Shoulder pain

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing the perfect pitch.

Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment.

This article explains some of the common causes of shoulder pain, as well as some general treatment options. Your doctor can give you more detailed information about your shoulder pain.

Anatomy

4e

This simplified illustration of the shoulder highlights the major components of the joint.

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

causes

There are a number of reasons why you might be experiencing shoulder pain, which include:

  • poor posture
  • frozen shoulder – a painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether
  • rotator cuff disorders – the rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep it stable
  • shoulder instability – where the shoulder is unstable and may have an unusually large range of movement (hypermobility)
  • acromioclavicular joint disorders – conditions, includingosteoarthritis that affect the acromioclavicular joint, which is the joint at the top of the shoulder
  • osteoarthritis in the shoulder joints
  • a broken (fractured) bone, such as a fracture of the humerus (upper arm bone) or broken collarbone

In some cases, pain in the shoulder isn't caused by a problem in the shoulder joint, but by a problem in another area, such as the neck, that is felt in the shoulder and upper back.

Neck and shoulder pain (shoulder pain)

Pain felt in the shoulder area can sometimes be coming from your neck. This is because the nerves and muscles that arise from your neck pass through your shoulder on their way down the arm. The nerves from your neck (Nerve Roots) also travel down your arm (via the Brachial Plexus). Thus neck pain may extend down your arm.

Pain from your neck is usually felt mainly at the top of your shoulder over your trapezius muscle, whilst pain from your shoulder is normally felt over your upper arm.

other symptoms

Shoulder pain may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Shoulder pain may originate in the shoulder itself or may be caused by conditions that affect other body areas, such as the neck, abdomen, chest, or upper arms.

Additional symptoms that may occur with shoulder pain include:

  • Achiness
  • Back, neck or arm pain
  • Bruising
  • Clicking and other noises when you move your arm
  • Fatigue
  • Fever
  • Grinding or popping feeling
  • Muscle stiffness and weakness
  • Painful movement of the arm
  • Swelling (edema) of the arm
  • Warmth or burning

Diagnosing shoulder pain

Your GP may be able to diagnose the cause of your shoulder pain by discussing your symptoms with you and examining your shoulder. In some cases, tests may be needed.

As well as asking exactly where the pain is, your GP will also need to know whether:

  • you have had any recent injuries
  • anything makes the pain feel better or worse
  • the pain is worse at night
  • the pain came on gradually or suddenly
  • the pain is affecting your everyday life – for example, at work or when exercising
  • you have any other symptoms

Physical examination : Your GP will probably carry out a physical examination of your shoulder area.

Arm movements : Your GP may also ask you to do some specific arm movements – for example, placing your hands on the back of your neck and pointing your elbows out to the side.

Investigations  : If you need any imaging tests to examine your shoulder in more detail, your GP may refer you for hospital tests  like x-ray and  MRI scan . You may also need some blood tests.

        Treating shoulder pain

There are several types of treatment for shoulder pain, depending on the cause of your shoulder pain and your symptoms.

Some treatment options, such as heat or ice packs and painkillers, may help to reduce pain and treat minor injuries at home.

You should see you GP if your pain is either the result of an injury, it's particularly bad, or there is no sign of improvement after a couple of weeks.

Your GP may refer you for specialist treatment with an orthopaedic surgeon (a specialist in conditions that affect the bones and muscles) or a rheumatologist

Avoiding activities

Depending on what is causing your shoulder pain, your GP may recommend that you avoid certain activities or movements that could make your symptoms worse.

For example, in the early, painful stage of frozen shoulder, you may be advised to avoid activities that involve lifting your arms above your head and stretching vigorously. However, you should continue using your shoulder for other activities, because keeping it still could make your symptoms worse.

Ice packs

If you injure your shoulder – for example, while playing sport – you can apply an ice pack to the affected area to reduce pain and inflammation.

You should apply the ice pack for 10-30 minutes. A bag of frozen peas, or similar, will also work well. Wrap the ice pack in a damp towel to avoid it directly touching your skin and causing ice burn.

Painkillers

If your pain is mild, taking painkillers such as paracetamol or codeine may be enough to control it. Always follow the dosage instructions on the packet to ensure the medicine is suitable and that you do not take too much.

If your shoulder pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID), such asibuprofen, diclofenac or naproxen.

As well as easing the pain, NSAIDs can also help reduce swelling in your shoulder capsule. They are most effective when taken regularly, rather than when your symptoms are most painful.

Hyaluronate injections

Hyaluronate is another medicine that can be injected into your shoulder to treat shoulder pain. One review of a number of studies found that hyaluronate was effective at reducing pain.

Magnet therapy

Magnetic therapy, also known as magnotherapy, is an alternative therapy that is used to treat several different disorders, such as, reducing pain and inflammation, curing depression and stress. The use of magnetic therapy is controversial as many medical practitioners do not consider it a credible therapy.

when therapeutic magnets are placed on the skin, their magnetic forces penetrate the body and interact with the iron in the blood. This magnetic attraction is said to increase blood flow and improve circulation. The stimulation is localized unless the magnets at placed on a major artery. In this case, the magnetic forces are believed to have a much wider field of effect.

Prp injection

Platelet-rich plasma (PRP) is the name given to blood plasma with a high concentration of platelets that contains huge doses of bioactive proteins, such as growth factors, that are critical in the repair and regeneration of tissues.

Acupuncture

Acupuncture treatment focuses on reducing inflammation, improving blood flow and decreasing pain.  Acupuncture excels at treating the chronic, nagging type injuries that don’t respond well to conventional treatment.

Acupuncture involves the insertion of thin, pre-sterilized needles in various areas of the body to elicit a response.  Acupuncture stimulates the release of the opiods (pain killing chemicals) as well as adenosine- a natural pain killer with anti-inflammatory properties.5

Massage therapy

There's no replacement for a professional massage therapist. Even though rubbing your own neck or shoulder with the opposite hand can provide temporary relief, an expert knows how to direct pressure for the best results.there are two type of massage therapy technique for shoulder pain : These include:

  • Swedish Massage-- actually increases the level of oxygen in your blood, leading to a decrease in muscle toxins and improved circulation.
  • Trigger Point Therapyactively identifies the location and intensity of sensation, providing natural management of chronic pain. Often, a single treatment results in a noticeable reduction of pain while ongoing treatment provides even more effective relief.

Physiotherapy

Physiotherapy uses a number of different physical methods to promote healing. If you are referred to a physiotherapist, they should explain to you what treatment they will use and how it will work.

Possible treatments include:

  • specific shoulder exercises – for example, if you have shoulder instability, you may be given exercises to strengthen your shoulder
  • massage – where the physiotherapist uses their hands to manipulate your shoulder

Shoulder exercises

If you have shoulder pain, it's important to keep your shoulder joint mobile with light and gentle movement. Not using your shoulder can cause your muscles to waste away and may make any stiffness worse. Therefore, if possible, you should continue using your shoulder as normal.

If your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you exercises to do without further damaging your shoulder.

You may be given exercises to do on your own, or you may complete the exercises with supervision from your GP or physiotherapist. You may also have manual therapy, where the healthcare professional moves your arm for you. Manual therapy uses special techniques to move the joints and soft tissues in your shoulder.

Surgery

Most shoulder problems improve without the need for surgery. But some conditions can be helped by surgery.

If an operation is needed it can often be performed using keyhole techniques, which require a smaller incision and often reduce your recovery time. Some common surgeries include:

  • trimming bone and tissue from the underside of the acromion at the top of your shoulder (subacromial decompression - see Figure 3)
  • repairing tears in the rotator cuff
  • releasing the tight capsule of a frozen shoulder.