Shoulder Pain

Overview

Your shoulder is a complex joint that allows for an incredible range of motion, but this mobility can also make it vulnerable to injury and pain. It’s a ball-and-socket joint where the upper arm bone fits into the shoulder blade, held together by muscles, tendons, and ligaments. Pain can arise from a number of causes, from overuse and trauma to underlying conditions like arthritis.

Types of Shoulder Pain

Whether the pain is acute and sudden or chronic and persistent, understanding the specific type of injury can help determine the right course of treatment.

1. Tendon Tears

Tendon tears often result from an acute injury, like a fall, or from the degenerative effects of aging and long-term overuse. These tears can be either partial, going only partway through the tendon, or complete, where the tendon fully separates from the bone. The rotator cuff and biceps tendons are the most common sites for these injuries.

2. Tendinitis

Tendinitis is the inflammation of a tendon, the fibrous cord that connects muscle to bone. This condition can be acute, caused by excessive overhead activities, or chronic, resulting from degenerative wear and tear over time. The most frequently affected tendons in the shoulder are the four tendons of the rotator cuff and the biceps tendon.

3. Fracture

Shoulder  fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade). These injuries often result from a fall or high-energy trauma, such as a car collision or sports impact, and are characterized by severe pain, swelling, and bruising.

4. Impingement

Shoulder impingement occurs when the acromion (the top of the shoulder blade) pinches the soft tissues below it, specifically the rotator cuff tendons and bursa, as the arm is lifted. This repeated friction can lead to inflammation, causing pain and limiting the ability to move the arm freely.

5. Arthritis

Arthritis can be a significant cause of shoulder pain. Osteoarthritis, or “wear-and-tear” arthritis, is the most common type and develops slowly over time as the joint’s cartilage breaks down. Other types of arthritis, like rheumatoid arthritis, can also affect the shoulder joint, causing inflammation and stiffness.

6. Bursitis

Bursae are small, fluid-filled sacs that act as cushions between bones and soft tissues. Bursitis is the inflammation and swelling of a bursa, often due to excessive use of the shoulder. This condition can cause pain and make everyday activities difficult.

7. Instability

Shoulder instability happens when the head of the humerus is forced out of the shoulder socket. This can be a partial dislocation (subluxation) or a complete dislocation. Once the supporting ligaments and muscles become loose or torn, repeated dislocations can occur, leading to pain and a feeling of unsteadiness when moving the arm.

Symptoms of Shoulder Pain

• Pain while moving the arm: This is a common symptom of various shoulder issues, especially when lifting the arm or reaching overhead.
• Stiffness or limited range of motion: You may find it difficult to move your arm or shoulder in certain directions.
• Weakness: The shoulder and arm may feel weak, making it hard to carry out normal activities.
• Deformity or swelling: The shoulder joint may look visibly out of place, or you might notice sudden swelling or bruising.
• Clicking, grinding, or popping sound: Some shoulder conditions can cause a sound or sensation of the joint catching or grinding when you move it.
• Intense pain: Severe, sharp pain is often a sign of a more serious injury, such as a fracture or dislocation.
• Referred pain: Pain that originates in the shoulder but travels to the neck, arm, or hand, often accompanied by a tingling sensation, may be caused by a problem with nerves in the neck.

Causes of Shoulder Pain

• Performing the same motion repeatedly, such as during sports (e.g., swimming or throwing) or work-related tasks (e.g., painting), can inflame soft tissues like the bursa and tendons, leading to conditions like bursitis or tendinitis.
• An acute injury can cause significant damage to the shoulder’s structure
• Nerve injury and the damage to the nerves can cause pain that extends beyond the shoulder itself.

Diagnosis

• Medical History: A doctor will ask questions about when the pain started, its severity, and if you have any pre-existing health conditions to determine potential causes.
• Physical Examination: The doctor will check for physical abnormalities, swelling, and muscle weakness. They will also assess your shoulder’s range of motion and strength.
• X-rays: This imaging test can show injuries to the bones of your shoulder joint, such as fractures, bone spurs, and arthritis.
• Magnetic Resonance Imaging (MRI) and Ultrasound: These tests provide detailed pictures of soft tissues, helping to identify injuries to ligaments and tendons.
• Computed Tomography (CT) Scan: A CT scan uses a combination of X-rays and computer technology to produce a very detailed view of the bones in the shoulder area.
• Electrodiagnostic Testing: A test such as an electromyography (EMG) may be used to evaluate nerve function and check for nerve-related problems.
• Arthroscopy: In this surgical procedure, a doctor uses a fiber-optic camera to look inside the joint, which can help reveal soft tissue injuries not visible through other tests.

Shoulder Pain Treatment

Treatment for shoulder pain varies widely depending on the cause and severity

Self-Care

• Rest: Avoid activities that worsen the pain to give the shoulder time to heal.
• Activity modification: Adjust daily routines and work habits to reduce strain on your shoulder.
• Heat or cold therapy: Apply an ice pack (wrapped in a towel) to reduce swelling and pain after a minor injury. For general muscle soreness, a heat pack can help ease tension.
• Over-the-counter medication: Use simple painkillers like ibuprofen to manage pain and inflammation.

Medical Care

• Physical therapy: A therapist can guide you through specific exercises to improve your shoulder’s strength, flexibility, and overall function.
• Medications: Your doctor may prescribe stronger anti-inflammatory drugs or recommend cortisone injections directly into the joint to relieve severe pain and swelling.
• Surgery: If other treatments don’t work, or if the injury is severe (e.g., a complete tendon tear or recurring dislocations), surgery may be necessary. Procedures can range from minimally invasive arthroscopy to traditional open surgeries, including shoulder replacement.

When to See a Doctor

Seek medical care immediately if the pain is intense, your shoulder looks deformed, or you can’t use your arm at all. You should also consult a doctor if the pain comes with sudden swelling, redness, or a fever. A professional evaluation is recommended to get a proper diagnosis and treatment plan.