Shoulder Pain: Causes and Treatment

Hereon, we discuss each the above specific shoulder problems one after the other, along with the treatment guidance.

To better understand shoulder problems and how they occur, it helps to begin with an explanation of the structure of the shoulder and how it functions.

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing the perfect ball.

[Continue reading or scroll to the bottom to understand the structure of Shoulder.]

Now let’s us address the different shoulder conditions that lead to shoulder pain , other symptoms and treatment.

Shoulder Pain Causes and Treatment

1) Shoulder Dislocation

The shoulder joint is the most frequently dislocated major joint of the body. In a typical case of dislocated shoulder, either a strong force pulls the shoulder outward (abduction) or extreme rotation of the joint pops the ball of the humerus out of shoulder socket.

Shoulder Dislocation commonly occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles. It could be of 2 types:

1. When a shoulder dislocates frequently, the condition is referred to as shoulder instability.
2. A partial dislocation in which the upper arm bone is partially in and partially out of the socket is called a called a subluxation.
3. Read more about Shoulder dislocation and its treatment here.

2) Rotator Cuff Disease: Tendinitis and Bursitis

Tendinitis and Bursitis  are closely related conditions and may occur alone or in combination.

Rotator Cuff Tendinitis:

Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome.

Rotator Cuff Bursitis:

Bursitis or inflammation of the bursa sacs that protect the shoulder, may accompany tendinitis and impingement syndrome.

What causes Rotator Cuff Tendinitis and Bursitis?

• Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis.
• Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.
• Repeated motion involving the arms, or
• The effects of the aging process on shoulder movement over many years, may also irritate and wear down the tendons, muscles, and surrounding structures.

What are the symptoms of Rotator Cuff Tendinitis and Bursitis ?

Signs of Rotator Cuff Tendinitis and Bursitis include :

• Slow onset of discomfort and pain in the upper shoulder or upper third of the arm
• Difficulty sleeping on the shoulder.
• Pain when the arm is lifted away from the body or overhead.
• Pain in the front or side of the shoulder that may travel down to the elbow and forearm, if tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm)
• Pain may also occur when the arm is forcefully pushed upward overhead.

How are Rotator Cuff Tendinitis and Bursitis diagnosed?

Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X rays do not show tendons or the bursae but may be helpful in ruling out bony abnormalities or arthritis. The doctor may remove and test fluid from the inflamed area to rule out infection. Impingement syndrome may be confirmed when injection of a small amount of anesthetic into the space under the acromion relieves pain.

What is the treatment for Rotator Cuff Tendinitis and Bursitis?

Once diagnosed, Rotator cuff problems are usually treated with the following:

1. The first step is to reduce pain and inflammation with rest, ice, and anti inflammatory medicines. [Read more about RICE protocol here]
2. After the first 2-3 days of RICE, ReLiva Physiotherapist will use ultrasound modality in most cases, to warm deep tissues and improve blood flow.
3. Gentle stretching and strengthening exercises are added gradually. These may be preceded or followed by use of an ice pack.
4. As pain reduces, physiotherapist will add basic exercises like joint mobility, strengthening.
5. If there is no improvement, your orthopedic doctor may inject a corticosteroid medicine into the space under the acromion. While steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture.
6. If there is still no improvement after 6 to 12 months, the doctor may recommend either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae.

3) Torn Rotator Cuff

Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause. Sports or occupations requiring repetitive overhead motion or heavy lifting can also place a significant strain on rotator cuff muscles and tendons. Over time, as a function of aging, tendons become weaker and degenerate. Eventually, this degeneration can lead to complete tears of both muscles and tendons. These tears are surprisingly common.

In fact, a tear of the rotator cuff is not necessarily an abnormal situation in older individuals if there is no significant pain or disability. Fortunately, these tears do not lead to any pain or disability in most people. However, some individuals can develop very significant pain as a result of these tears and they may require treatment.

What are the symptoms of Rotator Cuff tear?

When there is a torn rotator cuff, following symptoms may be observed:

• The patient feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body.
• Motions like those involved in getting dressed can be painful.
• The shoulder may feel weak, especially when trying to lift the arm into a horizontal position.
• A person may also feel or hear a click or pop when the shoulder is moved.
• Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon.
• The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.

How is Rotator Cuff Tear diagnosed?

The doctor may diagnose the tear with history and physical examination. However, it may not be able to locate the tear with just physical examination. Hence tests like MRI or ultrasonography help to determine the location as well as the severity (partial or full) of the tear.

What is the treatment for torn Rotator Cuff?

The treatment protocol for torn Rotator cuff usually includes the following:

• Rest is advised to the patients.
• Heat or cold application to the area also helps to relieve pain.
• Medications can be given to reduce the pain and inflammation.
• Physiotherapy treatment includes electrical stimulation of muscles and nerves, ultrasound, IFT or TENS.
• A cortisone injection near the inflamed area of the rotator cuff can be given in case of severe pain.
• If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder’s function. If there is no improvement with these flexibility and strength and restore the shoulder’s function.
• If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff.

Patients with rotator cuff tendinitis or bursitis that does not include a complete tear of the tendon can usually be treated without surgery with rehabilitative rotator cuff strengthening exercises. They are very effective.

4) Frozen Shoulder (Adhesive Capsulitis)

As the name implies, movement of the shoulder is severely restricted in people with a “frozen shoulder.” This condition, which doctors call adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain. Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Intermittent periods of use may cause inflammation. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move.

Interesting Facts about Frozen Shoulder:

• People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or those who have been in an accident, are at a higher risk for frozen shoulder.
• Frozen shoulder is more common among women than men.
• People between the ages of 40 and 70 are most likely to experience it.

[Read more about Frozen Shoulder, its causes and treatment here]

5)  Shoulder Fracture

A fracture involves a partial or total crack through a bone. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. A fracture usually involves the clavicle or the neck (area below the ball) of the humerus or the shaft.

How is Shoulder fracture treated?

When a fracture occurs, the doctor tries to bring the bones into normal alignment that will promote healing and restore arm movement. If someone’s clavicle is fractured, here is what they should do:

• Patient must initially wear a strap and sling around the chest to keep the clavicle in place.
• After removal of the strap and sling, the doctor will prescribe exercises to strengthen the shoulder and restore movement.
• Surgery is occasionally needed for certain clavicle fractures.

Fracture of the neck of the humerus is usually treated with a sling or shoulder stabilizer. If the bones are out of position, surgery may be necessary to reset them. Exercises become a major part for restoring shoulder strength and motion along with mobilisations after a certain period.

[Read more about recovering from fracture here]

6)  Arthritis of the Shoulder

Arthritis is a degenerative disease caused by either wear and tear of the cartilage (osteoarthritis) or an inflammation (rheumatoid arthritis) of one or more joints (glenohumeral / acromioclavicular). Arthritis not only affects joints, but may also affect supporting structures such as muscles, tendons, and ligaments.

[ Related Reading :  Arthritis – Do your Joints Pain? ]

• Diagnosis: A doctor may suspect the patient has arthritis when there is both pain and swelling in the joint. The diagnosis may be confirmed by a physical examination and x rays. Blood tests may be helpful for diagnosing rheumatoid arthritis.

How is Shoulder Arthritis treated?

Treatment of shoulder arthritis depends in part, on the type of arthritis.

1. Osteoarthritis of the shoulder is usually treated with 2 pronged approach:
   1. Nonsteroidal anti-inflammatory drugs
   2. Along with physiotherapy to restore normal functions
2. Rheumatoid arthritis requires :
   1. Physiotherapy as the 1st line of treatment to maintain and regain the muscle strength, joint mobility and
   2. Additional medications such as corticosteroids may or may not be given.
   3. In case of failure of the non-operative treatment, surgery is opted where surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. Physiotherapy is a MUST post surgery for full recovery.

Structure of Shoulder:

Book an appointment for Shoulder pain treatment today!