Shoulder pain is very common and the symptoms can indicate one diagnosis out of a group of shoulder conditions such as tendonitis, arthritis, bursitis and rotator cuff tears. Shoulder pains can arise from the shoulder structures themselves or be referred from nearby joints, discs or muscles.
Due to changes in the neck and shoulder structures occurring more strongly on one side or another, it is common to have right shoulder pain or left shoulder pain.
The shoulder girdle is made up of the shoulder blade or scapula, the collar bone or clavicle and the upper arm bone or humerus. The shoulder joint proper is the joint between the ball of the humerus and the socket, called the glenoid, on the scapula.
The shoulder joint is the most mobile joint in the body to allow us to place our hands in the great variety of positions required for different activities. The joint's great mobility comes from the big ball of the arm bone, the small socket and the lax capsule or fibrous bag which surrounds all our major joints.
However we pay for the mobility of the shoulder joint by having a joint which is relatively unstable and moderately easy to dislocate. Shoulder dislocation is the most common type of dislocation injury. The shoulder is a “soft tissue joint” in the sense that the function of the shoulder is greatly determined by the strength of the muscle groups surrounding it.
The Cause of Shoulder Pain
Rotator Cuff Pain and Rotator Cuff Tears
The rotator cuff or rotary cuff is a group of four muscles which start off from the scapula and head towards the upper end of the arm bone. When they approach the ball of the arm bone they are tendons, i.e. made of fibrous material, and they stick onto (insert into) the head of the arm bone. This allows the muscles to pull and the pull to be transmitted to the arm bone by the tendons of each muscle. The tendons become intermeshed with each other over the head of the arm bone and make up the cuff.
The rotator cuff tendons can be affected in various ways and one is just the passage of time, which results in small tears developing in the tendons. These can be painful and interrupt the ability of the muscles to do their job supporting the shoulder so the large shoulder muscles can lift the arm.
“Grey hair equals cuff tear” is a saying amongst shoulder surgeons which illustrates how important our age is to the type of shoulder problems we are likely to have.
Shoulder impingement is caused when part of the rotator cuff tendon, usually the supraspinatus muscle tendon, passes repeatedly with pressure under the bony arch directly above the shoulder joint. This can cause inflammation and pain and lead to cuff tears with time. This tendinitis may be referred to as rotator cuff tendinitis and can be due to time and use, repeated excessive use such as in sport or due to an injury.
Shoulder Pain and Neck pain
Neck pain and shoulder pain often go together as the neck can refer pain out to the shoulder and shoulder blade areas and give the impression there is a shoulder problem when there is none. Upper back pain in particular is connected with shoulder pain but anyone with middle back pain should also be examined with this in mind if they complain of neck and shoulder pain. Shoulder pain and arm pain may indicate a nerve root problem in the neck - a shoulder pain "trapped nerve".
Back pain in the lower areas is not generally connected with shoulder pain but there are back pain causes which can include shoulder pain symptoms and for which back pain treatment may cover the problems with the shoulder. Nerve root symptoms (like sciatica in the arm) can involve the shoulder girdle, shoulder and arm and need distinguishing from true shoulder problems. Kidney pain may radiate upwards towards the shoulder or be part of a back pain syndrome.
Osteoarthritis of the shoulder joint is not common and may be part of a generalised arthritic condition in some patients.
A bursa is a lubricating sac between two anatomical structures which slide past each other during bodily movement, potentially causing friction. A healthy bursa allows smooth, painless and friction free movement but if inflamed they can cause pain and movement limitation.
Frozen shoulder syndrome is a troublesome pain and stiffness problem in the shoulder, often after only trivial injury which can take over two years to settle and in some cases is treated with shoulder pain surgery. Frozen shoulder pain relief is difficult to achieve but physiotherapy, injections, manipulation or an operation may be required.
Inflammation of the tendons apart from the rotator cuff can occur, with bicipital tendinitis, where the biceps tendon becomes inflamed at the front of the shoulder, is the most commonly described type.
Shoulder Dislocations and Shoulder Fractures
These traumatic injuries are common, dislocations in younger people doing sport and fractures in older people who fall.
In rare cases a sudden onset of severe shoulder pain can be the indication that someone is having a heart attack. If this is suspected or the patient has shortness of breath, pain in the arm, side of jaw or neck, sweating or dizziness then emergency medical help should be summoned. As a cause of shoulder pain, cancer is extremely uncommon but any indication that the pain does not have a musculoskeletal cause should be discussed promptly with a doctor.
Shoulder Pain Remedies
Physiotherapy as relief for shoulder pain can be useful to assess the type of shoulder problem present and suggest management and treatment. Acute pain is treated by a physio with rest, splinting, ice and painkillers as appropriate. Once the pain has settled from the acute level then rehabilitation exercises are begun with the physio and progress towards normal over a period of weeks.
Shoulder muscle pain is often attributed to trigger point problems in the muscles themselves which are identifiable with the fingers. Physios treat this kind of problem with stretches, strengthening, postural changes, acupuncture, trigger point compression and advice.
Prevention of a recurrence may involve moderating or altering an activity which may have been a shoulder pain cause.