Exploring the Reasons Behind Shoulder Pain: Diagnosis and Treatment

Shoulder pain is a common occurrence globally, with women more likely to report such pain than men. Although it's challenging to provide a specific value for the prevalence due to various factors, including underreporting in low-income countries, it's still sufficient to say that many people worldwide experience pain in their shoulders at some point in their lifetime.

Understanding the Anatomy of Your Shoulder Joint

The shoulder joint is a ball-and-socket joint that allows a wide range of motion. It is made up of several important structures, each with its own function.

Bones

The main bones involved in the shoulder joint are:

Humerus (upper arm bone): The humerus forms the ball of the ball-and-socket joint and allows the arm to move in various directions.

Scapula (shoulder blade): The scapula is a shoulder joint bone that provides a stable base for the shoulder joint and serves as the attachment site for several muscles and tendons.

Clavicle (collarbone): The clavicle helps to connect the shoulder to the rest of the body and provides support for arm movements.

Muscles

The muscles of the shoulder joint facilitate movement and stability of the shoulder joint. Here are the major shoulder muscles that make up the said joint:

Rotator Cuff: The rotator cuff is comprised of a group of four muscles (the supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons that help stabilise the shoulder joint and enable a wide range of motion, including lifting, rotating, and reaching with the arm.

Deltoid Muscle: The deltoid muscle is a large, triangular-shaped muscle located on the uppermost part of the arm and the top of the shoulder. It's an important muscle for overall shoulder strength and plays a significant role in various everyday activities such as lifting, throwing, and reaching.

Tendons, Ligaments, and Cartilage

The tendons, ligaments, and cartilage of the shoulder joint play important roles in stabilising the joint, providing support, and enabling smooth movement.

Tendons are tough, fibrous tissues that connect muscles to bones.

Ligaments are tough bands of tissue that connect the bones and help stabilise the shoulder joint.

Cartilage is a smooth, rubbery tissue that covers the ends of bones, providing cushioning and reducing friction between them. The shoulder joint has cartilage called the labrum, which forms a cup or shoulder socket for the head of the humerus, adding stability to the joint.

Why Shoulder Pain Occurs: Risk Factors and Associated Conditions

Risk Factors

A shoulder problem may be caused by a variety of factors, including both lifestyle choices and medical conditions. Some common risk factors for developing shoulder problems include:

Overuse: Engaging in repetitive activities or sports that involve overhead movements can lead to shoulder pain over time.

Poor shoulder posture: Slouching or hunching can strain the muscles and tendons around the shoulder joint, leading to pain and discomfort.

Age: As we age, the risk of developing shoulder pain increases. The wear and tear on our joints over time can contribute to conditions such as arthritis and tendon degeneration.

Frozen Shoulders

One of the conditions associated with shoulder pain is adhesive capsulitis, commonly known as frozen shoulder. It occurs when the tissues around the shoulder joint become inflamed, leading to the development of adhesions and scar tissue. This causes the shoulder capsule to thicken and tighten, restricting the shoulder's range of motion. A frozen shoulder can limit your range of motion and make daily activities challenging.

Rotator Cuff Tear

Acute injuries or degeneration in the rotator cuff, including the muscles and tendons, over time can result in a torn rotator cuff. Rotator cuff tears can be partial or full-thickness tears, indicating the extent of the damage to the tendon. Symptoms of a rotator cuff tear may include pain, weakness, and a decreased range of motion in the shoulder.

Rotator Cuff Tendonitis

Rotator cuff tendonitis, also often called rotator cuff tendinitis, is a rotator cuff problem characterised by inflammation, irritation, or micro-tears in the tendons of the rotator cuff in the shoulder joint. It typically occurs due to repetitive overhead arm movements, injury, or ageing, leading to pain, weakness, and reduced range of motion in the shoulder.

Rotator Cuff Tendonitis

Shoulder impingement occurs when the tendons or bursa in the shoulder become compressed or irritated. This can happen due to repetitive overhead movements or structural abnormalities in the shoulder joint. Shoulder impingement can cause pain, weakness, and a decreased range of motion.

Shoulder Impingement

Shoulder impingement, also known as subacromial impingement, occurs when the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac) in the shoulder become pinched or compressed during arm movements.

This can happen when the space between the acromion (a bony process on the shoulder blade) and the rotator cuff narrows, leading to irritation, inflammation, and pain. It can result from repetitive overhead arm movements, structural abnormalities, or muscle imbalances.

Subacromial Bursitis

The subacromial bursa is a fluid-filled sac located between the rotator cuff tendons and the acromion, which is part of the shoulder blade. When this bursa becomes inflamed, it is known as subacromial bursitis. This condition can cause pain, swelling, and tenderness in the shoulder.

Shoulder Dislocation

Shoulder dislocation is a shoulder injury that typically happens when the arm is forcefully twisted or pulled away from the body, causing the humerus to come out of its normal position. Shoulder dislocations can result in intense pain, swelling, and an inability to move the affected arm.

Shoulder Fractures

Shoulder fractures refer to the damage or breakage of one or several bones in the shoulder joint. These fractures can result from various causes, such as falls, direct blows, or trauma. The symptoms of a shoulder fracture may include redness, significant pain, swelling, bruising, and difficulty moving the arm.

Arthritis

Arthritis is a term used to describe inflammation of one or more joints, leading to joint pain, swelling, stiffness, and reduced range of motion. Arthritis pain can vary from mild to severe and can affect daily activities and quality of life.

There are many types of arthritis, with osteoarthritis and rheumatoid arthritis being the most common. Osteoarthritis, which occurs due to wear and tear of the cartilage in the shoulder joint, can cause pain, stiffness, and limited mobility. Rheumatoid arthritis, an autoimmune disease, can also affect the shoulder joint and lead to pain and inflammation.

Referred Pain

A discomfort felt in the shoulder that originates from a different location in the body, also called referred pain of the shoulder, may be indicative of serious medical conditions that occur in the body part where the severe pain originated, especially when it's a sudden pain such as in a heart attack.

This type of pain can be confusing as the source of the discomfort is not in the shoulder itself but is "referred" from another area. Referred pain from the neck, upper back, or even the heart can manifest as shoulder pain.

When to See a Doctor

Shoulder pain can range from mild discomfort to severe, debilitating pain. While some instances of shoulder pain may resolve on their own with rest and self-care, there are situations in which it is crucial to seek medical attention. You should consult a doctor if:

The pain is severe and persists: If your shoulder pain is intense and doesn't improve with rest or over-the-counter pain medications, it is advisable to see a healthcare professional.

You cannot use your arm: If your shoulder pain is accompanied by an inability to move or use your arm, it may indicate a more serious underlying condition that requires medical evaluation.

The pain follows an injury: If you have recently experienced trauma or a fall that resulted in shoulder pain, it is essential to get a proper diagnosis to rule out any fractures or significant injuries.

Doctors may check out your medical history, perform a physical examination, and request additional diagnostic procedures like blood or imaging tests to determine why you feel pain in your shoulder.

How to Diagnose a Shoulder Pain

For proper shoulder diagnosis to more accurately determine the causes of shoulder pain, a healthcare professional will likely perform a comprehensive evaluation. This evaluation may include:

Medical history: Your doctor will ask you questions about your symptoms, medical history, and any previous injuries or conditions that may be contributing to your shoulder pain.

Physical examination: A physical examination of your shoulder joint will be conducted to assess range of motion, strength, and areas of tenderness or swelling.

Imaging tests: X-rays, MRI scans, or ultrasound may be recommended to visualise the structures within your shoulder joint and identify any abnormalities or injuries.

Managing Your Shoulder Pain

While the management of shoulder pain depends on the underlying cause and severity, there are several strategies that can help alleviate discomfort and improve function. Some common approaches to help manage pain in the shoulder area include injection of corticosteroid, physical therapy, surgery, and lifestyle changes or taking painkillers.

Lifestyle Changes

Making certain lifestyle modifications can have a positive impact on shoulder pain. These changes may include:

Posture correction: Maintaining good posture and avoiding slouching can help reduce strain on the shoulder joint.

Ergonomic adjustments: Adjusting your workspace or equipment to promote proper alignment and reduce repetitive movements can help prevent shoulder pain.

Exercise and stretching: Engaging in regular exercise and incorporating shoulder-strengthening and stretching exercises into your routine can improve shoulder stability and flexibility.

Painkillers

Over-the-counter pain medications, such as an anti-inflammatory medicine called nonsteroidal anti-inflammatory drugs, can provide temporary relief, especially in cases of mild shoulder pain. However, it would be best if you did not rely too much on painkillers when dealing with the pain in your shoulder and must consider other ways to manage shoulder pain when pain persists or increases in intensity.

Corticosteroid Injections

In some cases, corticosteroid injections may be recommended to reduce inflammation and provide pain relief. These injections are administered directly into the shoulder joint and can offer temporary relief for conditions such as tendinitis or bursitis.

Physiotherapy

Shoulder pain physiotherapy at Phoenix Rehab can help manage shoulder pain through a variety of specialised treatment modalities, including cold therapy, joint mobilisation, deep tissue release, manual therapy, and acupuncture.

These treatments, along with personalised exercises, aim to reduce pain, improve joint mobility, and accelerate the healing process, leading to better pain management and overall shoulder function.

Our physiotherapists may also provide holistic education on nutrition, lifestyle modifications, and other tips to promote quicker healing after surgery, further enhancing the benefits of shoulder pain physiotherapy.

Surgery

Surgery is typically considered a last resort when conservative treatment options have been exhausted. Surgical intervention may be necessary for conditions such as rotator cuff tears or severe arthritis. Your healthcare provider will discuss the benefits, risks, and expected outcomes of surgery if it is deemed necessary.

Final Words

By understanding the anatomy of your shoulder joint and recognising the risk factors and associated conditions, you can take proactive steps towards finding relief.

Remember to consult with a healthcare professional for an accurate diagnosis and personalised treatment plan. With the right approach, you can regain shoulder function and improve your overall quality of life.