The shoulders, just like any part of the body, comprises of joints, bones, ligaments, and muscles to help individuals move their arms and hands. However, the shoulders may also experience pain, swelling, and tenderness.
Shoulder pain is marked by some symptoms in various joints, tendons, muscles, and bursa. These are all involved in the motion of the shoulder. The onset of shoulder pain varies according to the underlying cause. It can be related to repetitive movements, trauma, or neurological events. Shoulder pain often comes with sequelae of activity limitation, and rarely, it develops into a chronic condition.
Regarding the most common areas of musculoskeletal pain, only lower back pain and knee pain surpasses shoulder pain. Shoulder disorders have a prevalence of five to 57 percent annually. Point prevalence, on the other hand, ranges from 14 to 21 percent. Also, 18 percent of disability payments from insurance are made for patients who have neck and shoulder pain.
Symptoms associated with shoulder pain vary, depending on the underlying cause of the pain.
- Shoulder pain
- The pain may radiate to the elbow, upper arms, and neck
Other symptoms associated with shoulder pain include the limited motion of the hand and arms, weakness, difficulty performing work, difficulty dressing and interrupted sleep.
Sources of Pain
Anatomical Structures in the Shoulder Joint
Several anatomical structures comprise the shoulder joint, each of these structures can be sources of pain. The shoulder joints are the scapulothoracic joint, glenohumeral joint, sternoclavicular joint, and acromioclavicular joint. These are the primary shoulder joint, secondary shoulder joint, and accessory shoulder joints, respectively.
Muscle groups that may be potential sources of shoulder pain include the scapular stabilizers (which are responsible for scapula position), rotator cuff (responsible for maintaining the balance of the glenohumeral joint), and prime movers (which are responsible for power movements). Finally, there are several bursae that may be sources of shoulder pain, and the most relevant of these are located in the subacromial space, an area in the shoulder.
Other symptoms of shoulder pain can help the physician pinpoint the etiology of the pain. Subacromial impingement is characterized by pain that radiates from the superolateral shoulder to the lateral brachium. Typically, the patient feels pain upon reaching. There is no rest pain. The pain associated with sub acromial impingement is insidious in onset, and an event may trigger it, or it may start a short time after an event.
Subacromial bursitis is characterized by pain that radiates from the superolateral shoulder to the lateral brachium. There is also pain with reaching. However, there is rest pain. The onset is usually sudden and rapid.
Adhesive causalities are characterized by rest pain, in which rest is defined as sitting with one’s hands on the lap. The pain becomes worse with reaching, and there is a progressive loss of motion. The onset is usually insidious.
Rotator Cuff Tears
Rotator cuff tears are characterized by weakness that exceeds pain. Usually, rotator cuff tears are caused by falling on an outstretched arm. Shoulder pain due to rotator cuff tears may be acute or chronic.
In biceps tendinopathy, the pain radiates from the anterior shoulder to the anterior brachium. In this type of condition, there is a pain with flexion of the biceps, especially if the wrist is supinated. The pain is usually insidious in onset and often accompanies impingement.
Multiple conditions or factors can lead to shoulder pain, either in combination or alone.
Inflammatory conditions may cause shoulder pain. In these conditions, the tendons and bursa are inflamed, and this is often due to anatomical factors (such as impingement) or overuse.
Tendons in the shoulder can also be torn (such as in rotator cuff tears), or degenerative processes can damage joint surfaces (such as in osteoarthritis).
Loose Capsules and Ligaments
Capsules and ligaments are often loose and lax, and they allow for excessive motion. This results in shoulder instability. The problem usually arises from congenital factors (which can cause instability) or from trauma (which causes one direction of instability). Also, excessive shoulder motion can lead to dislocation or subluxation.
The limited motion may also cause shoulder pain. For instance, ligaments and capsules are tight, and this may restrict the movement of the shoulders. This is especially apparent when raising the arms overhead or behind one’s back. The problem is following common periods of prolonged immobilization, but it can also occur if the shoulder joint is irritated, such as in adhesive capsulitis.
Muscle Weakness and Imbalance
Muscle weakness and imbalance are other causes of shoulder pain. In this condition, the muscles that balance the scapula or humeral head are weak, which results in inefficient shoulder motion. The problem can result from poor posture. It can also occur in athletes who train improperly or too much. Muscle weakness in the shoulder can also occur after a stroke.
Many factors may raise one’s risk of shoulder pain, including:
Age and Gender
Age and gender are personal risk factors that are connected to shoulder pain. The presence of pain increases with advancing age. Shoulder pain, however, is particularly prevalent in adolescents. In females, neck and shoulder pain during adolescence is linked with prevalent neck and shoulder pain during adulthood.
Psychosomatic stress symptoms were predictors of shoulder pain in adulthood. The onset of shoulder pain connected with adult age, which may be because aging is associated with degenerative processes. This may explain the increased prevalence of pain as people age.
Occupational factors may also be risk factors for shoulder pain. Work-related physical risk factors are related to the development of shoulder pain. The transition from minor or no pain to moderate or severe pain was mediated by psychosocial, physical, and workplace factors along with health-related factors and individual factors.
Repetitive work, work-related posture, high force demand and vibration, computer work, and psychosocial factors that may be present in some populations can increase the chances of developing shoulder pain.
Complications can arise from shoulder pain. If left untreated, acute shoulder pain can become chronic, leading to a host of complications.
One complication of shoulder pain is depression. The patient may feel depressed because he is unable to move. Depression can set in because of immobility and pain.
Depression itself involved many complications, such as the risk of suicide and decreased the quality of life. This usually occurs if the patient needs to be immobile for a long time, during which he cannot perform the functions that he needs to survive, such as eating or bathing.
Psychosocial complications can arise from untreated shoulder pain. The patient may be unable to move and perform the tasks of daily living. Thus, he may be unable to work and support himself and his family. Other psychosocial factors include isolation from social activities, which may also lead to depression.
Decreased Quality of Life
The decreased quality of life due to pain is not uncommon. The patient may feel unable to provide for himself and his family. He may feel less able to conduct tasks that he needs to do. The pain may cause suffering, which decreases the quality of life and restricts freedom of movement. Decreased quality of life is a factor that is related to morbidity and mortality and should be taken seriously by the doctor.
The first step in diagnosing the cause of shoulder pain is to take a thorough medical history. The doctor may ask how and when the pain started. He may also ask if the pain has occurred before, and how it was previously treated.
Other questions may be asked to determine the patient’s general health as well as the possible causes of shoulder pain. Since most shoulder pains are aggravated by specific activity and relieved by others, a thorough medical history can be a valuable factor in finding the source of pain.
Physical examinations will also be conducted. The doctor will look for physical abnormalities, deformity, swelling, or muscle weakness. The doctor may also check for tender areas and observe the range of motion of the shoulder.
The doctor may order specific tests to help identify the causes of shoulder pain. X-rays are usually requested, which will show any injuries to the bone. Magnetic resonance imaging (MRI) may also be indicated since it shows any injuries to soft tissues surrounding the bone.
The treatment of shoulder pain depends on the cause. However, shoulder pain is usually treated with pain killers and cold compress.
If the cause of pain is severe, such as a fracture, surgery may be warranted. Shoulder replacement surgery can also be done in cases where the shoulder joints are unable to function anymore.
To prevent shoulder pain, it is important to strengthen the shoulder muscles. Strong muscles and tissues will decrease the chances that injuries will occur. Regular exercise can help prevent shoulder injury by increasing strength and flexibility.
Eating a healthy diet along with exercising will keep a person in the good physical state. This will decrease the chances of injury. Preventing shoulder pain is done by preventing any injuries, traumas, or underlying inflammatory conditions that may cause shoulder pain.