments will vary according to the diagnosis of shoulder pain:
- Strengthening exercises for the rotator cuff muscles
- Exercises to ease stiffness and improve range of motion
- Improvement of shoulder, neck and spine posture
- Oral and topical painkillers for symptomatic relief
- Oral supplements which can aid in reducing inflammation and soft tissue degeneration
- Corticosteroid injections can be performed to provide immediate relief in cases of severe shoulder pain. The effect is short-term and usually lasts about three months.
- Surgical intervention may be indicated based on the diagnosis. Possible procedures include arthroscopic rotator cuff repair, Bankart repair for shoulder instability, and total shoulder replacement.