Shoulder pain is a very common complaint, affecting patients of all ages. Gradual wear and tear of soft tissues, or an acute injury of bones and ligaments within the joint can cause chronic pain. Shoulder pain can often be quite debilitating, interfering with all aspects of daily living. Locating the primary cause of the pain determines the type of treatment necessary to effectively eliminate the pain, and restore function and mobility to the shoulder.
Anatomy of the shoulder joint
The shoulder is one of the most sophisticated and complicated joints of the human body. It allows a high degree of mobility, but lacks bony and soft tissue stability. It is a ball-and-socket joint, consisting of the humeral head (ball) of the upper arm and the glenoid (socket) of the shoulder blade.
A series of four muscle tendons, known collectively as the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis), surround the shoulder, keeping the humerus in its proper place. The biceps muscle in the arm also connects to the top of the shoulder joint by way of a tendon.
Wear and tear, or injury to any of the bones, muscles, ligaments or soft tissues in the shoulder can destabilise the joint and cause shoulder pain.
Common causes of shoulder pain
Shoulder pain is classified as either acute (recent or sudden onset) or chronic (occurring gradually over time). An injury to any of the anatomical structures of the shoulder can cause pain in the shoulder or referred pain to the arm, chest, neck, and/or upper back. Common causes of shoulder pain include:
- Rotator cuff tear: Any of the four rotator cuff muscles or tendons (supraspinatus, infraspinatus, teres minor or subscapularis) can be torn as a result of injury or attrition. The most commonly injured tendon is the supraspinatus.
- Subacromial impingement (rotator cuff tendonitis): The subacromial space is the gap between the shoulder tip/roof (known as the acromion) and the shoulder joint below it. Narrowing of this space due to either bone spurs or inflamed tissue can cause subacromial impingement. This causes pain in the upper arm or top of the shoulder and can become chronic over time.
- Biceps tendinitis/tear: This is an injury to the tendon connecting the biceps to the shoulder blade, often causing sharp pain in the front area of the shoulder and radiating down to the elbow
- Labral tear: This is an injury to the ring of cartilage that surrounds the shoulder socket
- Calcific tendinopathy: This refers to deposits of calcium in any tendon of the body, but most commonly in the tendons of the rotator cuff, especially the supraspinatus. It can cause intense pain in the shoulder due to pressure build up as well as chemical irritation.
- Frozen shoulder (adhesive capsulitis): A condition where the capsule of the shoulder becomes thickened. Movement is impeded and results in stiffness. There is often pain in the early phases of adhesive capsulitis.
- Shoulder instability: A recurrent condition where the shoulder dislocates, usually after an injury.
- Osteoarthritis: Due to the degeneration of cartilage that surrounds and protects the shoulder joint, there is pain with any movement of the joint.
Early consultation for shoulder pain allows all potential treatment options to be explored.
When is treatment for shoulder pain recommended?
Acute injuries should be evaluated and treated promptly in order to prevent further injury and preserve long-term strength and function of the shoulder.
Chronic injuries that persist despite non-operative measures, such as analgesia and physiotherapy, should be assessed to prevent further long-term problems. This is especially indicated if there is significant pain and dysfunction that prevents you from performing your usual activities of daily living, work or recreational pursuits.
- Shoulder Pain
- Rotator Cuff Tear
- Shoulder Impingement
- SLAP Tears
- Shoulder Joint Arthritis
- Frozen Shoulder
- Shoulder Instability
- Shoulder Separation
- Shoulder Labral Tear
- Shoulder Dislocation
- Distal Biceps Rupture
- AC Joint Injuries
- Shoulder Trauma
- Clavicle Fracture
- Fractures of the Shoulder Blade
- Broken Arm
- Forearm Fractures in Children
- Elbow Fractures in Children
- Olecranon Fractures
- Radial Head Fractures
- Distal Humerus Fractures of Elbow
- Shoulder Injuries in Throwing Athletes