The shoulder joint consists of broad and many motion ranges. When there is an issue with the shoulder joint, it obstructs the ability to move which will result in pain, swelling, and a whole lot of discomfort. Aside from the femur bone, the shoulder is another example of a ball, and socket joint, it is made up of three major bones which are, the humerus bone, which is a long bone, the clavicle bone, also called the collar bone because of its anterior location, and the scapula called the shoulder blade also located at the back posteriorly. There are cartilages around the bones that help to prevent friction because they serve as cushions (1).
It is interesting to note that the shoulder joint is also made up of two sub-joints, namely, the acromioclavicular joint made up of the clavicle, and the scapula. Second is the glenohumeral joint comprising the ball of the humerus and the external part of the scapula. Surgeons refer to the shoulder joint as the joint with the highest mobility range in the body, with the help of the rotator cuff muscle (1). The supporting group of muscle around the shoulder joint is the rotator cuff muscle, and it consists of four tendons. Tendons are tissues in the body that attach the muscles to the bones (1).
Patients often complain of shoulder pain lifting objects or the arm when there is damage to the tendons or the bones surrounding the joint, which can manifest as pain, and swelling around the joint. Injury to the shoulder joint can result from different activities such as contact sports, falls, or manual labor putting pressure on the joint.
There can also be pains radiating from other parts of the body to the shoulder joint, as a result of certain diseases, examples of such, are diseases affecting the heart, liver, and spine. Old age is another factor that predisposes one to shoulder pain, the older, the more susceptible one is to shoulder, which can be explained as a result of degeneration of soft tissues occurring with age.
Sometimes, home care can take care of shoulder pain, and other times, it will involve the use of medications prescribed by health workers, and most times physical therapy. This article will explore all you need to know about the causes of shoulder pain, the associated symptoms, and how to treat, and prevent subsequent shoulder pain (1).
Symptoms Of Shoulder Pain
Pain to the shoulder joint can present in various dimensions, depending on the etiology, that is the cause. The following are the different clinical manifestations of shoulder pain:
- – Intensity: The intensity of shoulder pain differs. Pain can become very severe after exercise or on exertion, and gets relieved after taking medications, and another pain might be very severe all through both at rest and on exertion.
- – Radiation: shoulder pain is the pain that will radiate down your arm, and can go up to the hand.
- – Stiffness: it can get stiffed at times.
- – Immobility: patient can experience difficulty in moving the shoulder, or an inability to complete the range of motion.
- – Swelling: There can be associated swelling, as a result of fluid collection in the joint.
- – Loss of function: this is often the complication of shoulder pain, at times the patient experience inability to move the arm, and hand, which can translate to an inability to use the such limb.
- – Snapping sensation (2).
The pain in the shoulder joint can get severe, and will need the attention of health personnel. The following symptoms are warning signs that it is time to see a doctor for shoulder pain:
- – Immobility or reduced motion.
- – Pain with edema along the shoulder joint.
- – A pain that does not get relieved with the use of medication.
- – A pain that wakes the patient up from sleep or causes difficulty in falling asleep.
- – The pain getting worse despite the medication.
- – Shoulder pain with sharp pain describes as being sudden by the patient (3).
Causes Of Shoulder Pain
The following are the common conditions, and disorders responsible for pain in the shoulder:
- – Rotator cuff injuries
The rotator cuff is the muscle group surrounding the shoulder joint, it is made up of four small muscles that come together to aid the movement of the arm, and lifting. Sometimes, shoulder pain from lifting is traceable to injuries to the rotator cuff muscles. The muscles, alongside the tendon, work together to keep the ball and socket joint in position, which is a tough task. Injuries to the rotator cuff muscles can lead to:
- – Rotator cuff tears
Just as the name implies, it is a tear to the rotator cuff muscles, which can either be a complete tear or a partial tear of the rotator cuff muscles. The tear of the muscle can happen due to a single accident such as a fall on the arm, it may also be gradual in its onset as a repeat motion on the arm, a bricklayer will repeatedly use the shovel in a single direction, and can lead to raising of the arm frequently.
Shoulder pain while sleeping, at times can be a result of a tear to the rotator cuff muscle, or/and the tendons. Shoulder pain from lifting, in some cases, can be a pointer to a tear to the rotator cuff, or pains felt while trying to pick up high objects or comb the hair. In the past, immobility, and rest is sufficient alongside ice. But, patients are now advised to use non-steroidal anti-inflammatory drugs, and sometimes, physical therapy is employed (3).
- – Rotator cuff tendonitis
Rotator cuff tendonitis is said to occur when there is inflammation affecting the tendon surrounding the joint, this will cause the patient to be irritable, and if it happens in a child, such a child will cry at every slight provocation. The pain is always more at the front and side, there are times the shoulder joint can also appear stiff and difficult to move. Regular people at yoga studios often complain of features of rotator cuff tendonitis. The treatment is similar to that of a rotator cuff tear, rest, application of ice, and the use of non-steroidal anti-inflammatory drugs (3).
- – Bursitis
Inflammation affecting the bursae, that is the sac in between the joints, containing fluids that help prevent friction, and serve as a cushion, is called bursitis. A lot of time, this result from continuous use of the joint for a long period, arthritis of the joint, and the pathogenic microorganisms causing infection, which also leads to bursitis.
Studies have revealed that recently, gout has been counted as one of the commonest causes of bursitis. Subacromial bursitis is a term used when this inflammation happens at the shoulder blade area, just before the rotator cuff group of muscles. Uninterestingly, bursitis can happen alongside inflammation of the tendons around the joint. This will manifest as severe pain, pain enough to disturb or distract the patient from going on with their normal daily activities (4).
- – Shoulder dislocation
Shoulder dislocation is one of the common disorders of the shoulder joint, and causes severe pain at the shoulder joint. Shoulder dislocation occurs when the ball and socket joint of the shoulder is disrupted, that is the ball head of the humerus slips out of the socket, when this occurs, the pain is sufficient enough to disturb motion at the affected joint.
Depending on the severity of the dislocation, the shoulder can appear to be different in shape from the other normal shoulder, and sometimes, the bone can distort the skin too. Most shoulder dislocations occur as a result of injuries such as contact sports, accidents, or even falls. A previous shoulder dislocation is a risk factor for another shoulder dislocation in the future, and when this happens, orthopedics refers to it as chronic shoulder instability (4).
- – Osteoarthritis
Osteoarthritis is a disorder that affects the shoulder joint leading to a degeneration of the cartilage of the joint. Several joints of the body can be affected by osteoarthritis, such as the shoulder joint, the hips, and the spine. Other joints prone to osteoarthritis are the knee joints.
Pain is the major clinical manifestation of osteoarthritis, others are edema, redness, hotness or differential warmth, and joint stiffness, and when severe, there can be loss of function in the affected arm of the body, and this is a warning sign to see a doctor. Some people may also complain of some sensation when they try to lift or move the affected joint, such sensation is referred to as a grinding sensation. Other things can also predispose one to osteoarthritis of the joint, such as a previous injury to the shoulder joint (4).
- – Shoulder impingement syndrome.
Shoulder impingement syndrome is one of the causes of shoulder pain while sleeping, it occurs as a result of friction occurring between the soft tissues of the joint and the bones, the rubbing occurring can be as a result of any of the following:
- – Inflammation of the tendons
- – Swelling and pains in the bursae
- – Bone spurs which occur with aging
- – A malformed acromion bone, assuming a curved shape.
Shoulder impingement syndrome can result in pain felt at the outer part of the shoulder joint, shoulder pain lifting, shoulder pain worse at night, shoulder pain while sleeping, weakness of the arm, and sometimes, swelling is inevitable.
The treatment of shoulder impingement syndrome includes adequate rest of the shoulder joint, immobility, the use of anti-inflammatory medications, and exercises recommended by a physical therapist. Some doctors use corticosteroids on the affected joint to relieve the pain, and the swelling (5).
- – Frozen shoulder
A frozen shoulder often occurs as a result of the thickness of the connective tissues around the shoulder joint, which can reduce the range of motion around the joint. The pain from the frozen shoulder is enough to disturb the patient from sleeping well at night, causing shoulder pain while sleeping. The exact etiology of frozen shoulder is not known, but studies revealed that it occurs as a result of prolonged immobility a long time, however, some conditions like diabetes mellitus increase the susceptibility to frozen shoulder.
The clinical manifestation of a frozen shoulder is in stages, the first stage is the freezing of the shoulder, resulting in pain while moving the joint, causing a reduced range of motion. The second stage is the frozen stage, where the pain is reduced, while the joint gets stiffened and the patient finds it difficult to move the affected limb. The third stage is tagged thawing, it is like a convalescence stage where motion improves and the patient can move the joint better.
The pain resulting from a frozen shoulder is usually worse in the evening, and it causes shoulder pain while sleeping. The best remedy is to treat the pain using pain-relieving medications, and exercises recommended by a physical therapist, and on rare occasions, steroids and surgical interventions are used (5).
- – Shoulder pain from lifting
Weightlifters often experience shoulder pain lifting weights during their workout sessions. Studies have revealed that shoulder pain from lifting occurs as a result of three factors, weightlifters lifting heavy weights than they can carry, lifting weights without breaks in between, that is, too often, or a wrong technique of lifting. Any of the three is responsible for shoulder pain from lifting. Rotator cuff tear, tendinopathy, and impingement are the leading causes of shoulder pain from lifting.
Treatment Of Shoulder Pain
Most often than not, the cause of shoulder pain will dictate the treatment option, but there are general guidelines for the treatment of shoulder pain. These are:
- – Home care: This includes the use of the following
- – Rest the affected joint
- – Apply ice to the affected area
- – Gradual return to physical activities
- – Use of over-the-counter pain relievers such as acetaminophen
- – Clinic care: At the hospital or clinic, the following can be done to help the patient
- – Use of medications, such as the non-steroidal anti-inflammatory drugs (NSAIDs)
- – Injection of corticosteroids to relieve associated swelling
- – Referral to a physical therapist to recommend the needed exercises
- – Surgical manipulations, for cases such as dislocation (6)
When To See a Shoulder Pain Chiropractor
A chiropractor is a primary caregiver that takes care of the musculoskeletal system. They use various manipulations to treat joints and muscular issues. A patient can visit a shoulder pain chiropractor directly for their shoulder pain treatment because they are also primary caregivers or the doctor may refer directly to a shoulder pain chiropractor when the patient presents with conditions such as :
- – Frozen shoulder
- – Rotator cuff tears
- – Tendonitis
- – Others are Sprains at the joint. Bursitis, and unbelieving arthritis (7).
- 1. https://www.healthline.com/health/shoulder-numbness
- 2. https://www.omron-healthcare.ng/health-and-lifestyle/pain-management/body-aches-and-pains/shoulder-pain-causes-symptoms-and-treatment.html
- 3. https://health.clevelandclinic.org/shoulder-pain-most-common-causes-and-how-to-fix-it/
- 4. https://www.medicalnewstoday.com/articles/325231#impingement
- 5. https://www.healthline.com/health/pain-when-sleeping-on-shoulder#when-to-get-care
- 6. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/shoulder-pain
- 7. https://www.laurelmdchiropractor.com/blog/should-you-see-a-chiropractor-for-shoulder-pain#:~:text=Yes%2C%20chiropractors%20work%20on%20shoulders,that%20make%20up%20the%20spine.