Understanding Shoulder Pain
Musculoskeletal joint pains are a costly and growing issue, and this includes pain in the shoulder joint. Shoulder pain is fairly common, present in up to 70% of adults, and its prevalence only increases with age. Shoulder pain can have many causes, including injury, inflammation, overuse, or degeneration of the joint.
Occasionally, it could be a fracture after a fall or rarely, a more concerning cause like cancer. Therefore, it is important to see a doctor if it troubles you significantly or if you have any concerns, or it doesn’t resolve on its own.
Symptoms of Shoulder Pain
You may experience pain, swelling, warmth, deformity, numbness, tingling sensation, or weakness in your shoulders. Your shoulder’s range of motion may be affected as well, or you may feel some instability (‘popping out’ sensation) in the shoulder joint. Minor shoulder problems, such as sore muscles and aches and pains, are common.
Common Causes of Shoulder Pain
Rotator Cuff Tendinitis
Rotator cuff tendinitis is a common cause of shoulder pain, often triggered by overextension during activities like reaching behind or overhead movements, such as when driving or playing sports. The pain is caused by impingement of the rotator cuff tendon in the subacromial space, which can be exacerbated by bone spurs or a stiff coracoacromial ligament.
Diagnosis includes imaging like X-rays or MRIs, and treatment typically involves NSAIDs or a hydrocortisone and lignocaine injection. If a complete tear is suspected, further investigation via MRI is required before treatment.
Treatment often includes conservative measures like rest, physical therapy, NSAIDs, corticosteroid injections, and heat or ice therapy to reduce pain and inflammation. If these approaches fail to provide relief, surgery such as arthroscopic decompression may be considered.
Rotator Cuff Tear
Rotator cuff tears often result from falls, collisions, or repetitive overhead activities like tennis or weightlifting. They can also develop over time from recurrent tendinitis and may be linked to bone spurs.
Symptoms include shoulder weakness and pain during movement, although passive range of motion remains intact, distinguishing it from a frozen shoulder.
Without treatment, tears can lead to cuff tear arthropathy. Surgical repair, such as arthroscopic rotator cuff repair and acromioplasty, is recommended to restore function and prevent long-term damage.
Frozen Shoulder
Frozen shoulder (adhesive capsulitis) causes pain and stiffness in all directions due to inflammation and thickening of the shoulder capsule. It can develop after an injury or spontaneously in people over 40, especially women or those with conditions like diabetes or heart disease. Both active and passive movements are equally restricted.
Initial treatment includes physiotherapy, and if no improvement is seen, cortisone injections or arthroscopic capsular release may be necessary. Conservative treatment may not fully restore mobility, and surgical intervention may be needed after six months of limited progress.
SLAP Tear
A SLAP tear (Superior Labral from Anterior to Posterior) is a tear of the labrum in the shoulder joint, often caused by falls, shoulder traction, or repetitive overhead sports.
Symptoms include pain during overhead movements and a clicking sound in the shoulder.
Clinical tests, such as the crank and O’Brien stress tests, help diagnose SLAP tears, with MR arthrograms providing detailed imaging. While most cases can be treated conservatively, some may require arthroscopic repair of the biceps and labrum to restore function and relieve pain.
Arthritis of the Acromioclavicular and Glenohumeral Joint
Shoulder arthritis can result from injury, recurrent dislocations, or chronic rotator cuff tears, affecting either the acromioclavicular or glenohumeral joint.
Patients experience dull shoulder pain, morning stiffness, and discomfort that worsens at night, often disrupting sleep. In severe cases, pseudoparalysis can occur, where patients are unable to lift the shoulder.
Treatment may include pain management and, in advanced cases, reverse shoulder arthroplasty to relieve pain and restore mobility by reversing the joint’s configuration and enabling the deltoid to function more effectively.
Treatment Options for Shoulder Pain
Treatment for shoulder pain will depend on the underlying cause of the pain. Not all causes of shoulder pain require surgery. Non-surgical (conservative) options include rest, ice, medications, and physical therapy.
At TOCS, if appropriate, we also offer the unique option of a hybrid form of physical therapy. This combines physical visits to the physiotherapist with the use of a tele-rehabilitation device in between visits for greater patient convenience. Occasionally, more invasive treatment options like injections or surgery may be needed, depending on your condition and/or how it responds to non-surgical modalities of treatment.
Recovery and Rehabilitation
It is important to follow your orthopaedic specialist’s instructions for treatment and rehabilitation to ensure the best possible outcome for your shoulder pain. If you are experiencing shoulder pain, make an appointment with a shoulder specialist at Total Orthopaedic Care & Surgery for a detailed assessment of your condition.
