Shoulder Pain

The shoulder is a complex and highly mobile joint, allowing for a wide range of movements essential for daily activities. However, its complexity and frequent use make it vulnerable to various injuries and conditions. Shoulder pain can significantly affect quality of life, stemming from different underlying causes such as SLAP tears, frozen shoulder, abnormal acromioclavicular (AC) joint, rotator cuff tears, calcific tendonitis, bicep tendonitis, and shoulder osteoarthritis. This article explores these conditions, their symptoms, causes, diagnosis, and treatment options.

Anatomy of the Shoulder

The shoulder comprises three main bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). These are connected by muscles, tendons, and ligaments, forming the following joints:

1. Glenohumeral Joint – A ball-and-socket joint responsible for the shoulder’s wide range of motion.
2. Acromioclavicular (AC) Joint – The connection between the scapula and clavicle.
3. Sternoclavicular Joint – The joint between the sternum and clavicle.

Understanding these structures is key to identifying the root cause of shoulder pain.

Common Causes of Shoulder Pain

1. SLAP Tear

Superior Labrum from Anterior to Posterior (SLAP) tears refer to injuries of the cartilage surrounding the shoulder socket (labrum).

• Causes: Repetitive overhead activities, trauma, or aging-related degeneration.
• Symptoms: Deep shoulder pain, clicking or popping sounds, weakness, and decreased range of motion.
• Diagnosis: Physical examination, MRI, or arthroscopy.
• Treatment:
  • Conservative: Physical therapy, anti-inflammatory medications, and activity modification.
  • Surgical: Arthroscopic repair for severe cases.

2. Frozen Shoulder

Adhesive capsulitis, or frozen shoulder, involves stiffness and pain in the shoulder joint caused by thickening of the joint capsule.

• Stages:
  1. Freezing Phase: Gradual onset of pain and stiffness.
  2. Frozen Phase: Marked stiffness with some pain relief.
  3. Thawing Phase: Gradual return of motion.
• Causes: Often idiopathic, but associated with diabetes, prolonged immobility, or post-surgical recovery.
• Symptoms: Restricted motion and persistent pain, especially at night.
• Treatment:
  • Physical therapy to restore mobility.
  • Anti-inflammatory medications or corticosteroid injections.
  • In severe cases, manipulation under anesthesia or arthroscopic release.

3. Abnormal AC Joint

The acromioclavicular (AC) joint can become a source of pain due to injury, arthritis, or overuse.

• Conditions:
  • AC Joint Sprain: Often caused by trauma such as a fall.
  • Arthritis: Degeneration of the joint cartilage.
• Symptoms: Localized pain, swelling, and tenderness on the top of the shoulder.
• Diagnosis: X-rays and physical exams.
• Treatment:
  • Conservative: Rest, ice, anti-inflammatory medications, and physical therapy.
  • Surgical: Resection arthroplasty for severe arthritis or unresolved injuries.

4. Rotator Cuff Tear

The rotator cuff consists of four muscles and tendons stabilizing the shoulder. Tears can occur due to acute injuries or chronic wear and tear.

• Causes: Overuse, aging, or trauma (e.g., lifting heavy objects).
• Symptoms: Pain during arm movements, weakness, and difficulty lifting objects.
• Diagnosis: Physical tests (e.g., the drop arm test), ultrasound, or MRI.
• Treatment:
  • Conservative: Rest, strengthening exercises, and anti-inflammatory medications.
  • Surgical: Arthroscopic tendon repair or open surgery for complete tears.

5. Calcific Tendonitis

Calcific tendonitis is characterized by calcium deposits within the tendons, typically of the rotator cuff, causing inflammation and pain.

• Causes: The exact cause is unclear but may involve overuse or metabolic factors.
• Symptoms: Severe pain, particularly during movement, and limited range of motion.
• Diagnosis: X-rays to identify calcium deposits and ultrasound for inflammation.
• Treatment:
  • Non-surgical: NSAIDs, physical therapy, and extracorporeal shockwave therapy (ESWT).
  • Surgical: Arthroscopic removal of calcium deposits in refractory cases.

6. Bicep Tendonitis

Bicep tendonitis involves inflammation of the tendon connecting the biceps muscle to the shoulder.

• Causes: Repetitive overhead activities, heavy lifting, or shoulder instability.
• Symptoms: Front shoulder pain, weakness, and tenderness along the bicep tendon.
• Diagnosis: Clinical examination and imaging (MRI or ultrasound).
• Treatment:
  • Conservative: Rest, ice, NSAIDs, and physical therapy.
  • Surgical: Tendon repair or tenodesis for chronic cases.

7. Shoulder Osteoarthritis

Shoulder osteoarthritis occurs when the cartilage in the joint wears down, leading to pain and stiffness.

• Causes: Age-related wear and tear, previous injuries, or genetic predisposition.
• Symptoms: Gradual onset of pain, reduced range of motion, and grinding sensations.
• Diagnosis: X-rays to detect cartilage loss and bone spurs.
• Treatment:
  • Conservative: Pain management with NSAIDs, corticosteroid injections, and lifestyle modifications.
  • Surgical: Shoulder replacement surgery for advanced cases.

Diagnosis of Shoulder Pain

Accurate diagnosis is crucial for effective treatment. Common diagnostic approaches include:

• Clinical History and Examination: Assessing symptoms, range of motion, and strength.
• Imaging: X-rays, ultrasound, MRI, or CT scans to visualize soft tissues and bones.
• Specialized Tests: Arthroscopy or electromyography for detailed evaluation.

Treatment Modalities

1. Non-Surgical Approaches

• Physical Therapy: Essential for restoring mobility and strength.
• Medications: NSAIDs, corticosteroids, or hyaluronic acid injections.
• Lifestyle Modifications: Avoiding aggravating activities and ergonomic adjustments.

2. Surgical Options

When conservative measures fail, surgical intervention may be necessary. Common procedures include:

• Arthroscopy: Minimally invasive repair techniques.
• Open Surgery: For complex injuries or advanced arthritis.
• Joint Replacement: For severe osteoarthritis or irreparable joint damage.

Preventing Shoulder Pain

• Warm-Up Exercises: Prepare muscles and joints before physical activity.
• Strength Training: Build shoulder stability and resilience.
• Ergonomic Adjustments: Ensure proper posture and work setup.
• Avoid Overuse: Limit repetitive overhead movements.

Coping with Chronic Shoulder Pain

For individuals with persistent pain, strategies include:

• Mindfulness and relaxation techniques.
• Pain management programs.
• Support groups or counseling for emotional well-being.

When to Seek Medical Attention

Consult a healthcare provider if you experience:

• Persistent or worsening pain.
• Significant loss of motion or strength.
• Signs of infection such as redness, swelling, or fever.

Shoulder pain, though common, can arise from various underlying conditions that require tailored treatment strategies. Early diagnosis and appropriate management are key to preventing complications and restoring function. Whether it’s a SLAP tear, frozen shoulder, or osteoarthritis, understanding the cause of shoulder pain can guide individuals toward effective relief and recovery.

To consult a Doctor at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.