OVERVIEW

Shoulder discomfort is a very common condition, with a prevalence of approximately from 4% to 26%. Shoulder pain is the 3rd most prevalent musculoskeletal problem.

Shoulder pain refers to any discomfort in and around the shoulder. The shoulder is the human body's most movable joint. 

The shoulder is consists of three bones:

• Scapula (shoulder blade)

• Clavicle (collar bone)

• Humerus (arm bone)

These bones are joined together by soft tissues (ligaments, tendons, muscles, and joint capsules) to form a platform for the arm to work.

Shoulder pain can occur due to various reasons. Since shoulders play such an important role in our mobility, any injury or health problems associated with them can affect our movements and everyday life. Shoulder pains can be dull and sharp and could get unbearable if remained untreated. Let us look at some of the causes of shoulder pain listed below.

Causes Of Shoulder Pain

• Rheumatoid Arthritis:

  Rheumatoid arthritis- A disease in which the immune system targets its healthy cells, which may include joint lining.

• Osteoarthritis:

  Gradual wear and tear of the articular cartilage that leads to pain and stiffness.

• Rotator Cuff Tear: 

  Partial or complete tear in the rotator cuff muscles(supraspinatus, infraspinatus, tear minor, subscapularis)

• Frozen Shoulder:

  A common condition associated with severe restriction of shoulder movement, as well as rigidity and thickness of the joint capsule. 

• Shoulder Dislocation:

  An injury in which the upper arm bone comes out of the shoulder blade socket. Dislocation can occur forward, backward, or downward.

• Shoulder Impingement:

  Painful pinching of soft tissue between the shoulder’s ball-and-socket joint and acromion. It results from swelling of the soft tissues in the shoulder.

• Bursitis:

  Inflammation of the bursa which is a tiny fluid-filled sac that acts as a cushion to reduce friction between the bones

• Calcific Tendonitis:

  It refers to the deposition of calcium hydroxyapatite crystals commonly within the supraspinatus and infraspinatus tendons due to abnormal activity of the thyroid gland, diabetes, and genetics

• Fracture:

  Fractures are broken bones, commonly involving the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade) caused by injury to the shoulder as a consequence of an accident, sports injuries, fall, or any direct impact on the shoulder

• Avascular Necrosis:

  It refers to the death of bone tissue due to a lack of blood supply due to injury to the bone or fat deposits in blood vessels

• Thoracic Outlet Syndrome:

  It refers to a group of disorders that occur when blood vessels or nerves in the space between the collarbone and the first rib (thoracic outlet) are compressed.

• Referred Shoulder Pain:

  Referred shoulder pain indicates that a problem occurs someplace in the body other than where you are experiencing discomfort. They are as follows:

1. Whiplash injury (a medical term that describes the sensation of a neck injury due to sudden, strong back-and-forth movement of the neck)

2. Disc conditions

3. Ectopic pregnancy (pregnancy that happens outside of the uterus)

4. Diaphragm irritation

5. A liver abscess (pus-filled mass in the liver)

6. gallbladder disorders

7. Heart attack

8. Polymyalgia rheumatica

SIGNS & SYMPTOMS 

Signs of shoulder pain depend on the cause and severity. The signs can be as follows,     

• Shoulder Pain that may get worse on movements

• Pain radiating to the whole hand and fingers in severe cases

• Shoulder and upper arm weakness 

• A sense of joint slipping in and out of the joint socket

• Click sound while trying to move the arm

• Soreness, pain at night, redness, and restricted motion

• Arm, back, or neck pain

DIAGNOSIS

• The first step of diagnosis is to identify the root cause of the pain. The doctor will begin by enquiring about past injuries and the health conditions of the patient i.e., their medical history. 

• A thorough physical examination is done to understand more about the problem. 

• According to the symptoms and the severity, several tests are suggested like X-ray, CT scan, MRI, and Ultrasound. 

TREATMENT

Shoulder pain can be treated in one or more of the following ways based on the requirement.

1. Medications:

• The medicines prescribed by the doctors are usually beneficial in reducing pain and inflammation. 

• Both topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs) allow sleep normalisation and resumption of safe activities.

2. Surgery:

• Surgery may be suggested in cases where the symptoms are severe or other management does not provide any results.

•  Some of the conditions like recurrent dislocations, acute or chronic rotator cuff tears, severe joint issues, etc. are indications for surgery.

3. Physiotherapy:

• Physiotherapy electrical modalities like Interferential therapy, TENS, ultrasound, Laser, etc help in providing temporary pain relief but do not cure the root cause of any problem.

• Myofascial release, stretching, range of motion, and strengthening exercises help in enhancing mobility and function thus providing a long-term cure for the concerned problem and the associated pain. Following are the few types of exercises that help with relieving shoulder pain once the underlying cause is ruled out and then a proper shoulder rehabilitation protocol is designed.

4. Exercises:

a. Stretching Exercises:

Stretching exercises for the neck, shoulder, upper back will be beneficial as they, 

• Decrease the risk of injuries.

• Help the joints move through the full range of motion.

• Increase muscle blood flow.

• Enable muscles to work most effectively.

• Decrease muscle soreness

b. Strengthening Exercises:

Neck, shoulder, and back Strengthening exercises can be done with free, weights, weight machines and resistance bands, etc as they help in

• strengthens the muscles around the shoulder joint

• stabilises the shoulder joint thus helping to avoid injuries

• posture correction

c. Range of Motion Exercises:

Depending on the severity of pain and stiffness, range of motion exercises can be passive, active, or active-assisted. These exercises help in        

• Improving mobility, flexibility, strength in your shoulder muscles and joints.

• Helps prevent tightness and subsequent injury in the joint

5. Laser Treatment

What is Laser Treatment?

Laser (Light amplification by stimulated emission of radiation) treatment is a safe, painless, non-invasive, effective therapy to reduce pain and swelling to allow the body to restore damaged tissue. Red and infrared light is used for the relief of pain, speed up healing and decrease inflammation. 

Lasers are applied either by direct or indirect techniques.

The most commonly used lasers are Helium-neon (He-Ne) and Gallium arsenide (Ga-As)

Laser therapy includes two modes: continuous or pulsed mode.

Effects of laser therapy

• It reduces pain

• It reduces swelling

• Helps increase blood flow to the damaged area

• Promotes faster healing of damaged tissue

• It helps increase cellular energy

• It helps improve lymphatic flow and drainage

• It improves the immune system response allowing the body more resistant to infection

• It helps in the reduction of scar tissue

Types of Laser Therapy

in physiotherapy lasers are divided into two types based on the power output :

1. High-Powered Laser Therapy

2. Low-Level Laser Therapy

High-power Laser Therapy(HPLT)

1. Its power ranges from 500 to 10,000 milliwatts and they are classified as class IV providing for a far broader range of therapeutic approaches. 

2. Because of its increased power density, HPLT generates heat on the skin's surface.

3. Most of the injuries in the human body respond better to increased power and dose, which is determined by power output and duration.

4. Provides optimum ratio of absorption and penetration allows efficient simulation of tissue and pain receptors in up to 12cm depth

5. Sessions might last anything from thirty seconds and 10 minutes. During treatment, patients report a warming, calming sensation comparable to that of a massage. Most patients require 4 to 6 sessions, however, others may require more due to the severity of their injuries.

Low-Level Laser Therapy (LLLT)

• LLLT is also known as cold therapy. Low laser treatment devices are classified as Class III lasers, with powers ranging from 1 to 500 milliwatts.

• Various wavelengths and low-level lights are administered directly to a particular location during the treatment. 

• LLLT is thought to influence the activity of connective tissue cells (fibroblasts), hasten connective tissue healing, and acts as an anti-inflammatory agent.

Indications for laser therapy:

• Pain secondary to soft tissue injuries ( sprain. Strain, bursitis, post ACL surgery)

• Tennis elbow

• Plantar fasciitis

• IT Band Syndrome

• tendonitis

• Rotator Cuff Injuries

• Diabetic neuropathy

Contraindications for laser therapy

Laser therapy cannot be used in the following conditions:

• Eye, Over & around thyroid gland & endocrine glands

• Cancer: 

• Epileptics:

• Pregnancy

• Pacemakers, spinal stimulators

• Infected tissues

CONCLUSION

Laser treatment has become more popular in recent years for musculoskeletal injury recovery. However, the effectiveness of Low-Level Laser Therapy, particularly in shoulder recovery, remains under research because there isn't enough evidence to show that it helps with pain reduction and function. As a result, several trials on the usefulness of shoulder diseases are mixed. Studies on the benefits of laser therapy have yielded both positive and no-effect outcomes. Therefore, physiotherapy is the mainstay of treatment for various shoulder complaints as it helps in providing effective long-term solutions.