Index
Inflammation of the muscles, ligaments, or tendons is the most common cause of pain in this part of the body.
Shoulder pain is a common complaint—the causes of pain range from mild to very severe. There may be severe causes that require evaluation.
This inflammation can occur due to overuse or due to minor injuries. It is essential to clarify that the injuries could happen in the right or left shoulder.
This occurs essentially in all those who overwork their shoulder muscles and can certainly be made worse if used without warming up.
This may be what is causing your pain. If inflammation persists, it can cause tearing or partial tearing of the muscles. The rotator cuff is a collection of muscles in the shoulder that are often damaged. Pain at night is commonly associated with rotator cuff injuries.
Pinched nerves in the neck can also cause this pain. This is caused by the degeneration of the bones in the neck.
Compromised shoulder movement due to pain, stiffness, or weakness can cause considerable disability and affect a person’s ability to perform daily activities (eating, dressing, personal hygiene) and work.
The self-reported prevalence of shoulder pain is estimated to be between 16% and 26%. It is the third most common cause of musculoskeletal consultation in primary care, and approximately 1% of adults see a general practitioner with new shoulder pain each year.
Occupations are as diverse as construction and hairdressing are associated with an increased risk of shoulder disorders.
Physical factors such as heavy lifting, repetitive movements in awkward positions, and vibrations influence the level of symptoms and disability, and psychosocial factors are also important. Recent studies suggest that chronicity and recurrence are common.
So shoulder pain is joint pain that occurs due to injury, poor posture, psychological stress, spinal diseases, etc.
Shoulder pain can originate from the joint or associated tendons. Shoulder pain worsens with repetitive movements or manual arm work.
Symptoms
The general symptoms that cause the appearance of pain in the shoulders are:
- Shoulder pain along with tingling, numbness, and burning sensation.
- Stress or pressure radiating from the shoulder.
- There is a grating sound when the shoulder blade is pressed, or the arms are moved.
Causes
Common causes of pain in any of the shoulders are:
- Overuse of the shoulder muscles causes a strain on the muscles, leading to shoulder pain.
- Incorrect posture while sleeping can also cause shoulder blade pain, such as sleeping on one side for a long time or in an unusual pose that could strain your shoulders.
- Pain in one of the shoulders can also result from a broken scapula resulting from a sports injury or an accident, followed by severe pain and swelling.
- Shingles, which occur due to smoldering chickenpox, can cause a burning sensation or pain in the shoulder, especially on the right side.
- Myofascial pain can cause pain in the right shoulder due to damage to the tissues that cover the muscle.
- Rotator cuff injury can cause shoulder pain due to damaged or injured tendons located in the shoulder blade region.
- Nerve injury can also cause shoulder pain due to a damaged nerve in the shoulder and neck regions.
A primary care study using standardized clinical tests for shoulder disorders found rotator cuff tendinopathy in 85% of patients.
However, 77% of patients had a clinical diagnosis of more than one shoulder problem, e.g., tendinosis and impingement (57%); tendinosis, impingement, acromioclavicular disease, and adhesive capsulitis (6%).
Blood tests and X-rays are indicated only if there are “red flag” indicators, such as symptoms and signs of systemic disease:
- Weightloss.
- You generalized joint pain.
- Fever.
- Lymphadenopathy, new respiratory symptoms.
- History of cancer.
- Massive injury or bone tenderness or swelling.
Diagnosis
Several diagnostic measures can be taken to assess the presence and intensity of shoulder pain. The best of all is orthopedic tests, and the rest is up to the victim.
The different diagnostic tests are:
Orthopedic tests are specially designed to identify pathology in the shoulder area. It involves examining the regions of the neck, chest, cervix, spine, and armpits for the presence of swelling, bruising, or deformities in the muscles.
Tests are then performed to assess the shoulders’ stability, power, and range of movement.
These tests include:
- Painful arch test: aims to identify the painful arch or the position of maximum pain between 70 and 120 degrees of obstruction.
- Arm Drop Test – Identifies rotator cuff damage by slowly lowering the abducted arm to the waist.
- External Rotation Test: This test checks the outward rotation of the arm when the elbow is held to the side.
- Thick Arm Test: This test focuses on acromioclavicular pain where the affected arm must be raised to 90 degrees, followed by holding the other arm across the chest.
- Scan test: These tests are done to get a clear picture of the shoulder blade and the factors that cause pain.
- X-rays: uses electromagnetic radiation that produces an image of the internal structure, tissues, and bones of the shoulder region.
- Magnetic Resonance Imaging (MRI): This procedure consists of magnetic radiation and radio frequencies that provide a detailed image of the diseased shoulder.
- Computed tomography: Computed tomography uses X-rays to generate horizontal or axial images in the form of slices to provide detailed information about the shoulder region’s bones, muscles, and structure.
- Ultrasound: This technique uses high-frequency sound waves reflected off the shoulder region and translated into images.
- Electromyogram (EMG): This test is used to evaluate the presence of any nerve injury or damage in the shoulder region that may represent pain in any of the shoulders.
Some more common disorders and diseases
Rotator Cuff Disorders (Age 35-75)
Rotator cuff tendinopathy is the most common cause of shoulder pain. Work history can reveal heavy or repetitive movements significantly above shoulder level.
Although related to activity, it often occurs in the non-dominant arm and non-manual workers.
Evidence suggests genetic susceptibility in some families. Attrition may be present on the exam; active and resisted movements are painful and partially restricted, while passive activities are complete, although painful.
Although a painful arch is neither specific nor sensitive as a clinical sign, its presence reinforces the diagnosis of a rotator cuff disorder.
A rotator cuff tear is usually strongly indicated by history: traumatic in young people and atraumatic in older people (related to wear of bone spurs on the undersurface of the acromion or intrinsic degeneration of the cuff).
Several studies have suggested that there is no correlation between symptoms and loss of function in the presence of full-thickness supraspinatus tears and that lower rotator cuff tears may lead to an inability to rotate beyond 20 °
Likewise, partial and full-thickness tears are commonly found during the imaging of asymptomatic people.
The ‘arm drop test’ can be used to detect a significant or complete tear (high specificity and low sensitivity for this test have been reported in a secondary care population).
Adhesive capsulitis (“frozen shoulder”) and true glenohumeral arthritis are often preceded by a history of non-adhesive capsulitis symptoms, characterized by deep joint pain and restricting activities such as putting on a jacket (damaged external rotation).
Adhesive capsulitis is more common in people with diabetes and can also occur after prolonged immobilization. On examination, global pain is present, along with restricting all movements, both active and passive.
Acromioclavicular disease (adolescent to 50 years)
The acromioclavicular disease is usually secondary to trauma or osteoarthritis; Dramatic joint dislocation can occur after injury (adolescent to 30 years).
Pain, tenderness, and occasionally swelling are localized to this joint, and there is a restriction of passive horizontal adduction (flexion) of the shoulder, with the elbow extended, through the body. Acromioclavicular osteoarthritis can also cause subacromial impingement.
Treatment
Whether left or right, a functional holistic approach to shoulder pain, including adequate analgesia, is essential to motivate patients and promote rehabilitation.
However, the evidence for common primary care interventions, including steroid injections, is relatively weak. The general practitioner must decide if the pain originates in the shoulder; if it is from another party, the patient should be treated and referred appropriately.
Is the pain due to a rotator cuff disorder or a glenohumeral joint problem if the pain originates in the shoulder?
Pain relievers should be recommended for these two shoulder disorders (ideally paracetamol; non-steroidal anti-inflammatory drugs should be used intermittently as a second line if there are no contraindications).
Treatment for rotator cuff disorders (including possible minor tears)
Rotator cuff disorders should be treated initially with relative rest of the injured shoulder. The patient should return to regular activity or temporary modified work as soon as possible, within the limits of disability and pain.
In general, systematic reviews and more recent studies suggest equivalent short-term benefits for physical therapy (incorporating supervised exercise) and steroid injections in treating shoulder disorders.
In a primary care population with undifferentiated shoulder disorders, participants assigned to a physical therapy treatment group were less likely to see a general practitioner again than those who received steroid injections alone.
A single recent study reported that a subacromial xylocaine injection was as effective as the steroid plus xylocaine on all disease-specific outcomes at two weeks, with participants followed up at 6, 12, and 24 weeks.
Some professionals recommend larger injection volumes of up to 10 ml, as there is a theoretical benefit of hydrosilation of the subacromial bursa. However, there are no adequate tests to evaluate the results with a variation in the injected volume.
Therefore, subacromial corticosteroid injections, up to 10 ml in volume, should be considered for short-term pain relief and rehabilitation. If the initial response is good, the injections should be repeated up to three times, at six-week intervals.
There is no evidence to show that steroid injections are harmful or beneficial in the presence of a rotator cuff tear, so they should be avoided if the arms drop test is positive.
Treatment for glenohumeral disorders
The traditional teaching is that the natural history of a frozen shoulder is a two-year recovery; however, symptoms may persist for three years or more in some cases, particularly in patients with diabetes mellitus.
Corticosteroid injections (intra-articular, anterior approach) may be beneficial in reducing pain in the early phase.
There is no evidence that physical therapy alone is beneficial for adhesive capsulitis; When the joint is very painful, the movement is agonizing and can backfire.
Intra-articular corticosteroid injections and physical therapy, beginning one week after injection, may be beneficial in the short term.
However, in this study, the intra-articular injection was performed as a fluoroscopically guided technique, limiting the generalizability of these findings to primary care.
Complementary therapy
The only widely reported complementary therapy is acupuncture. The studies identified by the systematic review were small and methodologically diverse and provided little evidence to support or refute acupuncture for shoulder disorders.
The authors concluded that acupuncture could improve pain and function in the short term (two to four weeks).
Exercises for shoulder pain
Some exercises can help reduce pain and strengthen the shoulder. These exercises help control and support the shoulder blade by targeting the scapula muscle and making it more robust by allowing the shoulder joint’s wide range of motion.
Some of these exercises for shoulder pain are:
Exercise 1
Wall push-ups: The patient stands facing the wall with feet shoulder-width apart and palms placed against the wall at the front. Then the patient should push the upper body away from the wall.
Exercise 2
Seated shoulder push-ups: In this exercise, the patient sits in the chair with their hands on the armrest and their feet flat. Then they have to lift the body from the chair with the help of the arms.
Exercise 3
Shoulder flexion: consists of clapping the hands stretched out in front with the elbows straight, then raising the arms above the head and, later, down the head.
Exercises should be followed to prevent any shoulder injury and avoid subsequent pain. However, if shoulder blade pain has already manifested itself, follow preventive measures to prevent it from getting worse.
Preventive measures help reduce pain around the shoulder blade to a great extent. If it persists, seek immediate help, as shoulder blade pain can also indicate serious health problems.
Precautionary measures
In the same way, within shoulder pain treatment, measures should be taken to prevent a further increase in pain.
The measures ensure that the patient suffering from shoulder blade pain does not worsen and brings gradual relief.
Some of the preventive measures include:
Take plenty of rest: Rest helps you heal, which helps fight shoulder pain.
Reduction of physical activity: it is required to reduce the tension in the injured shoulder, avoiding the appearance of pain due to repetitive movements.
Heat and cold applications to treat shoulder pain: Applying ice packs for compression, followed by an alternative application of heat, can relieve pain. This should be done at least three times a day.
Proper Posture to Prevent Shoulder Pain: Following adequate posture, especially while sleeping, can prevent severe aches and pains around the shoulder blade.
Exercise: Regular exercise can ensure proper healing of shoulder blade pain as it helps to improve strength, flexibility, and mobility of the shoulder joint, gradually decreasing pain around the shoulder blade.
Physical therapy for shoulder pain: Regular chiropractic sessions can offer substantial relief to a diseased shoulder. Treatment includes deep friction therapy, which applies direct pressure to the shoulder blades and the affected area.
Medications: If all the above treatments fail to reduce pain, pain medications can be taken under medical supervision.
These include:
- Muscle relaxants.
- Anti-inflammatory drugs.
- Steroidal pain relievers.
Treatment of a possible disease: In cases where shoulder pain has been caused due to other conditions such as shingles, nerve damage, or fracture, medication and treatment should be specific to the present disease.
Future developments and surgical interventions
Surgery has a place in the management of emergencies, such as unreduced dislocation, infection, and acute traumatic rotator cuff tear.
Its role is less evident in frozen shoulder, so some surgeons advocate manipulation under anesthesia and arthroscopic release.
A recent study found equivalent results for graduate programs of supervised physical therapy and arthroscopic decompression for patients with rotator cuff disease.
For significant persistent disability associated with rotator cuff impingement and tear, surgery may effectively relieve pain and restore function in patients who have failed conservative treatment.
However, published studies generally involve small numbers of participants with limited long-term follow-up. There is controversy over the treatment of mildly symptomatic small rotator cuff tears.
Arguably, small tears need to be repaired to alleviate symptoms and prevent progression to more giant tears associated with high levels of disability. Still, there is little evidence to support this view.
For resistant acromioclavicular joint pain, an arthroscopic excision of the distal clavicle is a practical, low-risk procedure.
Surgery remains the mainstay of treatment in most cases of recurrent shoulder instability; Cases that do not require surgery will require specialized physical therapy and can be complex and resistant problems.
The management of osteoarthritis and rheumatoid arthritis has improved considerably in recent years, and joint replacement surgery, like other joints, relieves pain from end-stage disease.
Conclusions
Shoulder pain is a common and significant musculoskeletal problem. Management should be multidisciplinary and include self-help advice, analgesics, relative rest, and access to physical therapy. Steroid injections have a marginal short-term effect on pain.
The poorer prognosis is associated with increasing age, female sex, severe or recurrent symptoms at presentation, and related neck pain.
Mild trauma or overuse before pain onset, early presentation, and acute onset have a more favorable prognosis.
There is no evidence to show that early orthopedic intervention improves the prognosis for most rotator cuff or glenohumeral disorders.
