Shoulder Pain

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Young Asian man with pain from dislocated shoulder when training outdoors

Shoulder pain has unfortunately become a fact of life for many people in modern society. A 2011 study has reported that, on average, 14.7 of every 1000 patients seeking primary health care each year have this condition. The lifetime prevalence (the percentage of individuals who report experiencing it at some point in their lives) is as high as 70%

Part of the reason that shoulder pain is so common lies in the complexity of the joint. The shoulder really comprises two joints. It also has an intricate network of tendons and muscles that provide our arms with an astonishingly wide range of motion. The shoulder supports the upper arms in performing tasks as diverse as scratching our backs to painting a ceiling to executing the perfect golf stroke.

When it does occur, shoulder pain can differ widely between individuals in terms of its nature and longevity. Some of us experience pain only when moving the arm, while others feel it all the time. In some individuals, shoulder pain may last for a few days and then go away after a short rest. Others, however, may require surgery or some other advanced procedure to gain relief from their shoulder pain.

In this article, we will briefly describe how a doctor might go about diagnosing the cause of a patient’s shoulder pain. We will then list some of the most common causes of shoulder pain and the primary remedies for each.

Diagnosing Shoulder Pain

Medical History

Your doctor will likely thoroughly review your medical history as a first step in diagnosing the cause of your shoulder pain. He or she will probably be looking for any past shoulder injuries or other conditions that may be recurring to cause the pain.

In addition, your doctor will ask how and when your ;pain started, and what actions make it worse or better.

Physical Examination

This may be followed by a physical examination of your shoulder. Your doctor will check for any deformities, swelling or bruising in the area of your shoulder. An unusual alignment of the shoulder joint can for example  be a sign of a shoulder dislocation.

In addition to looking for any unusual aspects of your shoulder’s appearance, your doctor will likely also check to see whether you have normal shoulder range of motion and strength. You may be asked, for example, to lift your arm above your shoulder and hold it there.

Imaging & Other Studies

As a final step in the diagnosis of the cause of your shoulder pain, your doctor may order an imaging scan of your shoulder such as an X ray, CT scan or MRI.

In addition to the above tests, your doctor may also request an electrical test such as an electromyogram to evaluate your nerve function.

Other tests may include an arthrogram, in which a dye is first injected into your shoulder. This will then be followed by an MRI study to illustrate the behavior of the muscles, tendons and other tissues of the joint.

Arthroscopy may also be used. This involves the insertion of a small camera inside the shoulder to help doctors directly observe the condition of the soft tissues of the joint. Arthroscopy may be combined with surgery to correct the problem based on what the doctors find.

Causes & Treatment Of Shoulder Pain

Shoulder Arthritis

This is probably the most common cause of shoulder pain. There are two primary types of shoulder arthritis – osteoarthritis and rheumatoid arthritis.

Osteoarthritis

This is a wear and tear condition affecting the cartilage that covers the shoulder bones in the joint and that allows them to move smoothly over each other. Deterioration of the cartilage results in shoulder pain and stiffness. These may be especially severe when you try to move your shoulder.

There is no fundamental treatment for osteoarthritis but doctors can prescribe pain relief medications to ease your discomfort. They may also suggest physical therapy to ease joint stiffness and preserve range of motion. As the condition worsens, however, surgery such as joint replacement may become unavoidable.

Rheumatoid Arthritis

Rheumatoid arthritis is another type of arthritis caused by the immune system mistaking the lining of the shoulder joint for a foreign entity. As a result, it attacks and eventually destroys this lining. As with osteoarthritis, the result is pain and stiffness in the shoulder joint.

To help slow the progress of this disease, your doctor can prescribe immune suppressing medicine that will reduce the aggressive response of your immune system and slow the destruction of the joint lining.

Shoulder Soft Tissue Injuries

This is a broad group of injuries that includes four main sub categories. These are shoulder tendonitis, shoulder bursitis, rotator cuff tears and frozen shoulder.

Shoulder Tendonitis

This condition is also known as rotator cuff tendonitis (or tendinitis). It happens when one of the group of four muscles and tendons known as the rotator cuff becomes trapped between the upper arm and the socket of the shoulder blade. The resultant pinching of the tendons usually causes them to become irritated and inflamed. This in turn leads to pain when you move your shoulder or try to lift your arm over your head. Another name for this injury is rotator cuff impingement.

Rotator cuff tendinitis is very common among athletes in sports that involve overhead activity such as throwing, serving or smashing. These may include tennis, baseball and cricket, for example. If you work in an occupation that requires overhead activity such as painting, for example, you may also be susceptible to rotator tendonitis.

Temporarily refraining from activity that may stress the rotator tendons usually allows them to recover over time. Arm slings or shoulder supports can help take the pressure off the joint and promote healing. Anti inflammatory medications like Advil may also be useful. As with osteoarthritis, physical therapy will help to stretch and strengthen the rotator cuff muscles. This will help to reduce the risk of recurrence of rotator cuff problems.

Shoulder Bursitis

This is a related condition in which the fluid filled sacs within the shoulder joint become irritated and inflamed. When healthy, these sacs (the bursae) allow the tendons to glide smoothly over adjacent bones. Consequently, once they become inflamed, shoulder movement becomes painful. The symptoms of shoulder bursitis generally resemble those of shoulder tendonitis. In fact, the two conditions frequently occur together.

Rotator Cuff Injuries

If overused, the muscles of the rotator cuff can become overstretched or torn. This is another injury that is related to excessive overhead activity, and the symptoms also resemble those of rotator tendonitis.

Resting the shoulder allows the injured muscles to repair themselves naturally. Ice (or cold compresses)  and anti inflammatory medications are also useful. Surgeries are rarely required to treat rotator cuff injuries

Frozen Shoulder.

This is a condition caused by thickening of the tissues of the shoulder joint. As a result, you will have difficulty moving your arm freely and shoulder range of motion will be restricted.

Frozen shoulder is usually treated using a combination of medication and physical therapy.

Shoulder Dislocations Or Fractures

Shoulder dislocations occur when the top of the upper arm (the ball of the shoulder joint) becomes displaced from the socket of the joint. Doctors may be able to push the arm back into into the proper place in the socket. Otherwise, surgery may be required.

Shoulder fractures can be major injuries and will usually require surgical intervention of some kind. People with brittle bones or osteoporosis are at particular risk of this type of injury. Your doctor can advise you on the best course to follow. Usually, however, surgery is required to treat this type of injury.

Other Causes Of Shoulder Pain

A heart attack or spinal cord injury can cause shoulder pain. These are obviously serious and possibly life threatening events. Medical assistance will normally be urgently required.

Sometimes, shoulder pain can be caused by an injury somewhere else in the body. This type of pain is sometimes called “referred pain”. One way to detect it is to move your shoulder and see whether the pain worsens. If it does not, you may be experiencing referred shoulder pain.

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