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Conditions

Shoulder pain

What is shoulder pain?

Shoulder pain is discomfort involving the musculoskeletal tissues, nerves, or blood vessels of the shoulder area. This region includes the clavicle, upper humerus, and scapula. As a ball and socket joint, the shoulder is capable of wide range of motion and is therefore, more susceptible to injury. The shoulder performs several different types of movement and plays a role in lifting weight, so shoulder pain is very common and experienced by most adults at some point.

What causes shoulder pain?

Common causes of shoulder pain include:

  • Arthritis
  • Overuse or straining injury to muscles, tendons, or ligaments
  • Bone fracture
  • Joint dislocation
  • Pinched nerve
  • Frozen shoulder

Less common causes of shoulder pain include:

  • Heart attack
  • Tumor
  • Infection

When shoulder pain is secondary to conditions outside the shoulder (as in heart attack), it’s classified as “referred pain.”

Typical diagnosis

A diagnosis begins with a physical assessment along with medical history interview. The physician asks questions regarding the onset, character, and symptoms accompanying the pain. Imaging studies may be ordered to assess the anatomy of the shoulder, including X-ray, computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI).

Symptoms

Shoulder pain may be acute or chronic, described as an aching feeling or a sharp pain, and may be accompanied by weakness or limited range of motion. In most cases, the pain becomes worse during activities in which the shoulder is moved.

Patients who experience redness, swelling, discomfort to touch, or warmth at the site should be assessed by a doctor. If the patient experiences a sudden onset of swelling and excruciating pain, or the joint looks deformed or cannot be moved, immediate medical attention is needed. Shoulder pain is an emergency when accompanied by chest tightness, shortness of breath, or physical trauma.

Treatments

Treatments for fracture
Treating a fracture begins with immobilization in the form of a sling or figure eight strap for the collarbone or cast for the arm. Healing of the bone usually requires six weeks for children and up to 12 weeks for adults. Ice and over-the-counter pain relievers may control pain and swelling. If the broken bone is complicated, surgery may be required. Screws, plates, or rods may be implanted to maintain position of the bone while it heals.

Treatments for arthritis
The goal of arthritis treatment is to relieve pain and improve range of motion in the joint. Physical therapy and strengthening exercises may be helpful. Ice or heating pads may also relieve the pain, along with various anti-inflammatory medications such as ibuprofen, naproxen, and others.

Treatments (cont.)

Frozen shoulder treatments
Frozen shoulder treatment interventions seek to control pain and preserve movement. Over-the-counter pain relievers and anti-inflammatory drugs mentioned above may be ordered to make the patient more comfortable. Physical therapy can help in maintaining mobility of the shoulder. In most cases, frozen shoulder resolves on its own without further intervention within 12 to 18 months. If the pain and immobility do not resolve, other treatments are available.

Corticosteroid injections
Corticosteroid injections may decrease inflammation. A shoulder manipulation procedure may help loosen tissue that has tightened. This procedure is done under general anesthesia so the patient is unconscious and does not sense pain. For the most severe cases, surgery may be required to remove adhesions and scar tissue that impede movement of the shoulder.

Pinched nerve treatments
A pinched nerve is usually remedied with rest but may respond positively to physical therapy exercises that increase flexibility of the muscles and relieve pressure on the nerve. Learning to perform repetitive motions in a safe, ergonomic way may also help with a pinched nerve. Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, may provide relief of inflammation and therefore pain. If these methods are not effective, corticosteroid injections may be ordered to treat inflammation of the area and relieve nerve irritation.

Treatments

Treatment of shoulder pain is specific to the underlying cause. Most often, shoulder pain is the result of minor injury to the muscles, tendons, or ligaments and resolves after a short time of rest. Ice and over-the-counter pain medications or anti-inflammatories may also be ordered to decrease swelling and pain.

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