Pain - Shoulder Pain Causes, Tests, and Treatments

Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. Your shoulder is more prone to injuries than other joints because of its wide range of movement.

About 13.7 million people went to the doctor's office in 2003 for a shoulder problem, including 3.7 million visits for shoulder and upper arm sprains and strains. (Source: National Center for Health Statistics; Centers for Disease Control and Prevention 2003 National Ambulatory Medical Care Survey.)

One of the best ways to avoid injury is to keep physically fit, with a balanced program of aerobic exercise, stretching and strengthening exercises for your whole body. There is a range of exercise programs available from local fitness centers, to online services and even downloads for your MP3 or iPod players.

There are several reasons that cause pain and limit movement of your shoulder joint, including:

1. Rotator cuff disorders

Inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to tear.
The pain associated with rotator cuff problems is normally felt at the front or on the outside of your shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.

2. Rotator cuff tears

It is usually the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but sometimes the tear occurs in the muscle. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.

3. Frozen shoulder

Frozen shoulder, is characterized by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may become worse at night due to inactivity.

The exact cause of this condition is not known, but it sometimes develops following other shoulder injuries. Resting a painful, injured shoulder for too long can cause the shoulder muscles and connective structures to stiffen up, so when a shoulder injury occurs make an effort to keep it loose without putting to much strain on it.

Frozen shoulder can develop spontaneously, particularly if you have thyroid problems or diabetes seem to be at increased risk. Most people with frozen shoulder tend to improve within 2 years, with or without treatment. In the interim, however it can be quite painful.

4. Dislocated shoulder and shoulder instability

A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Your shoulder movement will be severely restricted. Your Doctor can usually put the shoulder bone back into place using gentle maneuvers.

If you suffer a dislocation, keep in mind that the shoulder joint sometimes becomes unstable and susceptible to repeated dislocations. This causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.

5. Arthritis

Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis will affect the shoulder joint.
Sometimes shoulder pain can be due to problems in your neck or a mixture of several different problems. A visit to your doctor is almost always necessary when it comes to a shoulder problem because in rare instances, shoulder pain may be caused by infection, problems with the nerves, or a tumor located somewhere else in your body.

As with any medical issue, a shoulder problem is generally diagnosed using a three-part process:

• Medical History – You tell your doctor about any injury or other condition that might be causing the pain.

• Physical Examination – Your doctor examines you by feeling for injury and to discover the limits of movement, location of pain, and extent of joint instability.

• Tests – Your doctor may order one or more of the tests for you listed below to make a specific diagnosis.

What tests are needed to determine the cause of your shoulder pain?

Your doctor will determine the cause of your pain based on your symptoms and a physical examination. Where the pain is felt, both at rest and when moving the shoulder, is a clue to the cause of the shoulder pain. Your doctor will also test your shoulder strength and the range of movement in your shoulder joint.

You may need an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this test, your doctor can look inside the shoulder joint using a small telescopic instrument that has a camera on the end. This is not as painful as it sounds.

How your shoulder pain will be treated

In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the extent of your shoulder problem and the level of pain.

Pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial treatment for shoulder pain. Ibuprofen is the best and Aspirin should be avoided.

Another simple way of easing shoulder pain is by applying a cold pack to your shoulder for 10 minutes at a time three or four times a day. Cold packs will reduce inflammation, and are most helpful when applied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.

A heat pad used at night when sleeping will keep the shoulder from stiffing up.
You should rest your shoulder for a couple of days after an injury, and if you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place.

However, with most shoulder problems it isn’t a good idea to rest for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent the shoulder joint from stiffening up.

Physiotherapy can help treat you shoulder pain.

Physiotherapy can help improve your shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including massage, ultrasound therapy, laser therapy and electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain.

Taping the shoulder joint can also help stabilize it and reduce pain during activities. Your doctor will refer you to a good Physiotherapist is he feels the extent of your injury warrants Physiotherapy.

Physiotherapists can also teach you special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder’s range of movement help reduce the pain and stiffness that occurs after a period of immobility. Range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.

Steroid injections can be effective but proceed with caution.

Depending on the cause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anesthetic, reduces inflammation and allows you to move the shoulder more comfortably. Make sure you understand what is involved in this kind of treatment to include the long term effect on your body. The jury is still out on the impact of this type of treatment.

Surgery may be necessary to treat your shoulder problem.

Because most people improve with the above treatments, only about 10 per cent of people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with degenerative arthritis.

There are also some conditions that need to be treated initially with an operation, including some rotator cuff tears and dislocated shoulders that cannot be reduced (put back in) with simple manual maneuvers. Sometimes frozen shoulder is treated with what’s known as manipulation under anesthesia. In this therapy, your shoulder is gently moved while you are under a general anesthetic to help improve its range of motion and of course avoid the treatment pain.

So make sure you do not self-diagnosis your shoulder problem, see your doctor. Keep in mind that it isn’t a good idea to rest it for too long or it will stiffen up. Use Cold and Heat intermittingly to speed up the healing process. Avoid strenuous activities and lifting heavy objects, but remember to move your shoulder to help make sure that you regain full use of the joint by returning to your normal activities as soon as possible and you will regain full use of your shoulder in a reasonable period of time.

But, if you are still experiencing pain, listen to it, it is a signal trying to tell you something is still wrong with your shoulder.