Shoulder pain is a common injury for many people whether sporting related or occupational. As many as 67% of people experience shoulder discomfort at some point in their lives. Symptoms include sharp or dull pain, restricted range of movement, impingement, clicking or grinding of the joint, referred pain to the arm and neck and also loss of strength. The shoulder is a complex joint which relies on the function of muscles, tendons, ligaments and barsae all working collectively.
The shoulder joint is the most mobile joint in the body. Although the shoulder joint allows great multidirectional movements it makes it prone to acute and chronic injuries. While most shoulder problems are due to an acute traumatic injury seen in contact sports, chronic degeneration in the elderly and postural issues in sedentary occupational workers is just as prevalent.
In this article we will look at the different causes of shoulder injury and dysfunction with practical ways to correct and restore pain and function again. When we say shoulder it includes the glenohumeral joint, acromioclavicular joint, scapula, clavicle, ligaments, the barsaes and muscles including the rotator cuff muscles, trapezius, rhomboids, pectorials, biceps, latissimus dorsi, teres and serrtus anterior.
Common Shoulder Conditions
Rotator Cuff Tendinitis is the most common condition of the shoulder causing inflammation of rotator cuff muscle tendons. The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion especially above shoulder level, heavylifting, trauma or poor posture.
The condition is often acute in nature seen in gym junkies but also chronic in the elderly population.
It is especially common after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age. The pain associated with rotator cuff problems is normally felt at the front or on the outside of the shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed, particularly when lying on the affected side.
Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain. Corrective action is needed to allow recovery. We need to limit exercise and sports in the short term to reduce inflammation and then to build functional strength related to the sport or exercises.
Rotator Cuff Tear is where you can partially or completely tear your rotator cuff tendon of the shoulder. This mainly happens from either repetitive motion or from direct trauma like a fall on your outstretched arm.
They can be acute or chonic in nature. The pain of an acute tear is sudden and can be excruciating. Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Shoulder pain, weakness, and stiffness of a chronic tear worsen slowly over time.
Frozen shoulder ('adhesive capsulitis') is a condition that occurs when the shoulder capsule thickens and becomes inflamed and tight. There also may be less synovial fluid to lubricate the joint. As a result, the shoulder becomes difficult to move. Frozen shoulder may occur as a result of another condition if the shoulder has been immobilised (for example due to surgery or injury). It goes through three stages: freezing, frozen and thawing. Over time you'll notice a decrease in your range of motion and then all of a sudden the pain escalates. It usually takes about 18 months for a frozen shoulder to completely thaw. You can cut the time down with physical therapy but it will still last a while.
Shoulder Bursitis is inflammation of the barsae which is a fluid filled sack to help cushion the
shoulder joint and reduce friction forces with movement. It’s often a longer term injury associated
with other conditions at the same time which may be primarily or secondary. The pain from bursitis is typically on the outside of your shoulder and it's made worse when using your arm above your head. Treatment is usually rest, ice or heat and pain relievers. Physical therapy is recommended to stretch and strengthen the shoulder muscles and increase range of motion. Treatment early is needed to prevent having quaterzone injections or surgery. If the condition is left too long it may be the last resort.
Labral Tears of the shoulder are very common. The labrum plays an important role in keeping your shoulder joint stable and in a proper position. When a labral tear is causing a shoulder dislocation, surgery may be necessary. Tearing of the labrum can be found in shoulders of all age groups. Some labral tears occur from an injury. Different injury mechanisms include: repetitive stresses, falls, sports trauma, or aging and wear and tear. Many tears of the labrum occur because of injuries or trauma (a fall or sports injury). These tears were usually caused by a shoulder dislocation. Pitching or overhead sports can cause labral tears from repetitive stress.
Shoulder Impingement is where either the supraspinatus or the long head of the bicep tendon is
impinged in the shoulder joint when lifting the arm. This can result in reduced muscle strength, loss
of shoulder mobility and referral down the arm to hand in some cases. Shoulder impingement often occurs after repeated overhead activity, like swimming. Corrective exercises to address internal rotation of the shoulder mainly stretching the pectorials in a doorway. Slow progressive strengthening exercises are also key to long term pain-free symptoms.
Osteoarthritis
Sometimes called degenerative joint disease, osteoarthritis (OA) stems from wear and tear on the shoulder joint. The condition destroys the firm cartilage that acts as a cushion between the bones and helps them to glide smoothly against each other. As the cartilage breaks down and the bones of the joint rub against each other, shoulder pain and swelling can limit your range of motion. For instance it may become difficult to lift your arm to brush your hair or reach up to a shelf. Sometimes you'll hear a grinding, clicking, or snapping sound as you move your shoulder.
Shoulder Instability
By design, shoulders are unstable, it's what allows them to move in so many ways. But the term "instability" is also a diagnosis that's given when the shoulder hurts because the ball of the joint is too loose and is able to slide around too much in the socket. Chronic strain and worsened instability can occur when an already loose shoulder is overused, especially if the use is repeatedly challenging the ligaments that help hold the shoulder in the socket.
Shoulder Dislocation
Shoulder instability exists on a continuum, and on the extreme end is complete dislocation or when the ball of the joint becomes so loose it actually comes out of the socket. It's also possible to partially dislocate your shoulder called subluxation, which occurs when the shoulder almost slips completely out of the socket but then pops back in. With subluxation people often notice that their shoulder feels loose and slips in certain positions, often when their arm is raised over their head. Both subluxation and dislocation can also result from trauma such as a fall or blow that occurs with enough force to overpower the strength of the muscles and ligaments of the shoulder.
Fractured Collarbone
Breaks in the collarbone (aka clavicle) one of the main bones in the shoulder, are fairly common. They account for about 5% of all adult fractures according to the American Academy of Orthopaedic Surgeons. This type of break usually occurs with trauma like when you fall onto your shoulder or your outstretched arm.
Neck Pain
People often have shoulder pain that's actually stemming or referring from the upper back or neck area. To help pinpoint the cause of your shoulder pain a physical therapist will usually take your medical history, do a physical exam, and ask a whole host of questions about your shoulder pain, including: When did you first start experiencing shoulder pain, what makes it better or worse, have you ever injured your shoulder, and is the shoulder pain associated with any neck pain?
Heart Attack
Left arm pain or shoulder pain can be a symptom of an impending heart attack—the shoulder can begin to hurt as a result of the pain radiating from the chest. If you think you're having a heart attack (other symptoms include tightness or pressure in the chest area, sweating, and nausea), seek immediate medical attention.
How to Prevent Shoulder Pain
So how do we correct and prevent shoulder problems and injuries from arising in the first place?
Unless traumatic in nature shoulder problems are mainly self perpetuating meaning your action has
a major effect on your outcomes and how long recovery will be.
Assessing what actives are aggravating your condition whether it is your work, exercise, posture, sport or sleeping position is important to manage symptoms and correct shoulder problems. In the acute stage rest and possibly anti-inflammaties are needed to help initially with inflammation and pain. Load needs to be reduced to allow recovery and corrective exercises slowly progressed to correct posture and shoulder mobility.
Looking long term posture is another key factor. It is true that most people have rounded shoulders and it is this internal rotation of the shoulders which is the single most important factor to improve.
If posture is not address shoulder problems will relapse or prolong recovery time. Stretching your
pectoral muscles in a doorway and lying over a foam roller in the mid of your back are the two most
beneficial stretches to use. When pain and function allows, strengthening the shoulder muscles is
important by doing retraction exercises where the shoulders squeeze together either with the use of
a theraband or weights in the gym. Seeking physical therapy early on is important.
Leaving your shoulder to rest and recover without treatment and advice has the ability to progress to a more chronic stage.
Having self awareness of your body is important to check in and know when help is needed. Shoulder movement is vital for everyday activities and can affect work, sleep and exercise. It’s only when your shoulders are painful or dysfunctional that we pay attention to them.
