The shoulder consists of multiple joints, tendons, and muscles that enable various arm movements, from scratching your back to throwing a pitch. However, excessive mobility can cause instability or soft tissue or bone structure impingement, resulting in pain. Pain may occur during movement or persist all the time, requiring medical diagnosis and treatment. This article outlines common causes of shoulder pain and general treatment options, while your doctor can provide specific information about your condition.
Anatomy: The structure of your shoulder comprises three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rounded head of the humerus bone fits into the glenoid, a socket in the shoulder blade. The rotator cuff, a group of muscles and tendons, works together to keep the arm bone centered in the socket. The rotator cuff covers the head of the humerus bone and connects it to the shoulder blade.
Shoulder problems typically fall under four categories: tendon inflammation (tendinitis or bursitis), instability, arthritis, or fracture. Less common causes of shoulder pain include tumors, infections, and nerve-related issues.
Bursitis occurs when the small fluid-filled sacs called bursae, which cushion bones and soft tissues in joints like the shoulder, become inflamed and swollen due to overuse. This often accompanies rotator cuff tendinitis, causing pain and difficulty performing daily activities.
Tendinitis happens when the cords that connect muscles to bones, called tendons, become inflamed due to overuse, acute injuries like excessive overhead activities, or chronic degenerative diseases. The four rotator cuff tendons and one biceps tendon are commonly affected, and these tendons and their muscles play a crucial role in shoulder movement and stability.
Instability:
Shoulder instability happens when the head of the upper arm bone is pushed out of the shoulder socket, which can result from sudden injury or overuse.
Shoulder dislocations can be partial, called subluxation, or complete, where the ball comes entirely out of the socket. If the ligaments, tendons, and muscles surrounding the shoulder are loose or torn, the dislocation may happen repeatedly, leading to pain and instability while raising or moving the arm. Frequent subluxations or dislocations increase the risk of developing arthritis in the joint.
Fracture:
Shoulder fractures occur when bones in the shoulder, such as the collarbone, upper arm bone, or shoulder blade, break. In older patients, shoulder fractures may happen due to a fall from standing height, while in younger patients, high-energy injuries from contact sports or motor vehicle accidents may cause them.
Fractures typically result in severe pain, swelling, and bruising around the shoulder area.
Doctor’s Examination:
If you experience acute pain, seek medical attention immediately. For less severe pain, you may rest for a few days to see if the problem resolves itself, but if the symptoms persist, you should see a doctor.
To diagnose the cause of your shoulder pain, your doctor will begin by taking a detailed medical history. This may involve asking questions about how and when the pain started, previous occurrences, and any treatments you may have received. Since certain activities can aggravate or relieve shoulder conditions, your medical history can be useful in identifying the source of your pain.
After gathering your medical history, your doctor will perform a comprehensive physical examination. During the examination, your doctor will check for physical abnormalities, swelling, deformities, muscle weakness, and tender areas. Additionally, your doctor will evaluate your range of motion and strength in the affected shoulder.
Tests:
To determine the cause of your shoulder pain and any underlying issues, your doctor may recommend certain tests. These tests may include X-rays to detect any injuries to the bones of the shoulder joint, magnetic resonance imaging (MRI) or ultrasound to produce clearer images of soft tissues like ligaments and tendons, computed tomography (CT) scans to get a detailed view of the bones in the shoulder area using x-rays and computer technology, and electrical studies such as an electromyogram (EMG) to assess nerve function.
Another test that may be ordered is an arthrogram, which involves injecting dye into the shoulder joint to provide a better view of the joint and surrounding muscles and tendons. This may be combined with an MRI. Arthroscopy is a surgical procedure where a fiber-optic camera is used to view inside the joint, allowing for the identification of soft tissue injuries that may not be apparent from physical examination or other tests. Arthroscopy may also be used to correct the problem causing the pain.
Treatment:
The treatment for shoulder pain may include resting, modifying activities, and undergoing physical therapy to improve shoulder flexibility and strength. Avoiding activities that cause overexertion or pain can help prevent shoulder pain. To alleviate inflammation and pain, medication may be prescribed, and in some cases, injections of numbing medications or steroids may be recommended.
Surgery may be necessary to resolve certain shoulder issues, such as recurring dislocations and some rotator cuff tears. However, most patients with shoulder pain will respond well to non-surgical treatment methods like rest, exercise, and medication.
Surgery may involve arthroscopy to repair damaged tissues or remove scar tissue, or open procedures for more extensive reconstructions or shoulder replacement.
