What Is Shoulder Pain?
Causes of shoulder pain include:
- 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
When shoulder pain is secondary to conditions outside the shoulder (as in heart attack), it’s classified as “referred pain.” 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. Usually, shoulder pain is a minor injury that resolves with rest, ice, and over-the-counter pain medications. Treating shoulder pain is dependent on identifying the underlying cause. 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.
Shoulder pain is a sign of damage to the local tissues or referred pain involving another area of the body. Overuse injury can affect the muscles, tendons, or ligaments of the shoulder, causing inflammation and pain. One common injury is a torn rotator cuff, involving the muscles and tendons that keep the humerus (arm bone) in the shoulder joint. Rotator cuff injury may be the result of repetitive use of the arm, lifting excessive weight, or falling. A torn rotator cuff can be an acute injury or one that occurs from weakening of the tissues over time.
Fractured bones or dislocated joints cause shoulder pain, as in the case of broken collarbone or a broken arm. The collarbone (clavicle) attaches the sternum to the scapula (shoulder blade) and is a common site of injury in children and teenagers. Falling, physical trauma from a car accident, or sports injuries may be associated with a broken collarbone. Similar to a broken collarbone, a broken arm may be caused by physical trauma, sports injury, or pulling and twisting of the arm (sometimes the result of child abuse).
Shoulder pain caused by arthritis may be due to wear and tear of the joint over years of physical activity, known as osteoarthritis. This condition is marked by breakdown of cartilage in the joint, resulting in swelling, pain, and stiffness. Rheumatoid arthritis is an autoimmune condition of chronic joint inflammation that causes pain.
Frozen shoulder (adhesive capsulitis) is a painful condition marked by stiffness and limited motion that progresses gradually until the shoulder is completely unable to move. A thickening of the connective tissue surrounding the shoulder joint is responsible for restricting shoulder movement. It’s unclear why some individuals suffer from frozen shoulder and others do not, and no exact cause has been defined. Patients who have undergone a surgery or arm fracture that required long-term immobilization of the shoulder are more often affected by this condition. Those with diabetes, heart disease, thyroid conditions, or Parkinson’s disease are at a higher risk for frozen shoulder.
A pinched nerve is the result of nerve impingement by bone, muscle, cartilage, or tendon within the shoulder area. This pressure impairs nerve impulses, leading to sensations of pain, numbness, tingling, or weakness. Weakened tissues or swelling in the joint secondary to arthritis, repetitive actions, or sports injury may be responsible for a pinched nerve in the shoulder.
The patient presenting with shoulder pain receives 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). Each study is capable of imaging different tissues, with X-ray being good for bone imaging and MRI helpful in understanding nerve or blood vessel issues. Electrodiagnostic studies, such as electromyography (EMG) or nerve conduction velocity (NCV), may also be ordered, especially if numbness and tingling are present.
Treatments for Shoulder Pain
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.
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.
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. Medications commonly prescribed include:
- Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen, which decrease pain and inflammation. NSAIDS can be taken orally or applied as a cream to the site.
- Analgesics, such as acetaminophen, tramadol, or narcotics, which provide pain relief but do not relieve inflammation.
- Corticosteroids, a class of drugs that decrease inflammation and have a suppressive effect on the immune system.
- Counterirritants, cream containing menthol or capsaicin, which inhibits the transmission of pain signals.
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Trexall) and hydroxychloroquine (Plaquenil), which act to weaken the immune system’s effort on destroying joint tissue and causing inflammation.
- Biologics, genetically engineered medications designed to target protein molecules that are part of the immune response. For example: etanercept (Enbrel) and infliximab (Remicade).
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 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.
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.
- Mayo Clinic Staff. (September 11, 2010). Shoulder Pain. Retrieved from http://www.mayoclinic.com/health/shoulder-pain/MY00189
- Ephraim K Brenman, DO. (March 1, 2007). Pain Management: Neck and Shoulder Pain. Retrieved from http://www.webmd.com/pain-management/guide/neck-shoulder
- Mayo Clinic Staff. (June 18, 2010). Broken Collarbone. Retrieved from http://www.mayoclinic.com/health/broken-collarbone/DS01184
- Mayo Clinic Staff. (April 28, 2011). Frozen Shoulder. Retrieved from http://www.mayoclinic.com/health/frozen-shoulder/DS00416
- Mayo Clinic Staff. (January 22, 2011). Arthritis. Retrieved from http://www.mayoclinic.com/health/arthritis/DS01122/DSECTION=lifestyle%2Dand%2Dhome%2Dremedies
- Robert Williams, MD. (May 24, 2011). Shoulder Pain. Retrieved from http://www.localhealth.com/article/shoulder-pain-1