Shoulder Pain

DID YOU KNOW THAT…

Shoulder pain is common with an annual population prevalence of up to 46.7% and lifetime prevalence of up to 66.7%. It is mainly managed in primary care where it is the third most common musculoskeletal (MSK) reason to consult a healthcare professional.

The clinical management  is based on the clinical history and physical examination to establish the likely clinical diagnosis. It is important to differentiate between the most common clinical causes such as subacromial impingement, acromioclavicular joint (ACJ) disorders, adhesive capsulitis ‘frozen shoulder’, rotator cuff disorders (RC), and the neck or serious pathology.

Common causes of shoulder pain:

Subacromial impingement

This is a common condition in approximately 44% to 65% of all complaints of shoulder pain. It involves a reduction in space when moving or lifting the arm causing the bursa and rotator cuff tendons to become trapped inside the joint. This can be caused by:

  • A tendon which becomes swollen or torn due to overuse meaning it does not function correctly,
  • The bursa which becomes irritated / inflamed
  • The shape of the acromion (curved or hooked)
  • The growth of a bone spur.

 Acromioclavicular joint dysfunction

The acromioclavicular joint is a diarthrodial joint with a small disc that connects the clavicle (collar bone) with the acromion (part of the shoulder blade). The dysfunction in this joint can be due to a trauma, such as a joint dislocation when falling onto an outstretched hand or elbow, or degenerative conditions such as osteoarthritis. Pain is often felt at the end of the clavicle  and can cause pain when lying on the affected shoulder.

Adhesive capsulitis or frozen shoulder

Adhesive shoulder capsulitis describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral (shoulder) joint, leading to stiffness, pain and dysfunction. The incidence of adhesive capsulitis in the general population is approximately 3% to 5% but as high as 20% in patients with diabetes and in middle age women.

Others at risk include:

  • People who must wear a shoulder sling for a long period after an injury or surgery
  • People must remain still for long periods of time due to a recent stroke or surgery
  • People with thyroid disorders

Adhesive capsulitis can be primary or secondary. Primary (or idiopathic) adhesive capsulitis can occur spontaneously without any specific trauma or inciting event. Secondary adhesive capsulitis is often observed after peri-articular fracture dislocation of the glenohumeral joint or other severe articular trauma.

Rotator cuff disorders

The rotator cuff muscles are the muscles which support the shoulder joint. There two different causes of rotator cuff disorders:

Rotator cuff tear:

It is often the result of wear and tear from daily use, especially in a jobs which involve to move the arm repetitively in a certain way, like a painter or a carpenter, or sports which also involve repetitive movements like tennis and baseball. It can be caused by trauma such as falls or by lifting heavy objects. The rotator cuff tears can cause pain but also weakness in the shoulder movements.

Rotator cuff tendinopathy:

Is caused by the lack of healing of the tendons of the rotator cuff which have been irritated due to repetitive movements or overloading. Examples include increases in exercise such as swimming further distances or increasing speed without adequate training or DIY involving painting overhead.

The body, following this overload, is not able to repair the tendon properly which can cause degeneration. Catching shoulder pains early can hault this degeneration in the tendon but shoulders are often stubborn to treat.

The rotator cuff tendinopathies can cause pain in resisted movements but the strength is still preserved.

How can you treat your shoulder pain?

  1. Avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head for a few days or weeks. Ask your GP or physiotherapist when you can restart these activities.
  2. Don’t stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder doesn’t become weak or stiff but try to do more breaks between them to avoid pain worsens.
  3. Hold an ice pack if the pain is started recently or there is inflammation or heat packs if the pain has been for longer and there is stiffness.
  4. Take painkillers – anti-inflammatory painkillers  or paracetamol may help. Your GP can prescribe painkillers if needed.
  5. Go to your physiotherapist to have an assessment, treatment and ask for advice.
  6. Strengthen, strengthen, strengthen – the shoulder is a very mobile joint and strength is the key to regaining full use of the shoulder.
  7. See a consultant – last but certainly not least if your symptoms don’t improve get an XRAY or scan which may help in your management.