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Shoulder Pain
What causes shoulder pain?
Shoulder pain is a common problem with a number of different causes. It is often a symptom of another problem. There are a number of reasons why you might be experiencing shoulder pain, which include:
- poor posture
- frozen shoulder – a very painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether
- rotator cuff disorders – the rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep it stable
- shoulder instability – where the shoulder is unstable and has an unusually large range of movement (hypermobility). Hypermobile shoulders dislocate very easily.
- acromioclavicular joint disorders – conditions that affect the acromioclavicular joint, which is the joint at the very tip of the shoulder
- osteoarthritis in the shoulder joints
- a broken bone, such as a fracture of the humerus (upper arm bone) or collarbone
In some cases, pain in the shoulder isn't caused by a problem in the shoulder joint, but by a problem in another area, such as the neck, that is felt in the shoulder and upper back. There are also a number of medical conditions that can present with pain in the shoulder.
How do we treat shoulder pain at the Mansfield Clinic?
The most important thing is to make an accurate diagnosis of the cause of your pain, and Dr Allfree will make a careful and thorough assessment of your shoulder to try to determine the nature of the problem.
Once a diagnosis has been made, a number of different treatment strategies will be recommended by Dr Allfree, including one or more of the following:
- Manual therapy such as osteopathy
- A specially tailored exercise programme.
- If your shoulder pain is severe, such as in certain cases of frozen shoulder, painkillers may not be enough to control the pain. In this case, you may have cortisone injected into and around your shoulder joint.
- Shock wave therapy may be beneficial in certain cases that do not respond to cortisone injections.
- If all conservative measures fail, surgery may be the only other option. If surgical advice is needed, Dr Allfree will be able to arrange a referral.
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Diagnosing the cause of shoulder pain
Shoulder pain is a common problem with a number of different causes. Dr Allfree may be able to diagnose the cause of your shoulder pain by discussing your symptoms with you and examining your shoulder. In some cases, he may need to arrange some further tests such as X-rays or an MRI scan.
As well as asking exactly where the pain is, Dr Allfree will need to know whether:
- you have had any recent injuries
- anything makes the pain feel better or worse
- the pain is worse at night
- the pain came on gradually or suddenly
- the pain is affecting your everyday life – for example, at work or when exercising
- you have any other symptoms
Physical examination
Dr Allfree will carry out a thorough physical examination of your shoulder area. He will:
- compare your shoulders
- check for any redness, swelling or bruising
- check whether your joint is dislocated (whether the joint has come out of its correct position) – if it is, your shoulder will be in an unusual position
- feel your shoulder bones and joints to see whether this causes any pain
Arm movements
Dr Allfree will also ask you to do some specific arm movements – for example, placing your hands on the back of your neck and pointing your elbows out to the side. The type of movements that cause pain will help him to determine the underlying cause.
Investigations
Further investigations are not usually necessary, but if you do need any imaging tests to examine your shoulder in more detail, Dr Allfree will be able to arrange these for you.
X-ray
You may have a shoulder X-ray if the inside of your shoulder joint needs to be examined to rule out other damage. An X-ray uses radiation to detect problems with your bones such as osteoarthritis, or a fracture.
Magnetic resonance imaging (MRI) scan
A magnetic resonance imaging (MRI) scan uses strong magnetic fields to produce a detailed image of the inside of your body. An MRI scan is not just one picture, it is a series of cross-sectional “slices” through the joint, that gives a lot of information about the joint and the soft tissues surrounding it. MRI scans can be very helpful in making a diagnosis of the cause of the shoulder pain if it is not possible to make the diagnosis just by examining the joint.
Blood tests
A sample of your blood may be tested to rule out conditions that can cause shoulder pain or similar symptoms, such as:
- Polymyalgia Rheumatica – a condition that inflames the tissues of the joints, causing symptoms of muscle pain and stiffness, typically worse first thing in the morning
- A cancerous tumour, although this is rare
- Diabetes – people with diabetes are more likely to develop frozen shoulder
Treating shoulder pain
There are things you can do yourself to treat shoulder pain, including using painkillers such as ibuprofen, or ice packs to reduce inflammation and relieve pain. Avoiding activities that may aggravate your symptoms will also help.
Depending on the cause of your shoulder pain, Dr Allfree may suggest different treatment options. including:
- Manual therapy: such as osteopathy
- Corticosteroid injections: if your shoulder pain is severe, such as in certain cases of frozen shoulder, tendinitis or bursitis, painkillers may not be enough to control the pain. In this case, Dr Allfree may recommend injecting a corticosteroid into and around your shoulder joint. Corticosteroid injections can help relieve pain caused by frozen shoulder and increase your range of movement for several weeks at a time, particularly during the first stage of symptoms. However, the injections cannot cure your condition completely and your symptoms may gradually return. Research also suggests that corticosteroid injections can provide pain relief for shoulder tendinitis. They may also improve your ability to use your shoulder. After having a corticosteroid injection, you may experience side effects at the site of the injection. These may include temporary worsening of the pain, lightening or thinning of your skin.
- Shock wave therapy: This may be beneficial in cases of calcific tendinitis of the shoulder.
- Surgery: If all conservative measures fail, this may be the only other option. If surgical advice is needed, Dr Allfree will be able to arrange a referral.