The shoulder is a versatile ball and socket joint that is responsible for a wide range of functions.If you start to experience pain from the shoulder, it can have a significant impact on the ability to perform many functions that we take for granted. These can range from getting out of bed to getting dressed to even combing your hair.
Shoulder pain may be the result of damaged soft tissues such as muscles, tendons or ligaments. If the cause is a strained muscle or tendon or a sprained ligament, the pain will usually be accompanied by swelling and tenderness at the joint and by difficulty using the shoulder for routine everyday functions.
Other possible causes could be a shoulder dislocation or a bone fracture. Yet another common cause of such pain is shoulder arthritis, bursitis or tendonitis. Even a heart attack can lead in some cases to shoulder pain. However, in this case, the pain is usually primarily in the chest and referred to the shoulder.
Each possible cause of shoulder pain can have different accompanying symptoms. In this article, we will briefly look at the most common causes of shoulder pain and summarize the remedies for each cause.
The shoulder comprises 3 main bones:
As with many of the joints of the body, the bones are cushioned by a layer of cartilage that prevents direct inter-bone contact inside the joint.
The junction between the scapula and the clavicle is known as the acromioclavicular (AC) joint. The glenohumeral (or shoulder joint) joint is the intersection between the humerus and the scapula.
In addition to these bones, there are 4 muscles responsible for shoulder movements, and tendons connecting these muscles to the bones of the shoulder joint. This group of four muscles makes up the rotator cuff. The ability to lift the arm over the head without pain is dependent on having healthy rotator cuff muscles and tendons as well as uninjured shoulder bones.
The most common causes of shoulder pain are summarised below. In addition to the conditions mentioned, shoulder pain can sometimes be a result of a problem in or an injury to a different part of the body. This type of pain is referred to in medical circles as referred pain.
One way to differentiate between referred pain and that resulting from an actual shoulder problem is by moving your shoulder. If the pain does not change when you do this, it is probably referred pain.
This is probably the most common cause of shoulder pain and is the result of irritation and swelling of the 4 tendons that comprise the rotator cuff. It is sometimes referred to simply as shoulder tendonitis. There is often a preceding history of repetitive movement or heavy lifting.
Along with pain when lifting objects above shoulder height, the patient will experience decreased shoulder strength and difficulty raising the arm above shoulder level. To be precise, there is pain in an arc between 60 and 120 degrees on abduction of the arm.
This injury is most commonly treated by resting the shoulder and allowing the injured tendons to heal naturally. In other words, the activity that led to the injury should be avoided for a while. NSAIDS can be used for pain relief. Doctors may also prescribe a course of physical therapy to stretch and strengthen the shoulder muscles and reduce the risk that the injury may return. A steroid injection can be considered if there is no satisfactory response to rest, analgesia and physiotherapy.
This is another common cause of shoulder pain and is the result of one or more of the tendons that form the rotator cuff getting stuck between the acromion process of the scapula and the head of the humerus. This injury is common in sports that require frequent throwing or serving motions, such as baseball (pitching) or tennis (serving).
The accompanying symptoms are similar to those described above for rotator cuff tendonitis. The patient with an injured rotator cuff will feel pain from just lifting the arm above shoulder level. He or she will also have difficulty performing overhead functions due to the pain and accompanying weakness in the shoulder, together with loss of movement. Sometimes, there is a grinding or popping sensation with movement of the shoulder.
As with rotator cuff tendinitis, rotator cuff impingement is most commonly treated by home care and rest. Icing the shoulder (or applying a cold compress to it) can also help mitigate pain and swelling. A course of physical therapy is also an important part of the treatment. If there is significant pain and inflammation, anti-inflammatory medications such as Advil (ibuprofen) may be prescribed.
If the above conservative treatments do not relieve the condition, the doctor may suggest surgery to increase the space for the rotator cuff tendons to move without being trapped in the glenohumeral joint.
The two most common forms of shoulder arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is a wear and tear condition affecting the cartilage covering the bones of the shoulder. As it progresses, the cartilage deteriorates and the bones start to contact each other directly, causing significant pain. In addition to the pain, other clinical signs include stiffness and decreased movement of the joint. There is no fundamental cure, but doctors can prescribe medications like NSAIDs to ease the pain. Physiotherapy and steroid injections sometimes also play a role. There are also various surgical treatments that can reduce the points of contact between the bones in order to ease the pain.
Rheumatoid arthritis is an autoimmune condition in which the body’s immune system attacks the joint lining of the shoulder. Although this process cannot be stopped, doctors can slow its progress by means of medications that suppress the immune system.
Tears in the cartilage covering the shoulder bones can be an occasional cause of shoulder pain, as can rotator cuff tears. These tears are usually due to trauma. The patient will have shoulder weakness and inability to raise the arm over the head.
These injuries are commonly treated by resting the shoulder and allowing the damaged tissues to recover naturally. Pain relief using medications like NSAIDs can also play a role. An orthopaedic referral is sometimes needed for an acute tear.
Like other joints, the shoulder contains fluid filled sacs that help the tendons of the joint to glide smoothly over the adjacent bones. Usually, as a result of overuse, these sacs (or bursae) can become irritated, leading to a condition known as shoulder bursitis. This condition, too can be treated by temporarily refraining from strenuous activities involving the shoulder. In most cases, the bursae will then recover naturally over time.
Broken or cracked shoulder bones can be a significant cause of shoulder pain. Elderly individuals with osteoporosis can experience these injuries from falls or collisions. Treating them successfully normally requires surgery.
A frozen shoulder injury, also known as adhesive capsulitis, is caused by thickening and inflammation of shoulder tissues that leaves inadequate room for the bones to move freely in the joint. It occurs more commonly in the 40-60 year age group and in diabetics.. Symptoms can last up to 3 years from onset to complete resolution. These include restricted shoulder movement (especially external rotation), stiffness and pain deep in the joint. It is normally treated by a combination of medications like NSAIDs, steroid injections and physical therapy.
A dislocated shoulder injury can be the cause of significant shoulder pain. It is treatable by a variety of approaches ranging from a “closed reduction” (the doctor pushing the shoulder back into the joint) to surgery.
Other possible causes of shoulder pain are cardiac (heart) attack (myocardial infarction) or a spinal cord injury or wear and tear of the joints of the cervical spine. In these cases, the pain in the shoulder is referred from the heart and the cervical spine respectively. These are extremely serious events that can lead to serious disability or death. However, they are much less common than the causes listed above. However, anyone suspecting that their shoulder pain may be due to these causes should seek medical assistance immediately. In these particular cases, the patient would usually have some pain in the chest and cervical spine as well as in the shoulder.
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