Shoulder Pain: Types, Causes and Treatment

The shoulder is a ball and socket joint, wherein the ball (humeral head) is large, and the socket (glenoid) is small, facilitating movement in an almost 360-degree arc.

The two surfaces are covered by a polish (much like the paint on a wall) that reduces friction between them when they glide against each other, constituting the glenohumeral joint. However, the shoulder, due to this anatomy, is inherently unstable. To overcome this, the shoulder joint has certain unique features—the socket has banking all around it (labrum), which is a slightly elevated region made of cartilage. This is akin to a plate that has raised edges and prevents food from spilling over. Apart from this, the shoulder is covered with muscles all around that contain the ball within the socket.

The muscles that move the shoulder are attached via rope-like structures called rotator cuff tendons to a part of the ball. The whole function is much like a water well as it has a man/woman, a rope and a bucket. The bucket is the arm, the muscles the individual, and the rope the tendons. If there is any problem with the rope or individual, the bucket won’t come up. Two more accessory joints are less spoken of, but are part of the shoulder joint complex.

The joint between the collarbone and sternum (breast bone) is called the sternoclavicular joint, and between the collarbone and shoulder blade is called the acromioclavicular joint. These joints are responsible for performing overhead activities like the extreme raising of the arms.

Types of Shoulder Pain

Adhesive Capsulitis (Frozen Shoulder) 

This condition is most commonly seen in people who have diabetes. The shoulder joint gets inflamed (swollen), and movement gradually gets restricted, ultimately leading to a frozen shoulder. The condition is more often than not self-limiting, i.e., after an average of 6–9 months, the infection subsides. However, during this period, it is intensely debilitating, with an inability to use/ sleep on the affected side. The condition has three stages:

1. Freezing: when it gradually gets stiff
2. Frozen: when movements are grossly restricted
3. Thawing: when movements begin to return

Gleno-Humeral (Ball & Socket) Arthritis 

This condition is seen frequently in people who have injured the shoulder or are suffering from long-standing diseases like rheumatoid arthritis or inflammatory arthritis. One presents with a gross restriction of movement in all directions, with a grinding feeling in the joint whenever it is moved. In this condition, essentially, the cartilage /paint coating the two bony surfaces gets rubbed off, and ultimately, bone grinds against bone. For individuals experiencing this debilitating condition, consulting the best orthopaedics doctor in Delhi or elsewhere can provide access to a thorough evaluation and advanced treatment options, including the possibility of shoulder replacement surgery at a specialised shoulder replacement hospital in Delhi or other locations.

Injury 

Shoulder injuries come in different types, like fractures (breaks in the bone), tendon issues (especially in the rotator cuff tendons), and dislocations. Shoulder fractures are quite common; the ball part of the joint breaks more often than the socket. 

Tendon injuries occur mainly in two groups of the population: the sporty and elderly. People who are into sports may injure themselves while playing sports, while the elderly may get a trivia injury to an already weak tendon. 

Dislocations 

These primarily occur due to falls. If it’s the first time, then the treatment is mainly conservative, with rest in a sling for 3 weeks. If it appears more than once, in all probability, the banking of the socket has flattened out, allowing the ball to slide out of the socket. 

Impingement 

Above the tendons is a bone called the acromion. The space between the tendons and bone is enough so that the tendons never touch the bone when the arm is lifted. Sometimes, the shape of the bone above is more hooked and touches the tendons when the arms are lifted. This causes swelling of the tendon covering and severe pain. This is called impingement.

Acromioclavicular Joint Arthritis 

This pain typically occurs on the top of the shoulder and is worsened by the overhead lifting of the arm. Treatment involves physiotherapy and injection of a local steroid into the joint. Arthroscopic surgery is rarely used for rubbing bone surfaces.

Shoulder Pain Causes 

The common causes of shoulder pain include:

• Osteoarthritis: This common joint condition happens when the cushioning cartilage in the shoulders wears down. Osteoarthritis leads to pain and stiffness because the bones start rubbing together.
• Rheumatoid arthritis: In rheumatoid arthritis, the immune system mistakenly attacks the lining of the joints, leading to pain and stiffness in the shoulders.
• Referred pain: Sometimes one might feel shoulder pain not because there's something wrong with the shoulder itself, but because another part of the body, like the gallbladder or liver, has a problem.
• Tendinitis: The tendons in the rotator cuff (a group of muscles and tendons that secure the arm to the shoulder) can get swollen and painful. This can happen over time or suddenly if one falls or the shoulder gets hit.
• Bone spurs: These are little bumps of bone that grow and can press on the rotator cuff, which makes the shoulder move in a way that it shouldn't. This rubbing can cause the tendons to be sore or even tear them.

Shoulder Pain Diagnosis 

Doctors approach shoulder pain with a detailed evaluation, which includes a review of the patient's symptoms, a comprehensive physical examination, and imaging tests when necessary to establish an accurate diagnosis.

Physical Examination 

During the examination, practitioners assess the patient's shoulder by palpating various parts to identify any pain or abnormalities and by testing the arm's strength and the shoulder's range of motion. They may also investigate other areas, such as the neck or abdomen, to exclude potential non-shoulder-related sources of the pain.

Imaging Tests 

Patients may undergo one or more of the following imaging tests:

• X-rays: These images can reveal bone-related issues within the shoulder, like fractures or bone spurs indicative of osteoarthritis.
• MRI Scans: These scans provide detailed images of the shoulder's tendons, ligaments, and muscles and can help diagnose conditions such as rotator cuff tears.

Differential Diagnosis

Shoulder pain can sometimes be deceptive, arising from areas other than the shoulder, such as a herniated disc in the neck or gallbladder disease. In rare circumstances, the pain could be a sign of a heart attack or internal bleeding from the liver or spleen.

If doctors suspect the pain is due to a condition unrelated to the shoulder, they will adjust their focus to investigate these potential causes. For instance, they might order an electrocardiogram (ECG) if a heart attack is suspected or an abdominal ultrasound for likely gallbladder disease.

Read more - How Can Physiotherapy Reduce Your Shoulder Pain?

What are the Treatment Options for Shoulder Pain? 

The treatment for shoulder pain can vary depending on the underlying cause and the specific type of shoulder pain. Some common treatment options for different types of shoulder pain include:

Adhesive Capsulitis (Frozen Shoulder) 

Treatment largely centres on pain management and preserving movement via physiotherapy. Injections into the shoulder are sometimes attempted to ease pain and facilitate physiotherapy. However, if the condition does not subside within 6–9 months, arthroscopic (keyhole) shoulder release may be tried, which is a quick and immediate solution to the problem.

Gleno-Humeral (Ball & Socket) Arthritis 

Treatment initially centres on local physiotherapy like heat therapy. If the pain doesn’t subside, an injection may be tried for temporary relief. Ultimately, shoulder replacement surgery may be the only solution when the quality of life is grossly compromised.

Tendon Injuries

The tendons, when broken more often, are difficult to fix back. This is one condition where vigorous physiotherapy pre-operative methods may be detrimental because they may worsen the tear. The tear is repaired via arthroscopic (keyhole) or open surgery using tiny plastic/metal screws with threads coming out of them that are used to stitch the tendons.

Dislocations 

Dislocations in the shoulder are often treated with closed reduction, where the dislocated bone is repositioned. Following this, a period of immobilisation and rehabilitation helps restore strength and stability. For recurrent or complex dislocations, surgical stabilisation procedures may be necessary to prevent further occurrences. Individualised care is essential.

Impingement 

Impingement of the shoulder typically involves compression of tendons or bursa in the subacromial space. Treatment usually starts with rest, physical therapy to strengthen the shoulder, and anti-inflammatory medications. In some cases, corticosteroid injections may be used for temporary relief. Surgery may be considered for severe or persistent impingement.

Acromioclavicular Joint Arthritis 

Treatment for Acromioclavicular (AC) joint arthritis involves a combination of non-surgical methods such as rest, anti-inflammatory medications, physical therapy, and corticosteroid injections. In more severe cases, surgical options like distal clavicle excision or joint reconstruction may be considered to alleviate pain and improve shoulder function.

Treat Shoulder Pain at Home

Mild shoulder pain can be alleviated at home by adhering to the RICE method, which stands for:

• Resting the affected shoulder.
• Applying ice to the sore area.
• Using compression as needed.
• Elevating the shoulder.

This entails taking NSAIDs (nonsteroidal anti-inflammatory drugs) or acetaminophen for pain as prescribed, and avoiding heat application when swelling is present. Stretching and massaging the shoulder muscles are also recommended.

Read more - How to Treat a Frozen Shoulder?

Shoulder Pain Prevention

Preventing shoulder pain isn't always possible, mainly due to accidents, injuries, or underlying conditions. However, one can lower the risk of shoulder injuries by:

• Using appropriate protective gear.
• Immediately discontinue any activity if you experience pain.
• Allowing your body sufficient time for rest and recovery after physical activities
• Incorporating stretching, warm-up, and cool-down routines before and after sports or exercise.

Final words

Effective diagnosis and treatment are crucial for managing shoulder pain and maintaining quality of life. Max Hospitals, with its dedication to clinical excellence and personalised healthcare, offers comprehensive solutions for those suffering from shoulder pain. By entrusting your care to the adept team at Max Hospitals, patients can anticipate a custom-tailored treatment regimen incorporating cutting-edge techniques and a holistic approach to care. This commitment ensures that individuals benefit from a compassionate, patient-centric experience aimed at restoring mobility, alleviating pain, and improving overall well-being for optimal health outcomes.