SHOULDER PAIN – CAUSES, SYMPTOMS AND TREATMENTS
The shoulder has a wide and versatile range of motion. When something goes wrong with your shoulder, it hampers your ability to move freely and can cause a great deal of pain and discomfort. The shoulder joint is the most mobile joint in the body. It moves the shoulder forward and backward. It also allows the arm to move in a circular motion and to move up and away from the body. Shoulders get their range of motion from the rotator cuff. The rotator cuff is made up of four tendons. Tendons are the tissues that connect muscles to bone. It may be painful or difficult to lift your arm over your head if the tendons or bones around the rotator cuff are damaged or swollen.
Here’s what you need know about shoulder pain, including causes, diagnosis, treatment, and prevention.
What causes shoulder pain?
Several factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis. This is a condition characterized by swollen tendons. Sometimes shoulder pain is the result of injury to another location in your body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse when you move your shoulder.
Other causes of shoulder pain include:
- torn cartilage
- torn rotator cuff
- swollen bursa sacs or tendons
- bone spurs (bony projections that develop along the edges of bones)
- pinched nerve in the neck or shoulder
- broken shoulder or arm bone
- frozen shoulder
- dislocated shoulder
- injury due to overuse or repetitive use
- spinal cord injury
- heart attack
You can injure your shoulder by performing manual labor, playing sports, or even by repetitive movement. Certain diseases can bring about pain that travels to the shoulder. These include diseases of the cervical spine (neck), as well as liver, heart, or gallbladder disease. You are more likely to have problems with your shoulder as you grow older, especially after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age. In many cases, you can treat shoulder pain at home. However, physical therapy, medications, or surgery may also be necessary.
Most shoulder problems only affect a small area and should last a relatively short time.
But sometimes the problem in your shoulder could be part of a wider, long-term condition such as osteoarthritis. It’s fairly common for people with rheumatoid arthritis to have pain and swelling in their shoulders. Osteoarthritis is less likely to affect your shoulders than other joints, unless you’ve injured them in the past.
How is the cause of shoulder pain diagnosed?
Your doctor will want to find out the cause of your shoulder pain. They’ll request your medical history and do a physical examination. They’ll feel for tenderness and swelling and will also assess your range of motion and joint stability. Imaging tests, such as an X-ray or MRI, can produce detailed pictures of your shoulder to help with the diagnosis. Blood tests aren’t usually needed for most shoulder problems, but they’re sometimes used to rule out other conditions, including some types of arthritis. X-rays are good for looking for problems with the bones in your shoulder and minor changes in the joints. However, small changes are quite common and may not be the cause of your trouble. X-rays can only show bones and other hard substances, but they won’t show injuries to soft tissue like muscles.
An ultrasound scan can show swelling, as well as damage and problems with the tendons, muscles or other soft tissues in the shoulder. It uses high-frequency sound waves to examine and build pictures of the inside of the body.
You may be referred for magnetic resonance imaging (MRI) scans if your doctor suspects a more complex problem with the soft tissue in your shoulder. An MRI uses radio waves to build a picture to show what’s happening to the bones and soft tissue, such as the muscles and tendons, inside your shoulder. Sometimes dye is injected into the shoulder before the MRI to get a clearer picture – especially in cases of shoulder dislocation. Nerve conduction studies can show whether your problems are being caused by the nerves in your arm being pinched or irritated. They measure the electrical activity in the muscles and nerves. It’s common to feel slight pain or discomfort, like a tapping on the skin, but the test doesn’t last long.
Your doctor may also ask questions to determine the cause. Questions may include:
- Is the pain in one shoulder or both?
- Did this pain begin suddenly? If so, what were you doing?
- Does the pain move to other areas of your body?
- Can you pinpoint the area of pain?
- Does it hurt when you’re not moving?
- Does it hurt more when you move in certain ways?
- Is it a sharp pain or a dull ache?
- Has the area of pain been red, hot, or swollen?
- Does the pain keep you awake at night?
- What makes it worse and what makes it better?
- Have you had to limit your activities because of your shoulder pain?
When should I seek medical help?
You should contact your doctor if you experience fever, inability to move your shoulder, lasting bruising, heat and tenderness around the joint, or pain that persists beyond a few weeks of home treatment.
How can I prevent shoulder pain?
Simple shoulder exercises can help stretch and strengthen muscles and rotator cuff tendons. A physical therapist or occupational therapist can show you how to do them properly. If you’ve had previous shoulder issues, use ice for 15 minutes after exercising to prevent future injuries. After having bursitis or tendinitis, performing simple range-of-motion exercises every day can keep you from getting frozen shoulder.
There are several ways you can help your shoulder pain:
- Heat or cold therapy
- Reduce the strain
- Rest and exercise
- Complementary treatments
If your shoulder pain doesn’t improve with simple home treatments, there are other alternatives your doctor can recommend for you to try:
- Occupational therapy
- Steroid injections
Most shoulder problems will benefit from physiotherapy.
Physiotherapists are specialists who can help reduce your shoulder pain and show you how to improve the way your shoulder works by using a variety of strengthening and stretching exercise, massage and other therapeutic techniques.
They’ll work with you to improve your symptoms and help get your shoulder moving properly again. What they suggest for you will depend on whether your problem is short-term or a long-standing condition. Almost everyone will benefit from physiotherapy, using methods such as:
- exercises to strengthen weakened muscles, change their co-ordination and improve function
- advice on improving shoulder, neck and spine posture
- exercises to ease or prevent stiffness
- exercise to increase the range of joint movement
- applying adhesive tape to the skin to reduce the strain on the tissues, and to help increase your awareness of the position of the shoulder and shoulder blade
- manual treatments to the soft tissues and joints – such as massage and manipulation.
- Some minor shoulder pain can be treated at home. Icing the shoulder for 15 to 20 minutes three or four times a day for several days can help reduce pain. Use an ice bag or wrap ice in a towel because putting ice directly on your skin can cause frostbite and burn the skin.
- Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. Limit overhead work or activities.
- Other home treatments include using over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and inflammation and compressing the area with an elastic bandage to reduce swelling.
Your doctor may also prescribe medication such as nonsteroidal anti-inflammatory medications (NSAIDs) or corticosteroids. Corticosteroids are powerful anti-inflammatory drugs that can be taken by mouth or your doctor can inject into your shoulder. Simple painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen tablets and gels, from a chemist or supermarket can help. A pharmacist should be able to give you good advice on what could work best for your condition. But don’t use them for more than two weeks without seeking further medical advice.
Each shoulder problem has its own pattern of symptoms that can help your doctor or a physiotherapist make a diagnosis. Most conditions make it painful to use or move your shoulder, but some make your shoulder feel stiff.
Your doctor or physiotherapist will need to see which movements are the most painful, as this could show where the problem is. They will usually ask how the problem started, how it has developed and how it affects your daily activities.
If you can, try to write a few notes about when and how the problem started and what makes it feel worse before your appointment. This will help you get a more accurate diagnosis.
Usually your physiotherapist or doctor can recommend the best course of treatment once they’ve diagnosed what your condition is. However, they may send you for further tests if they suspect your problems are being caused by arthritis or a more complicated condition.
Although you should aim for a balance between rest and exercise, it’s best to remain generally active and try to exercise every day.
You may feel some slight discomfort during and after the exercises, but this should settle within 24 hours. If you feel a sudden or sharp pain you should stop exercising and speak to a doctor, physiotherapist or nurse before trying again.
Remember to keep exercising regularly, even after your shoulder pain has cleared up.
Some conditions, such as a rotator cuff injury, will need specialist advice from a physiotherapist or doctor before you start doing any exercise. If you are unsure about how best to improve your condition seek advice first. These exercises are designed to help ease some shoulder pain and strengthen the structures that support your shoulder. When you start these exercises, it’s important to take them in your stride and not push yourself too much.
Squeeze your shoulder blades back and together and hold for five seconds. Pull your shoulder blades downward and hold for five seconds. Relax and repeat 10 times.
Door press (a)
Stand in a doorway with your elbow bent at a right angle and the back of your wrist against the door frame. Try to push your arm outwards against the door frame. Hold for 5 seconds. Do 3 sets of 10 repetitions on each side.
Door press (b)
Use your other arm and, still with your elbow at a right angle, push your palm towards the door frame. Hold for 5 seconds. Do 3 sets of 10 repetitions on each side.
Stand with your good hand resting on a chair. Let your other arm hand down and try to swing it gently backwards and forwards and in a circular motion. Repeat about 5 times. Try this 2-3 times a day.
- Most cases of shoulder pain aren’t caused by anything serious and will ease within 2 weeks.
- You can take painkillers to ease pain. Taking them before exercise can help you stay active without causing extra pain.
- Using an ice pack, learning how to protect your joints and being aware of your posture will help cases of shoulder pain.
- Try the exercises suggested here to help ease pain and prevent future symptoms.
Aim for a balance between rest and activity to prevent your shoulder from stiffening. Try to avoid the movements that are most painful, especially those that hold your arm away from your body and above shoulder height. It’s important to remain generally active, even if you have to limit how much you do.
When raising your arm, you can reduce the strain or pull on your shoulder by:
- keeping your elbow bent and at the side of your body
- keeping your palm facing the ceiling when reaching up.
When lowering your arm, bend your elbow, bringing your hand closer to your body.
If your pain increases when exercising, stop doing it and seek medical advice. Otherwise, remember to keep exercising regularly, even after your shoulder pain has cleared up.