Shoulder pain is a symptom associated with sports people and those who engage in demanding manual labour. However, this is not true. Shoulder pain is common among the general population and is predominant in people aged 50 years or more.
The shoulder is a complex structure with a wide and versatile range of motion. It is a joint made up of three bones (the humerus bone of the arm, the collarbone and the shoulder blade). These are linked together with muscles through strap like structures known as tendons. The joint is lined with a special fluid that allows it to glide easily during motion. The shoulder joint is the most mobile in the body. If any of these structures are damaged, the outcome is almost invariably painful.
This is a form of joint disease in which the protective lining of the bone wears down and leads to pain. Most people with arthritis report joint pain, stiffness, swelling, weakness and a clicking sound when they move. Arthritis is more common in people over 60 years but it can occur earlier in people who have injured the shoulder.
Muscle and tendon damage
The tendons and muscles around the shoulder can become inflamed or torn leading to pain. The pain is more pronounced when performing repetitive movement, sleeping on the affected side, reaching for objects overhead or when trying to reach behind your back.
If the arm bone (humerus) slips out of place, the shoulder is referred to as being dislocated. The resultant effect is severe pain and inability to use the shoulder. Most dislocations occur after a fall, accident or sports. Shoulder dislocation can be either partial or complete. Both can usually be corrected without surgery.
If any of the three bones that form the shoulder joint are broken, there will be shoulder pain, swelling, deformity and bruising. Fractures are usually easy to identify with a plain radiograph (x-ray). These fractures can be treated either with surgery or conservatively depending on the location and severity of the fracture.
This is a relatively uncommon cause of shoulder pain. Often it occurs after shoulder surgery and can be managed with antibiotics.
As earlier mentioned, the shoulder has some fluid that allows it to move easily. This fluid is found in little sacs known as bursa. The bursa can become inflamed leading to a dull ache in the shoulder. This pain is worse on motion. Bursitis is common in people who engage in sports or perform manual work.
Shoulder impingement occurs when the top of the shoulder blade puts pressure on the underlying soft tissues. Pain is usually experienced when the arm is lifted.
If shoulder problems are not properly addressed, the tissues around the joint may become thickened and inflamed leading to immobility of the shoulder. This is known as a ‘frozen shoulder’. This condition causes significant pain, stiffness and reduces the range of motion at the shoulder drastically.
Occasionally, shoulder pain can come from an organ outside the shoulder. This includes diseases of the heart, liver, gall bladder and neck. Heart attack usually causes pain in the chest and this may spread to the neck, shoulder and arm. This is a medical emergency. Liver and gall bladder pain is usually located in the right upper part of the belly but in some conditions affecting these organs, it may spread to the right shoulder. Neck pain originating from the spine and backbone may also cause shoulder pain.
A review of symptoms and a thorough physical examination will help the doctor determine the cause of the shoulder pain. Sometimes, tests are necessary.
These include plain radiographs (X-rays) and MRI scans. If there are concerns about muscles or nerves, special tests may be done to assess for this. In a few cases, the orthopaedic surgeon may need to put in a special camera into your shoulder to assess for cause of pain. In these cases, the same procedure can be used to fix the problem.
In many cases, you can treat shoulder pain at home. However, physical therapy, exercise, medication, or surgery may also be necessary.
Should you rest the shoulder or exercise it?
The best management of shoulder pain is determined by its cause. For example, if the pain is caused by a fracture or dislocation, rest the shoulder. If the pain is caused by arthritis, resting the shoulder may lead to worsening of the stiffness and tightening of the joint. In cases of arthritis, motion is necessary to improve function. Ask your doctor about the best plan for managing your condition.
Physiotherapy and exercise reduces stress on the shoulder joint and improves its stability. The exercises strengthen the muscles around the shoulder joint as well so that they can reduce the pressure.
Drugs usually reduce inflammation. These are given either as tablet form or sometimes as injections.
Surgery is reserved for managing conditions that do not respond to non-surgical treatment options. Surgical procedures include repairing torn tissues, removing scar tissue, fixing fractures, and shoulder replacement.