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Jai Ganesh

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Registered: 2005-06-28

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Shoulder Pain

Shoulder Pain

Gist

The most common cause of shoulder pain occurs when rotator cuff tendons become trapped under the bony area in the shoulder. The tendons become inflamed or damaged. This condition is called rotator cuff tendinitis or bursitis.

Summary

Shoulder pain is any type of pain or discomfort you feel in your shoulder. Your shoulder is called a ball-and-socket joint. It can move in many directions and it’s considered to be the most movable joint in the body. But it’s actually two joints (the acromioclavicular joint and the glenohumeral joint).

Your shoulder joins with your upper-arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The humerus fits into the rounded socket of the scapula. Each shoulder is held in place by a group of four muscles and tendons, called a rotator cuff, which covers and protects the humerus and lets you raise and move your arm.

There are also ligaments that hold bone to bone, and a sac filled with fluid that cushions the humerus head inside the joint. Because there are so many parts to the shoulder, there are many reasons why your shoulder might hurt. You might injure it in a fall or accident, or you could have overdone a chore like painting. Sometimes, shoulder pain comes from a condition like arthritis. It can even stem from problems in other parts of your body, which is called referred pain.

Depending on what’s causing the pain, it can be sharp or achy. It can be sudden or come on gradually. It can also stop you from doing some of your regular activities. Using a painful shoulder could cause further damage, so it’s important to find out why your shoulder hurts and get treatment as soon as possible.

Shoulder Injury Symptoms

The shoulder's ball-and-socket joint gives you great range of motion, but it comes at the expense of stability. The shoulder joint gets dislocated more often than any other joint in the body. And repeated stress from the way you use your shoulders on the job or playing sports can lead to tears and other injuries.

Ask yourself some questions to help you decide if you have a shoulder injury:

* Can you move your arm normally, or is your shoulder too stiff or painful?
* Do you feel like your shoulder could pop out of the socket?
* Is your shoulder strong enough for things you normally do?

You can treat some shoulder injuries at home for a few days with rest and ice. You can bandage it to hold it in place if necessary, and raise it above your heart. But some injuries need professional help. Here are signs that you need to see a doctor right away:

* Your shoulder joint looks deformed.
* You can’t use your shoulder at all.
* The pain is intense.
* Your shoulder swells suddenly.
* Your arm or hand is weak or numb.
* The pain comes with swelling, redness, or a fever.
* You have pain that lasts for more than 2 to 4 weeks.
* The skin around your shoulder becomes discolored.

Details

Your shoulder is a ball and socket joint and very mobile. It may hurt for many reasons, from injury and overuse to chronic conditions or diseases. You need to know the cause to get effective treatment.

The shoulder has a wide and versatile range of motion. When something goes wrong with your shoulder, it hampers your ability to move freely and can cause a great deal of pain and discomfort.

The shoulder is a ball-and-socket joint that has three main bones: the humerus (long arm bone), the clavicle (collarbone), and the scapula (also known as the shoulder blade).

These bones are cushioned by a layer of cartilage. There are two main joints. The acromioclavicular joint is between the highest part of the scapula and the clavicle.

The glenohumeral joint is made up of the top, ball-shaped part of the humerus bone and the outer edge of the scapula. This joint is also known as the shoulder joint.

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 your arm over your head if the tendons or bones around the rotator cuff are damaged or swollen.

You can injure your shoulder by performing manual labor, 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.

You’re more likely to have problems with your shoulder as you grow older, especially after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age.

In many cases, you can treat shoulder pain at home. However, physical therapy, medications, or surgery may also be necessary.

Here’s what you need know about shoulder pain, including causes, diagnosis, treatment, and prevention.

What causes shoulder pain?

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 acromium (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 your body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse when you move your 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

How is the cause of shoulder pain diagnosed?

Your doctor will want to find out the cause of your shoulder pain. They’ll request your medical history and do a physical examination.

They’ll feel for tenderness and swelling and will also assess your range of motion and joint stability. Imaging tests, such as an X-ray or MRI, can produce detailed pictures of your shoulder to help with the diagnosis.

Your doctor may also ask questions to determine the cause. Questions may include:

* Is the pain in one shoulder or both?
* Did this pain begin suddenly? If so, what were you doing?
* Does the pain move to other areas of your body?
* Can you pinpoint the area of pain?
* Does it hurt when you’re not moving?
* Does it hurt more when you move in certain ways?
* Is it a sharp pain or a dull ache?
* Has the area of pain been red, hot, or swollen?
* Does the pain keep you awake at night?
* What makes it worse and what makes it better?
* Have you had to limit your activities because of your shoulder pain?

When should I seek medical help?

You should contact your doctor if you experience fever, inability to move your shoulder, lasting bruising, heat and tenderness around the joint, or pain that persists beyond a few weeks of home treatment.

If your shoulder pain is sudden and not related to an injury, call 911 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

Also, call 911 or go to an emergency room immediately if you injured your shoulder and are bleeding, swollen, or you can see exposed tissue.

What are the treatment options for shoulder pain?

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.

Your 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 your doctor can inject into your shoulder.

If you’ve had shoulder surgery, follow after-care instructions carefully.

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 your 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.

Additional Information

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Other regions within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that the brain may interpret as arising from the shoulder.

Shoulder structures and functions

The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Two joints facilitate shoulder movement. The acromioclavicular (AC) joint is located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. The glenohumeral joint, to which the term "shoulder joint" commonly refers, is a ball-and-socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. The "ball" is the top, rounded portion of the upper arm bone or humerus; the "socket," or glenoid, is a dish-shaped part of the outer edge of the scapula into which the ball fits. Arm movement is further facilitated by the ability of the scapula itself to slide along the rib cage. The capsule is a soft tissue envelope that encircles the glenohumeral joint. It is lined by a thin, smooth synovial membrane.

The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach shoulder bones to each other, providing stability. For example, the front of the joint capsule is anchored by three glenohumeral ligaments.

The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.

Four filmy sac-like structures called bursa permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.

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