Shoulder pain in the adult patient can be very confusing for both the patient and doctor alike. Not only does pain often refer to different parts of the shoulder, neck and upper arm but the anatomy of the shoulder is for many doctors confusing.
Signs & Symptoms that you should be on the lookout:(please consult a physician should identify any of the below)
The shoulder is an important joint in your body due to its range of movement. It is integral to being able to perform duties overhead, reaching your back and stretching out to grab hold of something. It is a joint with little inherent stability and therefore if a weakness / defect develops in some of its stabilisers (muscle or bone) it can lead to persistent poor function.
History of trauma with weakness that lasts more than few days.
Inability to lift arm above shoulder height (using your other arm to help).
Shoulder pain at night and at rest.
Deformity in your shoulder.
Neck and shoulder pain accompanied with “pins & needles” down the arm.
Limited movement (not able to tuck in shirt at your back).
Repetitive / recurrent shoulder dislocations.
Impingment Syndrome (Sub-Acromial Bursitis)
This is the most common cause for shoulder pain. Usually the pain is associated with overhead activities. Pain is dull and aching in nature, but is not usually associated with any weakness. Most often occurs in middle aged patients.
Recommended treatment and care needed for this condition:
Non surgical - Success managing up-to 80% of cases, thesse include oral anti-inflammatories, sub-acromial cortisone infiltrations and home exercises. The other 20% of patients often require surgery.
Surgical - This is performed by arthroscopy (keyhole) and is performed under general anaesthetic. The patient remains in a sling for 2 weeks post surgery. Driving is not recommended during this period. Full shoulder function is regained approximately 6 weeks to 3 months post surgery.
Rotator Cuff Syndrome / Tear
This condition specifically relates to the rotator cuff muscles of the shoulder. They play an integral role in using your arm above shoulder height and behind your back. These muscles attach to the upper arm / humeral head by means of a tendon. These tendons can detach / tear from the bone leading to pain and weakness of the upper limb. Overhead functions are often difficult due to the inability to lift the arm above chest height.
The cause for these tears can vary from traumatic to degenerative (“wear and tear”).
Recommended treatment and care needed for this condition:
Surgery is often needed to regain full use of the arm.
Surgery entails an arthroscopic procedure where the tendon is reattached to the bone by means of titanium anchors and suturing material. Post operative recovery entails the wearing of a sling for 6 weeks 24 hours per day. Driving is strongly discouraged during this period. After the initial 6 weeks, rehabilitation commences with the help of a physiotherapist (weekly sessions). Full pain free shoulder function is only regained at 3 to 6 months after surgery.
Cervical Spine Pathology
Neck problems can often “masquerade" as shoulder pain, making it tricky to tell them apart. While real shoulder pain usually stays near the upper arm and feels like a dull ache, pain coming from the cervical spine (neck) often feels like an "electric shock" or burning sensation that travels past the elbow and into the hand. A specialist shoulder surgeon considers this causation and may also utilize differential infiltrations into various locations to provide additional information.
Treatment & When to Seek Help Most neck-related pain improves with physical therapy, anti-inflammatory medication, and rest. However, you should seek further medical attention if you notice "red flags" like clumsy hands, difficulty walking / balancing, or weakness that gets worse. Should the pain remains severe after 6 weeks of basic treatment, please seek immediate medical care.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder (adhesive capsulitis) is characterized by severe, often nocturnal, shoulder pain and increasing stiffness. The pain can be excruciating, particularly when making sudden movements, such as catching a falling object. It is a common condition that mainly affects women in their 40s or 50s.
People with type I or II diabetes mellitus face a significantly higher risk of developing this condition. Other contributing factors include shoulder trauma, recent surgery, thyroid dysfunction (hypo / hyperthyroidism), and Parkinson's disease.
Treatment and Care While conservative measures, such as physiotherapy, are usually effective in managing the condition, surgery may be necessary in persistent or severe cases. Surgical intervention typically involves arthroscopic release of the adhesive glenohumeral capsule, which facilitates early and intense post-operative movement. Physiotherapy is crucial for restoring mobility and alleviating symptoms.
Calcium crystals are deposited in the tendon of the rotator cuff muscles. These can increase in size and eventually rupture causing extreme pain. It is well known that this condition can resolve itself given enough time. There are however certain cases where it causes severe pain and discomfort.
It is a common condition affecting mostly female patients in their 40 or 50’s. Patients typically suffer with severe pain (especially at night) and progressive shoulder stiffness. Patients with diabetes mellitus (type I or II) have a much higher chance of developing this condition. Other associated risk factors include trauma to the shoulder, recent shoulder surgery, or even conditions such as hypo or hyperthyroidism and Parkinson’s disease.
Recommended treatment and care needed for this condition: Various non-surgical treatment options can provide relief in these cases. These include: subacromial cortisone infiltrations, shockwave therapy and "needling". Surgical removal with the help of arthroscopy is also an option (especially in persistent cases) and can give complete relief. The post operative recovery entails the wearing of a sling for 2 weeks and thereafter physiotherapy can commence. Recurrence of the condition after surgery can however occur in 10% of patients.
Various non-surgical treatment options can provide relief in these cases. These include: subacromial cortisone infiltrations, shockwave therapy and "needling".
Surgical removal with the help of arthroscopy is also an option (especially in persistent cases) and can give complete relief. The post operative recovery entails the wearing of a sling for 2 weeks and thereafter physiotherapy can commence. Recurrence of the condition after surgery can however occur in 10% of patients.
Shoulder Instability / Dislocation
Pain is usually associated with an acute dislocation incident. Once the joint is reduced (ball back in socket) the pain and discomfort improves considerably. Pain may flare up again with episodes of dislocation or even subluxation (partial dislocation) especially if a soft / bony lesion is still present in the shoulder. Pain is therefore mostly episodic in nature and associated with certain activities. In cases where a lesion is present which predisposes the patient to repeat dislocation or in high demand sports persons, surgery is indicated to prevent recurring episodes of dislocation. Multiple episodes of shoulder dislocation/subluxation may lead to osteoarthritis of the shoulder in the long term. Recommended treatment and care needed for this condition: The specific pathology involved and several patient factors will determine whether an arthroscopic repair (Bankart repair) or open procedure (Laterjet procedure) will be necessary to resolve the problem.
Glenohumeral Shoulder Arthritis
Not as common as hip and knee arthritis. Glenohumeral arthritis mostly affects older patients. Various factors can contribute to its development such as previous trauma or fracture of the upper end of the humerus. Neglected chronic rotator cuff tears also leads to arthritis. Replacement with a metal joint gives relief and improvement of function. Mostly affects elderly patients. Various factors can contribute to its development such as previous trauma or fracture of the upper end of the humerus. Neglected chronic rotator cuff tears also leads to glenohumeral joint arthritis. Recommended treatment and care needed for this condition: Conservative measures such as pain medication and physiotherapy can give relief. The only option that remains if these measures fail, is a shoulder replacement. The arthritic humeral head is excised and a metal head and stem inserted. Patients who undergo this surgery have an improvement in experienced pain as well as shoulder range of motion. This is major surgery and patients usually remain in hospital for 2-3 days post operative. Patients remain in a sling for 4-6 weeks and thereafter they commence with physiotherapy. Optimal shoulder function only returns after 6 months of rehabilitation.
Bicep Related Pathology (Tendonitis / SLAP)
The biceps tendon travels through the shoulder joint and attaches to the superior part of the glenoid, inside the shoulder joint. This attachment can tear from the glenoid (SLAP) in athletes who perform repetitive overhead actions (eg cricket and baseball players). A traumatic incident such as a fall on an outstretched arm can also lead to detachment of the tendon. A dull pain is usually experience with certain activities such as throwing or bowling. Recommended treatment and care needed for this condition: Repair of the detached bicep anchor by arthroscopic means is the only effective way in managing this problem. The recovery entails the wearing of a sling for 6 weeks post surgery. Normal sporting activities can usually only resume after 4-6 months of rehabilitation.
Brachial Plexus Neuritis
This neuritis can cause confusing shoulder and upper limb symptoms. Inflammation is present in this big bundle of nerves on the way to the upper arm. Symptoms are similar to that of cervical spine radiculopathy (pinched nerve in neck). Often in this condition the pain commences in the neck and shoulder, but it is accompanied by weakness in the arm, wrist and hand. Recommended treatment and care needed for this condition: Specialised tests are necessary to confirm the diagnosis. Patients are under the treatment of neurologists and treatment entails large doses of steroids. Recovery may take up to 6 months.