Reasons, Treatment, and When to Contact Your Healthcare Provider

Shoulder pain has many different causes and treatments. It is not easy to understand the difference between different types of shoulder pain, such as frozen shoulder , scapula pain, or rotator cuff tear symptoms . This is why you should seek medical attention if you have shoulder pain, and treatment depends on the cause, your general health, and your level of activity.

Shoulder pain can be caused by osteoarthritis, muscle tears, tendonitis, and many other causes.

There are three bones in the shoulder joint:

  1. Humerus (shoulder)
  2. Scapula (scapula)
  3. Clavicle (clavicle)

The upper part of the humerus is ball-shaped and fits into a shallow depression in the scapula. Strong ligaments hold the ball in the center of the socket, and the rotator cuff muscles (which also cover the shoulder bone) lift and rotate the arm .

A problem with any part of the architecture of the shoulder joint can cause pain, weakness, or instability in the shoulder.

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Causes

Shoulder pain is a very common problem. Given the complex anatomy of the shoulder joint, there are many possible causes. And the location of the shoulder pain can help determine which part of the joint is affected.

Beyond the shoulder

Some problems can cause pain on the outside of the shoulder, and the most common cause is a rotator cuff tear .

Rotator cuff problem

The shoulder is moved by four muscles of the rotator cuff, including the deltoid .

There are three main types of rotator cuff problems.

  1. Tendinitis : inflammation of the tendons (which connect the shoulder muscles to the shoulder bone).
  2. Bursitis : inflammation of the bursa (fluid-filled space).
  3. Rotator cuff tear: The rotator cuff tendons are damaged as they attach to the bone .

Rotator cuff problems cause pain, especially with activities like reaching or throwing . Deep shoulder pain tends to be worse or worse at night, it may wake you up, or make it difficult for you to fall asleep .

Rotator cuff problems can be associated with limited active range of motion. Because it is difficult to voluntarily move a damaged or inflamed muscle, your shoulder may feel stiff. But if someone does the work for you by raising one arm (passive movement), your shoulder will most likely move normally.

Frozen shoulder

Frozen shoulder, also called adhesive capsulitis, is a common condition that produces stiffness and pain in the joints that can be persistent. Although many shoulder conditions, including rotator cuff tendonitis, can be associated with frozen shoulder, the cause is often unknown .

When the shoulder is frozen, both active and passive range of motion is reduced .

Calcific tendinitis

Calcific tendinitis occurs when calcium crystals deposit within a tendon, most commonly the rotator cuff tendons. This condition usually causes progressive shoulder pain that is worse at night and from overhead movements, such as putting on a shirt. Although some people develop chronic diseases, many of the symptoms go away on their own within three to six months .

Shoulder front

Pain in the front of the shoulder is most commonly associated with the biceps tendon, a tendon that inserts deep into the shoulder. Conditions include biceps tendonitis, SLAP tears, and biceps tendon ruptures .

Biceps tendonitis

Biceps tendon problems usually cause gradual pain in the front of the shoulder that can continue down the biceps . Pain is often worse with repetitive lifting, carrying heavy bags, or overhead lifting, and may worsen with exercise. evening.

Biceps tendon problems can also cause a clicking sound when the shoulder is rotated in an arch.

Biceps tendon tear

Biceps tendon rupture can occur if the biceps muscle becomes loose near the joint. Symptoms of a biceps tendon tear include a sudden "pop" along with increased pain, bruising, swelling, and often swelling just above the antecubital fossa (in front of the elbow) .

SLAP Tears

An anteroposterior tear of the upper lip ( SLAP tear ) is a special type of tear in the labrum (cartilage in the shoulder joint). One of the most common reasons is landing on an outstretched hand.

It is also common among athletes who throw overhead (such as baseball pitchers) or workers who perform repetitive aerial activities. Symptoms can include deep shoulder pain, pinching and clicking sensation when moving.

Shoulder osteoarthritis

With shoulder osteoarthritis , you may have deep shoulder pain or pain in the front of your shoulder, as well as stiffness. Usually there is a decrease in both active and passive range of motion. Shoulder arthritis can sometimes be preceded by an injury to the arm, neck, or shoulder that occurred several years ago .

Shoulder top

Arthritis of the shoulder is less common than arthritis of the knee and hip joints and, in severe cases, can be treated with joint replacement surgery .

The most common cause of upper shoulder pain is an abnormality of the acromioclavicular (AC) joint. AC joint problems include AC arthritis , AC separation, and distal osteolysis of the clavicle.

AC arthritis

Arthritis can cause smooth cartilage abrasion, cartilage roughness, and bone spurs , which can limit mobility.

Exposed bones and uneven cartilage can cause crackles (a grinding sensation), especially when the head is reached or across the chest.

AC separation

AC split (also called shoulder split) can occur after falling directly onto the shoulder, damaging the ligaments that surround the AC joint. Depending on the severity of the ligament injury over the shoulder, a lump may form due to the separation of the scapula from the clavicle.

Osteolysis of the distal clavicle

Distal clavicle osteolysis causes sharp or aching pain at the end of the clavicle (clavicle). Most of the time it affects weightlifters or other people who repeatedly lift or carry heavy objects .

All over the shoulder

The tendons, ligaments, and muscles of the shoulder provide stability. If these tissues become loose or tear, it can lead to instability or dislocation of the shoulder.

Shoulder instability

Instability, as the name suggests, causes the joint to loosen. It could be caused by injury (dislocation) or overuse. Shoulders that appear unstable can slip out of the joint .

Multidirectional instability can result from chronic loosening of the ligaments. This is usually seen in young, athletic women, and you may feel like your shoulder is not holding tight in place ( shoulder subluxation ). The sensation is often described as a "dead hand" with excessive shoulder mobility.

Shoulder dislocation

A dislocation is an injury that occurs when the upper part of the arm bone detaches from the scapula. If someone dislocates their shoulder , the normal ligaments that hold the shoulder in that position can be damaged and the shoulder tends to slide out of the joint again .

When to contact a healthcare provider

If you experience new, worse, or severe shoulder pain, you should seek medical attention.

Some signs that you should see a doctor include:

  • Inability to carry objects or use the hand.
  • Injury causing joint deformity
  • Shoulder pain that occurs at night or while resting
  • Shoulder pain that lasts for several days.
  • Inability to raise your hand
  • Significant swelling or bruising around a joint or arm.
  • Signs of infection, including fever, redness of the skin, and warmth
  • Any other unusual symptoms associated with shoulder pain, such as abdominal pain or shortness of breath.

Diagnostics

Because there are many potential causes of shoulder pain, your healthcare provider will perform careful analysis of your symptoms, physical exams, and sometimes imaging tests to help make a correct diagnosis.

Physical exam

After reviewing your symptoms and medical history, your healthcare provider will perform a complete exam of your shoulder. They will press on different areas of your shoulder to measure pain or deformity. They will also assess your arm strength and shoulder range of motion.

Your healthcare provider may also examine other parts of your body, such as your neck or abdomen, to rule out other causes of pain besides the shoulder.

Display

You may need one or more of the following:

  • X- rays: An X-ray of the shoulder can visualize bone lesions or minor problems, such as bone spurs, which can indicate a diagnosis of osteoarthritis.
  • Magnetic Resonance Imaging ( MRI ): This test provides detailed images of the tendons, ligaments, and muscles that surround the shoulder joint. For example, an MRI scan can provide information about the location, size, and relative age of a rotator cuff tear.

Differential diagnosis

While it seems logical that shoulder pain is due to the shoulder, it is not always the case. Common shoulder pain, which is often difficult to identify, can sometimes be associated with a herniated disc in the neck or gallbladder disease. In rare cases, shoulder pain can be a sign of a heart attack or bleeding from the liver or spleen.

If your healthcare provider has concerns about a cause other than the shoulder joint, they may focus on that diagnosis. For example, an electrocardiogram (EKG) may be ordered along with cardiac enzymes if a heart attack is suspected, while an abdominal ultrasound may be ordered if a gallbladder disorder is suspected.

After all, figuring out the cause of shoulder pain is often difficult and not as easy as you might think.

Watch out

Treatment for shoulder pain depends entirely on the cause of the problem. And while one treatment protocol may be helpful for one problem, it may be useless or even harmful for another.

It is imperative that you seek medical attention so that you know what you are treating and how you should treat it before embarking on a program. Not all of the treatments listed here are suitable for all conditions, but some may be helpful in your situation.

Rest

The first treatment for many common types of shoulder pain is to rest the joint and allow the acute inflammation to subside. However, it is important to be careful when resting the joint, as prolonged immobilization can lead to stiffness.

Apply ice and heat

Ice packs are most commonly used to reduce swelling and pain in acute shoulder injuries, but they can also be used to treat shoulder injuries caused by overuse (such as rotator cuff tendonitis or bursitis). In these cases, ice is applied immediately after training over the head to minimize inflammation.

Heating pads are also used to treat chronic shoulder conditions, but usually before overhead exercises. Heat can relax muscles, relieve stiffness, and ease pain.

Talk to your doctor or physical therapist before applying ice or heat . Developing a specific plan for the timing and duration of each treatment is important to optimize shoulder healing.

Physical activity

Physical therapy is an important aspect of shoulder pain treatment. Physical therapists can use a variety of techniques to increase your strength, restore mobility, and help you achieve pre-injury activity levels.

Medicines

The two most common medications used to relieve shoulder pain and swelling are non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections.

NSAIDs

Some NSAIDs are available without a prescription (such as ibuprofen), while others are prescribed only by prescription, such as Voltaren (diclofenac). They are commonly used to treat shoulder problems such as arthritis, bursitis, and tendonitis.

However, it is important to use them only for a short time and only under the supervision of your healthcare professional. NSAIDs are associated with some risks; be sure to tell your doctor if you are pregnant or have any health problems such as high blood pressure, asthma, or a history of kidney, liver, or stomach ulcers.

Steroid injection

After injecting steroids, your healthcare provider will inject cortisone , a powerful steroid medicine that relieves inflammation, into your shoulder. The injection can help relieve pain and make physical therapy easier.

Operation

In some cases, surgery may be required if conservative measures don't work or if the shoulder injury is too severe to begin with. If you are planning shoulder surgery, you will need to consult an orthopedic surgeon .

Get the word of drug information

While it can be difficult to figure out the "why" of shoulder pain, try to be patient. The shoulder is a complex structure and, ultimately, a correct diagnosis is the key to its recovery.

If you develop shoulder disease, rest assured knowing that the vast majority of people get rid of its symptoms.

Frequently asked questions

  • Specific shoulder problems that can be worse at night include rotator cuff problems, calcific tendonitis , and biceps tendonitis . If you often have shoulder pain that is worse at night, see your doctor to diagnose the problem and help you find treatment.

  • Shoulder expulsion can occur due to an anteroposterior tear of the upper lip (SLAP tear). This is a tear of the articular lip, the cartilage of the shoulder joint. It could be due to a violent fall from the outstretched hand.

  • In many cases, frozen shoulder occurs without any associated injury or known cause. However, risk factors include diabetes, thyroid problems, shoulder surgery, heart disease, or Parkinson's disease.

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