Where is your shoulder pain coming from?
Shoulder pain is a common problem
Pain in the shoulders can have a significant impact on your daily life, interfering with even the simplest activities such as brushing your hair, getting dressed, or picking up the groceries. It is also very common – it is estimated that up to 70% of people will experience some form of shoulder pain in their lifetime. To understand why it is important to learn a little about the anatomy and function of the shoulder joint.
What most people call the shoulder is actually made up of three bones: the humerus (upper arm), scapula (shoulder blade) and clavicle (collarbone). The shoulder joint (glenohumeral joint) is formed where the head of the humerus sits into the glenoid socket on the scapula ie. Glenohumeral joint. Known as a ball-and-socket joint, this is the most mobile type of joint in the body. And while this permits a wide range of motion in the arm to support daily activities, mobility often comes at the cost of stability, making the shoulder joint more prone to injury or general wear and tear.
There are several tendons and ligaments that offer extra support for the shoulder. Tendons connect muscles to bone, while ligaments connect bone to bone. The rotator cuff muscles, which include the subscapularis, infraspinatus, supraspinatus, and teres minor, work collectively with these tendons and ligaments to keep the head of the humerus in the scapula and support a wide range of movement while contributing to stability of the joint. Additionally, the labrum is a structure in the shoulder that acts like a tee holding a golf ball. It deepens the glenoid providing a more secure fit for the head of the humerus. When the muscles and ligaments are stretched beyond their normal limits, the shoulder becomes unstable and is more prone to injury. Fortunately, the majority of shoulder pain stems from one of several common sources.
More about shoulder joint anatomy can be found here.
Common culprits of shoulder pain
Pain in between the shoulder blades, the front of the shoulder, or the top of the shoulder are common areas where shoulder pain originates. In younger people, shoulder pain is more likely to be due to a sport injury or accident. Many sports involve high impact or repetitive movements that can put a lot of stress on the shoulder and cause the ligaments to stretch beyond their normal limits. This significant force or overuse can lead to shoulder injuries, the most common of which include shoulder dislocations or subluxations (a partial dislocation), collarbone fractures, labrum tears or sprains of the acromioclavicular joint (or AC joint, another supporting joint where the top of the shoulder meets the collarbone). As we age, however, our shoulders tend to stiffen and general wear and tear increases the risk of a shoulder injury.
Common causes of shoulder pain include:
Frozen Shoulder: Adhesive capsulitis, more commonly known as frozen shoulder, occurs when the shoulder capsule thickens and becomes inflamed and tight. There may also be less synovial fluid to lubricate the joint. Common symptoms include swelling, pain, and stiffness, all of which can limit your range of motion. For some people with frozen shoulder, pain is worse at night and can impair their quality of sleep.
Synovitis: The synovial membrane of the shoulder can become inflamed as a result of an injury or another condition such as rheumatoid arthritis. This type of shoulder pain usually occurs in older individuals.
Shoulder bursitis: Pain associated with an inflamed bursa is also common. A bursa is a small fluid-filled sac that helps reduce friction between two structures, such as the bony tip of the shoulder and the rotator cuff tendon. While anyone can develop bursitis, people who perform very repetitive movements, such as athletes or musicians, have a higher risk.
Shoulder tendonitis: Inflammation of one of the tendons in the shoulder’s rotator cuff usually occurs over time. It can be a result of performing activities that require lifting above your head, such as in swimming or pitching, or even from sleeping on your shoulder every night. This might be why some people experience shoulder pain while sleeping on their side. It is also common in “weekend warrior” athletes, who exercise in sporadic bursts rather than regular training, so the body isn’t prepared for vigorous activity.
Cartilage is a smooth firm tissue that covers and protects the ends of bones where they meet in a joint. When the cartilage cushions between the bones in the shoulder start to wear down, the bones start to rub against one another. Osteoarthritis can present as pain or aching in the shoulder joint, joint stiffness or swelling, and a limited range of motion.
Injuries and sprains:
With excessive force, overuse, or general wear and tear, the ligaments, tendons, and muscles around the shoulder can become strained or torn. This type of pain can be quick-onset or develop gradually over time. It sometimes happens when the humerus comes partially out (subluxation) or completely out (dislocation) of the joint socket, which is more common in younger athletes.
Rotator cuff tear: A tear in one of the rotator cuff tendons that supports the shoulder joint is another common source of shoulder pain. This can be a partial tear, where only part of the tendon is ripped, or a full tear that causes the tendon to completely separate from the bone. Rotator cuff tears can occur from an injury or sport-related stress but are most common in older individuals as the tendons wear down over time.
Labral tear: Athletes who engage in high-energy, quick-snap motions over the shoulder, such as baseball pitchers or volleyball players, are most prone to tears in labrum – the cup-shaped rim of cartilage where the ligaments of the shoulder joint attach.
While these are some of the most common sources of shoulder pain, several other conditions can manifest as a “shoulder problem” too. Neck and upper back problems, injury to a nerve, or even conditions such as gallstones or pneumonia can all result in shoulder pain. If you are experiencing pain in your shoulder, it is always important to consult a sports medicine doctor for a comprehensive exam and diagnosis.
When should I see a doctor?
If you experience sudden shoulder pain accompanied by tightness in the chest, dizziness, or trouble breathing, it could be a sign of a heart attack and you should seek medical attention immediately.
While shoulder pain can subside on its own with time and rest, it often requires a visit to a sports medicine doctor to get an accurate diagnosis and treatment plan. If pain persists for more than a couple weeks, or worsens despite activity modification, then it is recommended you schedule an appointment with your sports medicine doctor. However, if you experience intense shoulder pain as a result of a sports injury, accident or fall, or it appears that the joint is out of place or unable to move, is recommended that you see a doctor as soon as possible.
While the complexity of the shoulder joint can make it difficult to identify the issue immediately, sports medicine doctors are specially trained in the diagnosis and treatment of shoulder pain. Starting with medical history and conducting a thorough physical exam, sometimes additional imaging tests aid in identifying the cause of pain. These could include an X-ray to look at the bones and joints, a computed tomography (CT) or magnetic resonance imaging (MRI) scan to produce detailed pictures of the shoulder. Ultrasound can be used in the office by your sports medicine physician to investigate the rotator cuff tendon for inflammation or tears.
Your treatment will depend on the cause and severity of your shoulder pain. For many people, sufficient rest, medication, a change of activity and exercises to increase strength and range of motion will help get you back to your normal activities. However, some people benefit from injections in the shoulder to reduce pain and inflammation. Occasionally, surgery is needed to help repair damage and prevent further injury. It is important to work with a physical therapist or sports medicine doctor to develop an effective treatment and rehabilitation program.
Don’t let shoulder pain interrupt your life
The long-term outlook for most people with shoulder pain is positive; rest and working with a sports medicine doctor to develop a treatment program will usually help relieve the pain over time. Fortunately, there are some things you can incorporate into your normal routine to help prevent shoulder pain or injury. Exercise is a great way to help increase strength and mobility, but make sure to exercise using proper technique! Posture and correct form are critical to injury prevention. Always remember to warm up before and stretch after a workout.
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