The shoulder joint has the greatest range of motion of any joint of the body, so it is not surprising that shoulder pain is a common problem and results from a wide variety of causes. These may be obvious as in sports related injuries or may be more subtle, emanating from your movement, or lack of, during regular daily life. Shoulder pain can also often be a symptom of another problem.
Below is a list of the most common reasons for shoulder pain.
- Poor posture while walking or sitting at work all day may lead to shoulder pain. This is due to lack of exercise so that the muscles around your joints become weak and the joint itself is not properly supported.
- Frozen shoulder or adhesive capsulitis can lead to pain and stiffness in and around the shoulder joint.
- The rotator cuff is the group of muscles and tendons that maintain the stability of the shoulder joint. Any damage to these structures will result in shoulder pain.
- Hypermobility of the shoulder joint may lead to shoulder instability and cause pain.
- The acromioclavicular joint is the main joint at the top of the shoulder where the clavicle (collar bone) and the scapula (shoulder blade) come together. It is a complex joint involving several ligaments and muscles that may be damaged, particularly during contact sports. It can also become dislocated.
- Osteoarthritis leads to the disintegration of the articular surfaces of the joint over time and will become more painful as the condition progresses.
- A broken collar bone, fractured humerus or other such acute injury will cause immediate pain.
- A true shoulder dislocation occurs when there is a separation of the humerus bone of the arm and the scapula at the glenohumeral joint.
- Referred pain from the neck or upper back can cause pain in the shoulders.
What should you do when you have shoulder pain?
Acute shoulder pain is likely to take place following an accident, sporting injury or otherwise, or following injury from overwork, for example lifting. Obviously, if broken bones are suspected you must attend an accident and emergency unit as soon as possible to have an x-ray taken. This will identify the extent of the damage and give the doctor important information as to how best to proceed to fix the damage. You should also seek immediate treatment if your shoulder is dislocated as it is easier to re-seat the joint before inflammation and swelling reach their peak.
For less severe shoulder damage, treatment can be started at home and it is useful to remember the acronym PRICE, which represents a series of steps to follow: protection, rest, ice, compression and elevation.
For minor tears, slight strains or over use, the initial task is to reduce inflammation, the body’s natural response to injury, as inflammation results in pain. An immediately useful treatment can be the application of ice for 10 to 30 minutes. Icing reduces inflammation as it decreases blood flow to the injured area. An application of ice can be made with a plastic bag filled with ice or alternately a bag of frozen vegetables, peas being ideal. If you often need to apply ice to reduce swelling, specially designed ice packs can be purchased to fit the damaged area. It is important to wrap the ice in a towel so that it doesn’t directly touch the skin as this may cause frostbite. Best practice is to rest from exercise for 2 to 4 days to allow your body to recover naturally. When you do start exercising again, start gradually, in increments, while building up the level of intensity.
Further home-based treatments include taking pain killers such as paracetamol or stronger non-steroidal anti-inflammatory drugs such as ibuprofen. The latter is designed be taken as a regular program over days or weeks and not just as a one-off remedy when there is pain.
Following a slight shoulder injury, you should avoid any activities that cause increased pain; however, it is best to keep your shoulder mobile by undertaking light activities as unused joints lead to muscle wastage and this may lead to further problems.
A supportive bandage or shoulder brace may be used to help strengthen the joint during recovery. This allows you to continue light exercise while knowing that the joint is being supported and strengthened.
If there is no improvement after a couple of weeks, or if your injury is particularly bad you should see your GP who may recommend physiotherapy or corticosteroid injections. Corticosteroid injections help to reduce pain levels but do nothing to help heal the joint, and may in fact be detrimental if too many are used.
Physiotherapy uses appropriate physical exercises and massage to encourage healing. Physiotherapy will initially involve manipulation of the joint to isolate the problem so that the practitioner can put together a series of exercises that will aid in the safe recovery of your shoulder.
Again, depending on the extent of the damage, the exercises will initially be light such as isometrics (flexing your muscles with no joint movement) and will build through a series of intensities over weeks or months until you are back to doing your regular 100 press-ups. Initially you will work with your own body weight, then, with improvement, weights, exercise bands or other training equipment may be added. Regular trips to the physio will gauge your rate of recovery and drive your new exercise regime. All of these activities are designed to minimise strain on your shoulder while exercising the damaged muscles and tendons, so building their strength in order to support the damaged joint.
If particularly bad, your doctor may recommend surgery to aid in repair of the joint. There are a variety of surgical procedures that can be performed to improve shoulder movement and help in joint repair. The specific surgery undertaken obviously depends of the extent of the damage that has taken place. Simple manipulation of the joint while the patient is under general anaesthetic may release tight areas that are causing pain and should be followed up with physiotherapy.
Keyhole surgery may be performed to remove problem scar tissue or release the joint to allow greater freedom of movement. Tears, such as a rotator cuff tear can benefit from keyhole surgery to repair the damaged tissue as this speeds up the body's natural repair process.
With shoulder joints that dislocate on a regular basis, doctors may also recommend surgery to tighten the structures that hold the joint in place.
Finally, if all else fails, or particularly in cases of advanced osteoarthritis, your doctor may recommend joint replacement where your own joint will be removed and replaced with a correctly sized prosthesis. These artificial joints have a lifespan or around 20 years so your age may be taken into consideration when selecting this option.
Importance of diagnosis to offer the best treatment
Timely diagnosis of a shoulder injury is really important as, depending on the extent of the damage, some injuries initially require immobilisation while others benefit from movement. If in doubt head off to A&E to have your shoulder checked out.
Many sporting injuries can be prevented by a good warm up regimen before starting to exercise. This includes a series of movements that increase the blood flow to the muscles and stretch the joints. Knowing your own level of fitness is important; it is when you push your body beyond these limits that accidents start to happen.