FAQ’s on Shoulder Pain
The shoulder is one of the most mobile joints of our body. The wide degrees of mobility come from its ball-and-socket configuration. This allows rotation and movement in different directions. The shoulder is made up of the humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).
The head of the humerus is a round protuberance that fits into the glenoid (socket that is located in the scapula). This joint is stabilized by the tendons and muscles of the rotator cuff (namely the supraspinatus, infraspinatus, teres minor and subscapularis).
What can cause shoulder pain?
A wide variety of conditions can cause shoulder pain. However, most shoulder injuries can be classified as fractures, arthritis, instability or tendinopathies. These are mostly injuries to the tissues of the joint, and the particular presentation of each will vary.
- Tendinitis – tendons connect the muscle to the bone. Inflammation of the tendons occurs after repeated injury or wear and tear over time. Activities that cause stress on the shoulder joint can cause acute tendinitis, or chronic tendinitis. The rotator cuff tendons are the most commonly affected by this condition.
- Tendon tears – the tendons can be torn from acute injury, or after progressive degeneration due to aging, wear and tear, among others. The tear can be partial, but sometimes can completely split the tendon. The rotator cuff tendon is commonly at risk for this injury
- Impingement – this occurs when the shoulder joint is unstable, and soft tissues are pinched by the acromion (top of the shoulder blade). This repeated irritation can cause tendinitis or bursitis over time, and can even lead to tears.
- Instability – partial or complete dislocations occur when the humeral head is displaced from the glenoid socket. This causes pain and damage to the tissues of the shoulder particularly that of the rotator cuff. Those who suffer dislocations are more at risk for subsequent dislocations
- Arthritis – there are many kinds of arthritis, but the most common is osteoarthritis, which results from progressive wear and tear, and is associated with aging. If left untreated it may even lead to stiffness and loss of range of motion.
- Fracture – this is usually after acute trauma to the shoulder joint. They often cause severe pain, swelling and bruising around the shoulder.
How is shoulder pain diagnosed?
The diagnosis of shoulder pain is made after a complete medical history and physical examination. Particular attention will be given to the details of the pain, including triggering events, aggravating movements, and others. You may also be asked to perform several clinical exams assessing the range of motion and the stability of the joint. Additional imaging studies may be requested, such as X-rays, Computerized Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) scans.
How is shoulder pain treated?
Treatment of shoulder pain will depend on the condition and its severity. Mild injuries can be treated with conservative options, such as oral anti-inflammatory and analgesic medications, or physical therapy and rehabilitation. Other options include minimally invasive procedures such as steroid injection, nerve blocks, or platelet-rich plasma therapy. Major open surgery is usually indicated only for severe injuries, or injuries that do not respond to conservative measures.
Adey-Wakeling Z, Crotty M, Shanahan EM. Suprascapular nerve block for shoulder pain in the first year after stroke: a randomized controlled trial. Stroke. 2013 Nov;44(11):3136-41. doi: 10.1161/STROKEAHA.113.002471.
Gill TK, Shanahan EM, Taylor AW, Buchbinder R, Hill CL. Shoulder pain in the community: an examination of associative factors using a longitudinal cohort study. Arthritis Care Res (Hoboken). 2013 Dec;65(12):2000-7. doi: 10.1002/acr.22082.
Hanvold TN, Wærsted M, Mengshoel AM, Bjertness E, Stigum H, Twisk J, Veiersted KB. The effect of work-related sustained trapezius muscle activity on the development of neck and shoulder pain among young adults. Scand J Work Environ Health. 2013 Jul;39(4):390-400. doi: 10.5271/sjweh.3357.
Jowett S, Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Conaghan PG. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis. Rheumatology (Oxford). 2013 Aug;52(8):1485-91. doi: 10.1093/rheumatology/ket149.