Shoulder Pain: Causes, Diagnosis and Treatment

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What is causing your shoulder pain?

The Shoulder region is one of the most common areas of pain and injury in our body and there are different reasons to explain why our shoulders hurt. The shoulder is a complex structure formed of bones such as the humerus, scapula and clavicle, muscles, tendons, ligaments and cartilage.

The shoulder itself is a ball & socket joint which allows for a wide range of movement. Unlike the hip joint the shoulder joint has to create its own ball & socket joint with the use of cartilage. This makes the shoulder more susceptible to injury because the shoulder itself is not thought to be a weight bearing joint, and for this reason the most common injuries occur during overhead movements.

Here are several conditions that can cause shoulder pain:

Shoulder arthritis

Shoulder Arthritis causes inflammation and pain in joints of the body. Joint surfaces are covered by cartilage to help promote smooth and flowing movement and to reduce friction and irritation. When the cartilage lining thins it affects the underlying bony surface causing the joint to progressively alter its shape and position. With regards to the shoulder, the effects of arthritis can cause the muscles and tendons to work harder. The shoulder can be affected by arthritis such as; osteoarthritis (although less common compared to other joints of the body), rheumatoid arthritis and post-traumatic arthritis.

Adhesive Capsulitis

Adhesive Capsulitis is a condition characterized by stiffness and pain in the shoulder joint. It is more commonly known as frozen shoulder and can take up to 18 months to resolve. The shoulder joint is surrounded by a capsule filled with synovial fluid that helps to keep the cartilage surfaces lubricated and the movement of the shoulder smooth and flowing. When the capsule becomes scarred or thickened this can lead to a frozen shoulder. A frozen shoulder will often go through 3 phases; a freezing phase, a frozen phase and a thawing phase.

Shoulder Dislocation

Shoulder Dislocation: this is when your upper arm bone (humerus) slides out of the joint cavity. Shoulder dislocations can be partial or full in nature and often need referral to A&E. It is advised that you do not relocate your shoulder yourself as you can often do more damage to the shoulder joint itself. Partial and full shoulder dislocations are most commonly caused by an injury or fall.

Shoulder Fractures

Shoulder Fractures: Fractures occur during trauma to the bones of the skeletal system. With regards to the shoulders, the most common fractures are of the clavicle, head of the humerus (upper arm bone) and scapula (shoulder blade). Shoulder fractures are most associated with falls and trauma injuries.

Rotator Cuff Injuries

Rotator Cuff Injuries: The rotator cuff is a group of four muscles that come together as tendons surrounding the shoulder joint. The muscles of the rotator cuff include the; supraspinatus, infraspinatus, teres minor and subscapularis. Over use, weakness, injury or trauma to the rotator cuff can cause shoulder pain and restriction of movement.

Shoulder tendonitis or tendinopathies

Shoulder tendonitis or tendinopathies: The tendons are the small structures that connect muscles to bone. If you have tendinitis, it means that your tendons are inflamed or irritated. This condition often involves the rotator cuff or biceps tendons. Overall shoulder tendinitis is often called swimmers shoulder, pitchers shoulder or tennis shoulder namely due to the overuse and repetitive movements and training involved in these sports.

Bursitis

Bursitis: Bursae are fluid-filled sacs found near joints. The bursae act as cushions for the tendons and muscles to stop friction and irritation from occurring. Bursitis occurs when these sacs become inflamed with inflammatory components that irritate the nerve fibers sending pain signals to the brain. Normally bursitis occurs due to repetitive motions and movements like throwing. Bursae can be found all over the body including the elbows, hips and knees.

How to treat and resolve shoulder pain and injury

Treatment for shoulder pain and injuries differs from person to person and depends on your presentation and medical history. In some cases shoulder pain and injury can be resolved by rest, exercise or movement. However in most cases physical therapy such as osteopathy and physiotherapy is required. Occasionally, medication, or surgery may also be necessary, although often last resorts. There are several methods you can use to help your injury improve:

Osteopathy & Physiotherapy: In most cases people with shoulder pain and injuries will seek the help and assistance of a physical therapist such as an Osteopath or physiotherapist. These highly skilled and educated practitioners will assess, examine and treat the pain and injury by tailoring the treatment to your individual needs. Techniques such as soft tissue massage, joint articulation, joint mobilisation along with taping, medical acupuncture and exercise rehabilitation will be used. In a few cases further tests may be required. This may include blood tests, MRI or X-ray to determine the origin of certain conditions.

Cold Compress: Cold compress can help reduce swelling in the shoulder. Cooling also helps to alleviate sharp pain. Try applying an ice pack for up to 20 minutes five times a day. Be careful not to apply a cold pack directly to skin, try covering it with a towel to avoid any freeze burns.

Compression: Wrap the shoulder with an elastic medical support or bandage to help reduce swelling and pain. Be careful not wrap your shoulder too strongly as you may restrict blood flow. If your arm or hand begins to feel numb or tingly, or turn blue then loosen the compression bandage.

Heat Therapy: Heat helps to relax tense muscles and relieve stiffness. It can also help with muscle pain and arthritis in the shoulder. Use a heated gel pack, heating pad, hot water bottle or heat creams such as deep heat or tiger balm.

Rest and activity modification: Stopping or changing certain activities that may have caused or aggravated the shoulder pain is a really good way to help resolve your shoulder pain. It’s important to mobilize the shoulder gently with non weight bearing exercises. Overall inactivity will not help resolve your shoulder injury. Careful and considered movement helps to keep the shoulder muscles strong and flexible which in turns aids recovery and strengthens the shoulder helping to avoid future injury.

Shoulder exercises and stretches: Shoulders need regular exercise and stretching in order to maintain optimal health, movement and function. Regular exercise can help to keep your shoulders in good condition, making them able to respond properly to daily activities. Keep in mind a few rules when you start training:

  • Stop doing any exercises that are causing you shoulder pain, or causing your shoulder injury to become progressively worse.
  • Remember that exercise has a positive effect if it is done correctly. Exercising incorrectly can also cause or worsen shoulder pain or injury, so make sure you have great technique and if needed gain advice from a personal trainer or physical therapist such as an osteopath.
  • Warming up your shoulder is really important to avoid further pain, damage and injury. Light shoulder rolls, gentle movements, or even a warm shower are all ways to warm up your muscles before exercise and stretching. This way you will prepare your body and your shoulder prior to physical activity thus reducing the risk of injury.

Here are four exercises to help improve the strength and range of motion of your shoulder:

Shoulder Pendulum Swings:

  • Stand and bend at the waist, with your uninjured arm hold onto a chair or bed for balance.
  • Let your arm on the injured side hang straight down.
  • Keep your neck relaxed and your back perpendicular to the floor.
  • Let your injured arm swing gently like a pendulum in circular movements. Do this 20 times in one direction and 20 in the other.
  • To make this exercise more challenging, hold a weight in the injured arm. This can be a dumbbell or a can of tinned goods.

Shoulder Wall Climbs:

  • Stand to the side of a wall with the affected arm on the wall.
  • With your finger tips, slowly start to crawl your hand up the wall as high as you can go within a pain free range. Then crawl your fingertips back down the wall to the starting position.
  • Repeat the exercise 10 times.
  • Make sure to keep your shoulder down and away from your ear when doing this exercise.
  • You can also do this exercise facing front onto the wall to challenge shoulder flexion movements.

Shoulder Blade Squeeze:

  • Stand up straight with your elbows bent to 90 degrees at your waist. Gently pull your shoulders down and away from your ears and keep your neck nice and relaxed.
  • Pull your elbows backwards by gently squeezing your shoulder blades together and down.
  • Hold the position for 5 seconds and then bring your arms back to the starting position.
  • Repeat this exercise 10 times.

Scapular Stabilisations:

  • Start in a four point kneeling position, with your hands slightly forwards of the shoulders. Elbows should be soft and your knees should be hip distance apart under the hips.
  • Lift one hand 3 inches off the floor and hold for a few seconds, when doing this squeeze the shoulder blades together. Lower the hand down.
  • Make sure to keep the shoulders level when transferring the weight to the stationary hand.
  • Repeat 8-10 times alternating hands each time.

Top tips to help prevent shoulder pain

  • Keep active and gently move your shoulder within a pain free range of motion.
  • Be mindful of the jobs and movements you are doing with your shoulders. Shoulder injuries can often occur due to repetitive or sudden movements. They can happen while playing sports, exercising and during everyday activities such as reaching for something on a shelf, gardening or any other activities involving raising your arms above your head.
  • Good posture is crucial in maintaining healthy shoulders. If you have poor posture or you slouch your back then your shoulders may roll forwards causing you to slouch more. Poor posture can make sitting at a computer more problematic and can increase the likelihood of shoulder, neck or back pain.
  • Support your shoulder with pillows when resting or use arm rest supports when seated.
  • Make sure you are resting enough to allow your body to heal and renew from everyday stressors.
  • Eating a healthy, balanced diet can also keep your body fueled with the nutrients it needs to function.

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