The shoulder is a complex articulation that joins three bones. One of them is called humerus, and it is the upper arm bone. The second is called scapula, and we usually recognize it as the shoulder blade. The third bone is commonly known as the clavicle or the collarbone.
The most important part of the articulation is the upper arm bone, which has a round protuberance or head that fits into the shoulder blade socket. This type of articulation is known as glenoid articulation, and it is very mobile. However, it is held in place by tendons and muscles that maintain the head of the humerus in the socket. These tendons are known as the rotator cuff and have the function of covering the head of the humerus and bringing it down to the shoulder blade to prevent dislocation.
In most cases, shoulder pain has to do with this articulation, and learning about its components will help us understand what triggers this symptom.
Overview
Shoulder pain is a symptom, not a disease by itself. This is a very mobile articulation, and such an increase in mobility can come with some instability problems, mainly if we use the articulation heavily or with many repetitive motions. These limitations often cause pain to the patient, which can be temporary or more permanent. In most cases, it goes away after a while, especially after taking painkillers. In other cases, patients need to search for a surgical solution to their problem.
In this article, you will find the most common diseases that lead to shoulder pain, how physical therapy is and what tests are appropriate for these cases, and how do you find relief from shoulder pain depending on its cause.
Causes and related diseases
In most cases, shoulder pain is triggered by inflammation or instability of the articulation. This inflammation can be secondary to a direct hit, arthritis, or a fracture in one of the bones that make up the articulation. A fracture can also cause instability, but you could also have a genetic predisposition or start experiencing instability after enduring trauma or performing an exercise with a bad technique.
Let us review the most common ailments that trigger shoulder pain and what are they about:
Bursitis
This is inflammation of the bursae. They are small sacs that surround and protect the joints. Bursae provide cushion to the joints because they prevent excessive friction between bones and the surrounding muscles. Thus, repetitive movements or heavy use of the shoulder articulation causes swelling to the bursa in the area located between the rotator cuff and the shoulder blade’s acromion. In many cases, tendinitis is also associated with pain. Thus, the most common type of bursitis is called subacromial bursitis, and it is usually accompanied by tendinitis.
Tendinitis
It is the inflammation of tendons and related tissues. The tendon is a fibrous and very elastic tissue that connects the bone and the muscle together. They are found at the end of the muscle and attaching directly to the bone. We can have acute tendinitis, found in sportspeople and people with physically heavy work. Chronic tendinitis is associated with arthritis and is triggered by repetitive motion, constant wear & tear, or degeneration of the articulation.
Tears and other soft tissue injuries
An injury to the tendon is a partial tear of the tissue. A complete tear is splitting or separation of the tendon from its bony attachment. In most cases, tears are due to trauma or incorrect and very violent movements that pull the tendon with enough force to break its attachment. The most common tendon tears and injuries affect the rotator cuff. A bicep tendon injury may also cause significant shoulder pain.
Shoulder impingement
It is an irritation or continued damage to the rotator cuff tendon and the bursa through articulation pressure by the acromion. This part of the shoulder blade is located on the top portion of the bone, so when you lift your arm, it rotates and puts pressure on soft tissue. Repeated motions when you have shoulder impingement causes tendonitis or bursitis and may turn into a limiting and painful condition by itself.
Shoulder instability
Shoulder mobility comes with a price, and that is the possibility of shoulder instability. You have instability if the head of the humerus is at risk of slipping out of the shoulder blade socket. The most common cause is a sudden and violent movement, but it can also be due to overuse injuries and articulation’s fragility. You can also have a partial dislocation of the shoulder, which is also very painful. Some people have loose tendons and ligaments with a higher risk of dislocation. Others could be born with a condition that increases the risk of repeated episodes of dislocation or subluxation.
Arthritis
This is also a significant cause of shoulder pain, and there are different types of arthritis. They all have in common inflammation as one of the main mechanisms. Your own immune system can trigger this inflammation in rheumatoid arthritis or by wear and tear in the case of osteoarthritis. They usually feature progressive symptoms, but we can also have arthritis after an articulation infection, which has a rapid onset. It is often associated with swelling and stiffness of the joint.
Fracture
Shoulder fractures usually involve the humerus, but you can also endure a fracture in the clavicle or the scapula. In most cases, fractures are caused by a direct hit or a high-energy injury. However, there are also pathologic fractures in which the bone breaks and gives away to minimal trauma that would not cause a rupture in healthy bone. This is common in older adults with osteoporosis and osteopenia, especially when they fall from their own height.
Associated signs and symptoms
Shoulder pain is only one symptom, and it is not enough to understand where it comes from. Other symptoms should be evaluated to trace back the cause and recommend treatment accordingly. The most common signs and symptoms reported along with shoulder pain are:
- Movement limitation: This is the most common sign, and doctors will make sure that movement limitation is not only due to the pain. It can also be due to changes in the articulation itself. In any case, the range of motion is compromised, and patients can’t fully use their articulation.
- Swelling: It is an increase in the volume or size, usually associated with inflammation. Swelling is particularly common in arthritis and other inflammatory conditions. It could be just an increase in volume or could be related to warmness and redness in the articulation.
- Stiffness: This symptom is associated with a significant reduction in the range of motion. The articulation is particularly difficult to move and seems like there’s an actual physical barrier that does not allow any movement.
- Weakness: Besides stiffness and movement limitation, patients with shoulder pain often report muscle weakness. The articulation’s capacity and the muscles that do the job are severely compromised, sometimes due to pain.
- Tingling or numbness: Some patients may also feel numbness or tingling in the articulation or nearby.
Diagnosis
It is imperative to seek medical help if you endured an acute lesion to the shoulder and started feeling severe pain. If your shoulder pain is mild or moderate, you may sometimes try resting or using home remedies. But when the symptom is maintained or improves for a short while, the best idea is to get properly diagnosed by a doctor.
You will get a complete evaluation in the doctor’s office, starting with a medical history and answering several questions. Then, you will go through a physical examination, which is fundamental to evaluate the symptoms. Finally, your doctor may recommend a few tests to confirm his suspicions and give you a diagnosis.
Thus, the workup to complete the diagnosis goes like this:
Medical history
History taking is fundamental, and it is done by asking you many questions about the pain. Your doctor will want to know how long have you had this shoulder pain if it was related to an event that you recall, and what triggers the pain. It is important to describe how it is felt, the degree of intensity, and whether it has become more intense as time passes. The doctor may also ask you about your day-to-day activities to search for specific events that may have led to the development of this type of pain.
Physical examination
This step is also essential because your doctor will have a few tests prepared to evaluate abnormalities in the articulation. His findings can be either anatomical or physiological. In other words, you could have a physical abnormality as in swelling or a functional abnormality as in a reduction of the range of motion. The physical exam starts with observation, touching the area to evaluate tenderness, and finishing with specific tests for different conditions.
Medical tests
They include X-ray, an ultrasound, electrical studies, and others that will confirm a doctor’s findings. The most common is X-rays, which clearly picture the bony structures and help doctors identify injuries to the articulation’s bony part. Magnetic resonance and ultrasound are typically used when doctors need to evaluate the soft tissues (muscles and ligaments, mainly). An electrical study such as EMG can be useful to assess nerve function and how the muscle responds to it. But sometimes these studies are not enough to diagnose the disease, and your doctor may require a more invasive procedure such as arthroscopy, in which a tiny camera is inserted inside the articulation to see live what is going on.
Treatment
In most cases, treating shoulder pain is not difficult. Acute and transient causes usually respond well to medication and ice packs. Chronic disease usually needs physiotherapy and medications to recover. In very severe cases, surgery can be considered, but only before conservative treatments fail.
Here’s a brief summary of the available treatments for shoulder pain:
- Hot and cold therapy: It uses hot and cold packs to provide relief for the pain and counter inflammation. It may also reduce the patient’s stiffness and other uncomfortable symptoms.
- Over-the-counter medications: They are basically painkillers and anti-inflammatories. They can help to control the symptom but do not actually cure the disease.
- Rest: In some cases, rest will be recommended to allow the body to heal itself before resuming any activity that impacts the shoulder articulation.
- Activity changes: You may need a few modifications in your daily activities to contribute to the treatment. For example, a change in your daily activities at work to reduce damage to the shoulder articulation and avoiding strenuous or repetitive physical work that involves the shoulder.
- Physiotherapy: It is fundamental, especially when you’ve had shoulder pain for a long time, and the function of the muscles is starting to suffer. In this case, a solid physiotherapy program can reduce stiffness and give you back your physical strength.
- Corticosteroid injections: When oral drugs do not improve the pain, an injection with steroids could be helpful. It is usually repeated to maintain the effects of the injection and provide relief. However, it is essential to consider the side effects of these injections. They sometimes accelerate degeneration of the articulation.
- Surgery: Surgical procedures are only reserved for patients who tried conservative treatments and failed. Before surgery, rehabilitation will be important to improve the outcome. There’s also post-surgical rehabilitation to get the muscles back to their previous state. Surgery is particularly useful in rotator cuff tears, severe joint damage due to arthritis, and frequent dislocations of the shoulder.