Shoulder pain affects the most movable joint of the body. The shoulder allows movement not only forward and backward, but also allows the arm to move in a circular motion as well as move up and away from the body. In addition, the shoulder is one of the most unstable joints in the body. As a result, the shoulder is susceptible to multiple problems and injuries.
The shoulder is a ball-and-socket joint with three main bones, cushioned by a layer of cartilage. Shoulders get their range of motion from the rotator cuff, which is made up of four tendons that connect muscles to bone. You can injure your shoulder by performing manual labor, playing sports, or just repetitive movements. Furthermore, certain diseases can produce pain that radiates into the shoulder.
You probably don’t think about your shoulders much, until you experience pain in one of them. Shoulder pain can make simple activities painful, like hair brushing, reaching behind your back, or reaching for something overhead.
As we get older, especially after age 60, we’re more likely to have shoulder problems. This is because the soft tissue surrounding the shoulder tends to degenerate with age. Fortunately, most cases of shoulder pain aren’t caused by anything serious and will generally improve within 2 weeks. When the pain doesn’t go away on its own, Novus Spine & Pain Center can help. Here’s what you need to know about shoulder pain, including causes, diagnosis, and treatment.
The shoulder joint may cause shoulder pain; however, the pain can also be from any of the surrounding muscles, ligaments, or tendons. Generally, shoulder pain that involves the shoulder joint typically worsens with activity or movement of the arm or shoulder.
However, various diseases and conditions that affect the chest or abdomen (such as heart disease or gallbladder disease) can also cause shoulder pain. Shoulder pain that arises from another structure is called referred pain. It usually doesn’t worsen with shoulder movement.
It is essential to point out that sudden pain in the left shoulder can be a sign of a heart attack. Should you experience sudden pressure or crushing pain in your shoulder, especially if the pain runs from your chest to the left jaw, arm, or neck, or is accompanied with shortness of breath, dizziness, or sweating, call 911 immediately.
If you experience a severe injury and find your shoulder to be very painful, swollen, bruised, or bleeding, contact a medical professional.
What Causes Shoulder Pain?
Several factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis, a condition characterized by swollen tendons. Another common cause of shoulder pain is impingement syndrome, where the rotator cuff gets caught between the bones of the shoulder.
The most common cause of shoulder pain occurs when rotator cuff tendons become trapped under the bony area in the shoulder. The tendons become inflamed or damaged (rotator cuff tendinitis or bursitis).
Some of the typical causes of shoulder pain include:
Arthritis is generally associated with the hips and knees, arthritis, osteoarthritis, rheumatoid arthritis, and septic arthritis; however, it can also affect the shoulder. The condition develops when the cartilage that cushions the bones in the shoulder erodes, causing the bones to rub against one another.
Avascular necrosis is the death of bone tissue as a result of limited blood flow.
Bone spurs are bony projections that develop along the edges of bones in the shoulder area.
Brachial plexus injury. This occurs when the nerve root is damaged or torn away from the spinal cord.
Break or fracture. A shoulder fracture is a break or cracks in the collarbone, arm bone, or shoulder.
Bursitis is an inflammation of bursae (small, fluid-filled sacs) that cushion and lubricate the shoulders.
Cervical radiculopathy is the inflammation or damage to a nerve root in the neck.
Dislocation. The ball of the upper arm bone (humerus) pops out of the socket (glenoid).
Frozen shoulder (adhesive capsulitis). The muscles, tendons, and ligaments inside the shoulder become stiff, making movement difficult and painful.
Glenoid labrum tear (shoulder joint tear). Injury to the cartilage that surrounds the rim of the shoulder socket.
Impingement syndrome. As one of the most common causes of shoulder pain, this condition is a form of tendinitis. It occurs when there is compression of tendons or bursa in the shoulder from bones of the shoulder.
Labral tear of the shoulder is the tearing of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place. It can be the result of injury or sometimes as part of the aging process.
Muscle tension is often linked to the way one stands or sits. The muscles between the neck and shoulder tighten and cause pain.
Overexertion. Sprains and strains can cause the muscles and tendons in the shoulder to become inflamed.
Rotator cuff injury. Overuse, aging, a fall, or other trauma can strain the rotator cuff tendons, causing them to become inflamed and lead to a tear.
Separated shoulder is an injury resulting from a fall, a blow to the shoulder, or other trauma that tears the ligaments that hold the joint together.
Shoulder joint instability is a problem that occurs when the structures surrounding the shoulder joint do not properly maintain the ball within its socket.
Spinal cord injury. Shoulder pain from overuse of the arm is common after a spinal cord injury.
Thoracic outlet syndrome occurs when the blood vessels or nerves become compressed between the collar bone and first rib.
Some diseases can also cause shoulder pain. These include:
Lyme disease. Lyme disease is an infectious disease spread by the bite of deer ticks infected with the bacteria Borrelia burgdorferi. If not treated early, the disease symptoms may progress to affect the joints, including the shoulder, as well as the heart and nervous system.
Other diseases. Some other causes of shoulder pain can include gallstones, liver abscess, angina, and an ectopic pregnancy.
What are the Symptoms of Shoulder Pain?
Shoulder pain is any pain in or around the shoulder joint. Swelling, damage, or bone changes around the rotator cuff can cause pain in the shoulder. There may be pain when lifting the arm above the head or moving it forward or behind your back. The pain may occur when simply moving the arm or when holding something while moving the arm.
How is Shoulder Pain Diagnosed?
To discover the cause of shoulder pain, a doctor will perform a physical examination with a focus on the shoulder. The doctor will check for tenderness and swelling, while assessing your range of motion and shoulder joint stability, to determine which movements are the most painful and identify the problem.
The doctor will also want to review your medical history and ask questions about any shoulder problems. Your doctor will want to know how the problem started, how it has developed, and how it affects your daily activities.
Blood tests aren’t usually needed for most shoulder problems; however, they can help rule out other possible causes of the pain, including some types of arthritis.
Imaging tests may help diagnose the problem. Tests that can produce detailed pictures of the shoulder include:
X-rays. Standard X-rays can reveal narrowing of the space between bones, arthritis-like diseases, tumors, or fractures.
MRI (magnetic resonance imaging) is a procedure that can reveal detailed images of the soft tissues and nerves, as well as problems with the tendons and ligaments.
Myelography is sometimes used as an alternative to MRI. This test involves the injection of a water-soluble dye in the area for better viewing of the nerve roots. The images are viewed with a real-time form of X-ray called fluoroscopy.
Electrodiagnostic (EMG) studies. EMG and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain, arm pain, numbness, and tingling.
Ultrasound is a scan that can show swelling, as well as damage and problems with the tendons, muscles, or other soft tissues in the shoulder.
Computerized axial tomography (CAT) scan is a test that combines X-rays and computers to produce multiple images, which are combined to depict cross-sectional slices of internal structures and soft tissues more clearly than traditional X-rays.
Bone scan includes a small amount of radioactive material that is injected into the bloodstream which collects in the bones enabling doctors to better see the area with a scanner.
Nerve conduction study is a test to measure electrical activity in the muscles and nerves. This test can show whether shoulder pain is being caused by a pinched or irritated nerve in the arm.
How is Shoulder Pain Treated?
Specific shoulder pain treatment depends on the cause and the severity of the pain. Treatment options include self-care measures, medications, non-invasive procedures as well as surgery for some types of conditions.
Some typical home remedies to relieve minor shoulder pain include:
Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) help reduce inflammation and pain.
Rest. Avoiding movements that cause or worsen the pain for several days before returning to normal activity is often helpful.
Hot and cold therapy. For aching shoulders without acute inflammation, heat may provide relief. Cold helps reduce inflammation and chronic pain. Apply an ice pack for 15 to 20 minutes three or four times a day for several days to help reduce pain. When using an ice pack, wrap it in a towel to avoid frostbite.
Compression. An elastic bandage to compress the area can help reduce swelling.
Elevation helps reduce swelling. When lying down, use pillows to keep the shoulder(s) elevated higher than the heart.
Exercise. A doctor or physical therapist can recommend exercises that can stretch and strengthen tendons and shoulder muscles. Range-of-motion exercises can help avoid frozen shoulder when recovering from tendinitis. Good posture will help keep shoulder muscles and tendons properly positioned.
Topical analgesics. For soft tissue (not bone-related), over-the-counter, topical preparations work through various active ingredients (trade names such as Aspercreme,Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot, VoltarenGel and Zostrix) can be helpful for people unable to take oral medications or when oral medications fail to relieve pain or reduce it to a manageable level.
If shoulder pain doesn’t improve with simple self-care treatments at home, there are alternative treatment options. Your doctor may prescribe medication which can include:
Nonsteroidal anti-inflammatory drugs. If over-the-counter pain relievers are not effective, prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) can help ease arthritis pain and inflammation.
Analgesics. Analgesics are among the most commonly prescribed drugs for many forms of arthritis. They also may be used to relieve pain from fractures and other injuries. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief.
Corticosteroids. Quick-acting drugs (similar to the cortisone made by your own body) are helpful in controlling inflammation. If the inflammation is limited to one or a few joints, your doctor may inject a corticosteroid preparation directly into the joint.
Regenerative (stem cell) therapy. Using the body’s own stem cells is a potentially more effective therapy to enhance tendon-to-bone healing over surgical procedures. Some common shoulder pain conditions that respond to stem cell therapy include:
Transcutaneous electrical nerve stimulation (TENS). Weak electric current is administered through electrodes placed on the skin. TENS is believed to stop pain receptor messages from reaching the brain by targeting sensory nerves. It may be useful for short-term pain control in some people with shoulder arthritis.
Electrical stimulation. Electrical stimulation of muscle tissue (called neuromuscular electrical stimulation) around the shoulder may also be useful for strengthening the muscles that support the joint and relieving pain in and around the joint. This technique works by targeting muscles and contracting them, which can aid in recovery.
Other treatments that can help with shoulder pain include:
Physical therapy. When pain begins, physical therapy may help strengthen the shoulder muscles and maintain joint range of motion. In some cases, a doctor may also prescribe physical therapy for some shoulder injuries or to aid in recovering from shoulder surgery.
Slings or shoulder immobilizers. For certain shoulder fractures, including most fractures of the scapula, using a sling to immobilize the affected joint is effective. The shoulder may be stiff when first removing the sling, so an exercise or physical therapy program is often necessary to regain full motion of the shoulder after an extended period of immobilization.
Assistive devices. When it is difficult to perform daily tasks (bathing, dressing, driving, or reaching for items), assistive devices can make it easier. Devices include reachers, zipper pulls, long-handled brushes or sponges, and specially designed adaptive clothing. Many assistive devices are available through medical supply stores and specialized mail-order catalogs. Your doctor and therapist can recommend the best assistive devices for you.
If a shoulder is injured or arthritis interferes with function and causes pain that can’t be controlled with medication, surgery may be an option – or a necessity. Some of the most commonly performed shoulder surgeries include:
Fracture repair. While many fractures can be healed by immobilization, other fractures require surgery to position the bones properly. In some cases, hardware is required to hold the pieces of bone in place while they heal. The type of repair procedure will depend on the bone fractured, and the severity of the fracture.
Shoulder replacement. For shoulder pain that fails to respond to nonoperative treatments, shoulder replacement surgery may be needed to relieve pain and restore mobility. Pain relief is the primary reason for having a shoulder replacement.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating shoulder pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.