Pain in the shoulder region is one of the most common complaints seen in sportspersons and desktop workers. The treatment of shoulder pain is multifactorial. It is mainly based on the condition and symptoms which are causing the pain.
Before knowing more about shoulder pain let us know what the shoulder joint is made up of.
Anatomy of Shoulder Joint
The shoulder joint is also known as the Glenohumeral Joint. It is a synovial joint. That means that it consists of a fluid known as synovial fluid in between the bones.
It is one of the largest and most complex joints of the human body. It mainly consists of the upper arm bone called the humerus and the shoulder blade or scapula. The humerus head acts as the ball that fits into the socket of the scapula called the glenoid fossa.
The shoulder joint is mainly responsible for allowing movement in the arm and shoulder.
The shoulder joint is however considered to be the most mobile joint of the body. In terms of stability, it is slightly compromised due to the size of the humerus head and scapular socket or glenoid fossa. The glenoid fossa is smaller in size than the humeral head. Hence, the shoulder joint relies more on the muscles, ligaments, and joint capsule for stability. These movements are carried about by the muscles attached to the shoulder joint. Due to his reason, any imbalance or trauma to these supporting structures can easily cause an injury to the shoulder joint.
Causes of Shoulder Pain
The shoulder joint comprises several other bones. The clavicle or collarbone, humerus or arm bone, and scapula or shoulder blade.
The shoulder joint even consists of a bursa or a fluid-filled sac that provides cushioning to the joint.
As the mobility component of the shoulder joint is more than the stability. The shoulder joint is vulnerable to injury or dislocation. The muscles, ligaments, and tendons which help move the shoulder are at a greater risk of injury.
Common causes of shoulder pain can be:
Pain and stiffness felt in the joints, usually seen in the elderly population can be arthritis. Arthritis is a degenerative condition usually affecting the most used joints of the body, especially the shoulder, knee, and wrist.
Bursitis is inflammation of the bursa in the shoulder joint. This can lead to pain on any movement, especially rotation of the shoulder.
Bone fractures are also common in the shoulder joint. Falling on an outstretched hand or direct impact trauma can cause a fracture of the shoulder joint.
4. Tendinitis or tendon pathologies
Inflammation in the tendon due to acute injury or overusing the tendon can cause tendon pathologies.
Pinched tendons or nerves under overlying structures due to a rapid jerky movement are quite common in young people. Playing sports, excessive overhead activities, or manipulations can cause impingement in the shoulder of either the nerves, muscles, or tendons.
6. Frozen shoulder
This is a self-limiting condition that causes pain and stiffness in the shoulder. It could take a couple of weeks or months for the pain and range of motion to become normal.
A fall on the outstretched hand can cause the humerus head to shift outside the glenoid fossa. This causes a dislocation in the shoulder joint. A change in the contour of the shoulder can be indicative of a dislocation.
Inflammation of the shoulder joint capsule can cause capsulitis. Pain in most of the movements of the shoulder joint can be indicative of capsulitis.
9. Myocardial Infarction
Also commonly known as a heart attack. Pain only in the left arm radiating to the entire forearm and difficulty in breathing can be the initiator of a heart attack. At such times, immediately rushing to the hospital is necessary.
Symptoms of Shoulder Pain
According to the causes of shoulder pain listed above. Shoulder pain can itself manifest in many different ways depending on the underlying condition. A tendinitis pain would not feel the same as fracture pain and so on.
Let us see the different kinds of shoulder pain possible:
Shoulder pain may present with variations in the day or night time pain.
Increased pain on strenuous activity versus pain even on resting
Stiffness or restricted like sensation while performing movements in the shoulder joint
Radiating pain is commonly seen in impingement or trauma to a nerve due to fracture.
Swelling in the shoulder due to fluid accumulation
Reduced range of motion in the affected shoulder region, seen in most conditions like frozen shoulder.
A clicking or popping sound in the shoulder while moving it.
Shoulder Pain based on different populations
According to a recent survey, shoulder pain affects 18–26% of people in their lifetime. One of the commonest regional pain syndromes affecting people of all age groups. However, the age and occupation of an individual can determine the type of injury and its symptoms.
The prevalence of shoulder pathologies is found to be higher in the female population than males. ‘
Obesity and a sedentary lifestyle can lead to shoulder pathologies. This is primarily seen in sudden activity or overuse.
Aged people are prone to shoulder pain more due to conditions that start appearing during that age. Degeneration and metabolic changes seen in the elderly are important factors contributing to shoulder pain in the aged population.
Presence of Co-existing medical disorders. Diabetes Mellitus, multiple sclerosis, and other systemic disease is also significant risk factor for shoulder pain.
Mental status. Depression, distress, anxiety, or poor mental health status is also found to affect shoulder injuries. This is due to the doubling of the cases of reported pain.
Athletes who participate in repeatedly performing overhead activities like golfing, swimming, etc are more prone to shoulder injuries.
An increased risk of a tear in the muscles around the joint, and impingement is seen commonly in sportspersons.
Lifting, pushing, caring, or holding heavy loads in the arm or shoulder are major risk factors for shoulder pain.
Industrial workers frequently exposed to vibratory tools, or working above shoulder height can put a strain on the shoulder joint.
Shoulder Pain treatment
Shoulder pain can be treated conservatively at home with some simple things to keep in mind. However, a detailed assessment by a doctor or Physiotherapist can help ineffective treatment. Consulting a specialist even helps in preventing the recurrence of the pain or shoulder condition in the future.
Shoulder Pain Treatment at home
Before consulting a doctor, immediate treatment for shoulder pain can reduce the risks of further injury to the area.
Applying an ice or a cold pack right after the injury to reduce or prevent swelling can be done. Acute injuries are often treated immediately with a cold pack. This is especially effective in sports injuries like ligament tear, muscle sprains, etc.
Applying a hot pack or a heat belt in the area in case of muscle spasms or diffuse pain in the shoulder region can also be done. Heat treatment causes vasodilation which in turn helps in increased blood supply to the shoulder region, relaxing the muscles. Finally helping in reducing pain.
Tying a sling from the shoulder to the wrist with materials available at home can be a good alternative. This sling will help in immobilizing the joint until a doctor examines it. It will even help in preventing further injury to the joint. Materials like a dupatta, towel, or scarf can be used to tie a sling at home.
Avoiding the specific movement that causes pain and avoiding movements with the affected hand can also help in reducing pain in the shoulder joint.
Using a compression garment or crepe bandage in case a swelling is present or suspected. This helps in decreasing the swelling and preventing further swelling or edema to develop.
Shoulder Pain Medical treatment
Shoulder pain if left untreated can hamper the ability to move the shoulder or affected arm at all. Even with home remedies, if the shoulder pain does not reduce. You should visit a doctor for the same.
If your shoulder pain is a result of trauma from a strong push or pull. You should visit a specialist immediately. For other conditions, please visit a doctor if the pain persists beyond two to three weeks.
Certain conditions like a rotator cuff injury or frozen shoulder if not treated on time would require surgical management.
On visiting a doctor, he will examine your shoulder, arm, and hand. He will ask you to perform some movements and palpate to understand the location of the pain.
The doctor might ask you to conduct diagnostic scans to confirm their diagnosis. An x-ray or MRI scan is mostly preferred in shoulder conditions. An x-ray would ideally highlight the bony outlines of the body. Whereas an MRI would show the bony as well as soft-tissue structures present in the region. To evaluate whether the pain is due to a ligament, tendon, or capsule a doctor would recommend an MRI. If the doctor suspects a fracture or bone pathology, he may suggest doing an X-ray scan.
Medications- The doctor might suggest you take pain killers to manage your pain. NSAIDs (Non-steroidal anti-inflammatory drugs) to reduce the swelling or inflammation in the region. Finally, corticosteroids and Vitamin D + Calcium supplements for effective healing of the injured body part.
The doctor might even recommend some general exercises or resting protocols to follow during the healing periods. Traction belt, heat belt, and suspension are some other adjuvants.
Shoulder Pain Treatment from a Physiotherapist
A physiotherapist is the best person to guide and treat shoulder pain. The therapist will assess your entire body and find the root cause of the pain. They will measure your range of motion, strength, pain level, instability level, and so on before designing an exercise program for you.
The therapist will suggest exercises to relieve pain, restore the normal range of motion of your shoulder and prevent further injury in the future.
These exercises are aimed at relieving tension and strain in your muscles. Which will further help in reducing pain and prevent future injury in the shoulder joint.
Following the RICE protocol is also suggested by the therapist. It consists of rest, ice therapy, compression, and elevation for acute treatment.
Mobility exercises: The therapist will suggest both passive and active exercises based on the condition and available range of motion. Pendulum exercises, shoulder rolls, shoulder circling, chest expansion exercises are some examples.
Stretching exercises: Stretching the muscles, tendons and the joint capsule is necessary to maintain the integrity of the entire joint. Crossover arm stretching, individual muscle stretches, wall pushups, sleeper stretches, wand exercises, and resistance exercises are some examples.
Stability exercises: Maintaining a proper scapular and shoulder complex posture is essential for maintaining shoulder joint integrity. Scapular muscle strengthening, posture correction, and breathing exercises are part of stability exercises. These exercises focus on the individual muscles and help in maintaining optimum breathing capacity.
Consult a physiotherapist around you or online physiotherapy for more details. A detailed assessment and management plan are necessary for each condition based on the lifestyle habits and movement patterns of a person.
Shoulder pain and its treatment are multifactorial. The causes and symptoms of shoulder pain are of prime importance to form a treatment plan. A treatment plan for tendonitis would not be appropriate for a fracture or bursitis condition.
Even on home remedies if your shoulder pain does not reduce, you should consult a physiotherapist for further management.