Dr. Tariq Jagnarine
Family Medicine/ Endocrinology/Diabetes
The shoulder has a wide and versatile range of motion. When something goes wrong with the shoulder, it hampers the ability to move freely, and can cause a great deal of pain and discomfort.
The shoulder joint is the most mobile joint in the body. It moves the shoulder forward and backward. It also allows the arm to move in a circular motion, and to move up and away from the body. Shoulders get their range of motion from the rotator cuff. The rotator cuff is made up of four tendons. Tendons are the tissues that connect muscles to bone. It may be painful or difficult to lift the arm over the head if the tendons or bones around the rotator cuff are damaged or swollen.
Persons can injure the shoulder by performing manual labour, playing sports, or even by repetitive movement. Certain diseases can bring about pain that travels to the shoulder. These include diseases of the cervical spine (neck), as well as liver, heart, or gallbladder disease.
Persons are more likely to have problems with the shoulder as they grow older, especially after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age.
In many cases, shoulder pain can be treated at home. However, physical therapy, medications, or surgery may also be necessary.
CAUSES
Several factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis.
This is a condition characterized by swollen tendons. Another common cause of shoulder pain is impingement syndrome where the rotator cuff gets caught between the acromion (part of the scapula that covers the ball) and humeral head (the ball portion of the humerus).
Sometimes shoulder pain is the result of injury to another location in the body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse when moving the shoulder.
Other causes of shoulder pain include:
• Arthritis
• Torn cartilage
• Torn rotator cuff
• Swollen bursa sacs or tendons
• Bone spurs (bony projections that develop along the edges of bones)
• Pinched nerve in the neck or shoulder
• Broken shoulder or arm bone
• Frozen shoulder
• Dislocated shoulder
• Injury due to overuse or repetitive use
• Spinal cord injury
• Heart attack
DIAGNOSIS
Doctors will find out the cause of the shoulder pain by requesting a medical history and doing a physical examination.
They’ll feel for tenderness and swelling and will also assess the range of motion and joint stability. Imaging tests, such as an X-ray or MRI, can produce detailed pictures of the shoulder to help with the diagnosis.
The doctor may also ask questions to determine the cause.
Contact a doctor if experiencing fever, inability to move the shoulder, lasting bruising, heat and tenderness around the joint, or pain that persists beyond a few weeks of home treatment.
If the shoulder pain is sudden and not related to an injury, see a doctor immediately. It may be a sign of a heart attack. Other signs of a heart attack include:
• Trouble breathing
• Chest tightness
• Dizziness
• Excessive sweating
• Pain in the neck or jaw
TREATMENT
Treatment will depend on the cause and severity of the shoulder pain. Some treatment options include physical or occupational therapy, a sling or shoulder immobilizer, or surgery.
The doctor may also prescribe medication such as nonsteroidal anti-inflammatory medications (NSAIDs) or corticosteroids. Corticosteroids are powerful anti-inflammatory drugs that can be taken by mouth or the doctor can inject into the shoulder.
Some minor shoulder pain can be treated at home. Icing the shoulder for 15 to 20 minutes three or four times a day for several days can help reduce pain. Use an ice bag or wrap ice in a towel because putting ice directly on the skin can cause frostbite and burn the skin.
Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. Limit overhead work or activities.
Other home treatments include using over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and inflammation and compressing the area with an elastic bandage to reduce swelling.
PREVENTION
Simple shoulder exercises can help stretch and strengthen muscles and rotator cuff tendons. A physical or occupational therapist can show people how to do them properly.
If having previous shoulder issues, use ice for 15 minutes after exercising, in order to prevent future injuries.
After having bursitis or tendinitis, performing simple range-of-motion exercises daily can keep people from getting frozen shoulder.
While shoulder injuries may be common, getting the right treatment as quickly as possible is important. Complete all physical therapy and other treatments even if the symptoms are better. This will prevent future shoulder issues from happening again.
