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Shoulder Pain

<Shoulder pain is an extremely common complaint. Your shoulder comprises three bones. The humerus or upper arm bone, the clavicle or collarbone and the scapula or shoulder blade. The tip of your upper arm bone connects into your shoulder blade through a rounded socket.

Shoulder Pain

Shoulder Pain

This socket is known as the glenoid. Its a network of tendons and muscles that ensure your arm bone remains hooked to the center of your shoulder socket. These tissues are known as the rotator cuff. They are located around the tip of your upper arm bone and connect it to the shoulder blade.

Shoulder pain can result from many causes. These causes can be grouped into four categories. Arthritis, instability, broken bones or fractures and tendinitis or bursitis – tendon tear or inflammation. The diagnosis of  shoulder pain has to be precise for the appropriate treatment to target the root causes.

Causes of Shoulder Pain

Bursitis : The bursa are tiny sacs filled with fluid situated in the joints of the body like the shoulder. They cushion the bones from the surrounding soft tissue and minimize friction between the bone and the sliding muscles. When you overuse your shoulder, the region between the rotator cuff and acromion or shoulder blade gets inflamed.

This leads to a condition known as sub-acromial bursitis. Bursitis and rotator cuff tendinitis always occur concurrently. Bursitis or tendinitis of the cuff is the leading diagnosis made on patients with shoulder pain.

Such mundane activities as dressing up and combing can become much harder. This arises when several tissues in the shoulder joint become painful and inflamed. When the tendon of the rotator cuff are severed from the bone, then it results in a Rotator Cuff Tear.  This condition will sometimes require surgery.

Shoulder Pain

Shoulder Pain

Tendinitis :  The cords connecting muscles to bones are known as tendons. Tendinitis is almost always caused when a tendon has been worn down gradually over a period of time. This process resembles a worn down shoe that eventually gets torn.

The two types of tendinitis are acute and chronic tendinitis. Repetitive ball throwing, like in baseball can result in acute tendinitis. Other related sporting or work activities involving overhead arm motion, can also result in acute tendinitis.

Repetitive wear and tear can be as a result of the ageing process. This coupled with arthritis and other degenerative diseases, can cause chronic tendinitis. One bicep tendon and four rotator cuff tendons, are the most frequently affected tendons in the shoulder.

The rotator cuff comprise four small muscles, together with tendons surrounding them. These tendons cover the tip of the your upper arm bone and secures it to your shoulder socket. Shoulder stability and motion are generated through your rotator cuff muscles.

Calcific Tendinitis occurs when calcium deposits into a tendon. This occurs especially in the rotator cuff tendons. The extent of an individuals symptoms determines his/her course of treatment.

Tendon Tears: These are degenerative conditions in the tendons as a result of the aging process or acute injury. Wear, tear and overuse can also lead to tearing and splitting of tendons. Biceps tendon rapture occurs when the tendon connecting the biceps muscle to the bone raptures next to the joint.

Impingement:  This occurs when the acromion or shoulder blade exerts pressure on the soft tissues underneath. This happens when the arm is lifted off the body. During the lift, the acromion impinges or grinds on the bursa and rotator cuff tendons. This can cause tendinitis or bursitis, resulting in limited motion and pain. Rotator cuff tear can ultimately result from serious impingement.

Shoulder Pain

Shoulder Pain

Shoulder instability is a condition that can lead to loose joints and dislocations. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. When the ball of the upper arm lodges out of the socket partially, this results in subluxation.

A complete dislocation means the ball comes all the way out of the  scapula or socket. Repeated dislocations can occur if the muscle and tendons surrounding the shoulder are torn or loosen up. Recurring shoulder dislocations may be complete or partial. These can cause unsteadiness and pain when you raise or move the arm from the body.

Arthritis in the shoulder joint can be developed from a series of dislocations and subluxations. A shoulder separation commonly referred to as an AC separation is caused by acromial-clavicle joint disruption. This injury varies significantly from a shoulder dislocation.

Arthritis: This can be a cause of shoulder pain. However, it is significantly minimal compared to hip and knee arthritis. Osteoarthritis is the most common form of arthritis.

Other forms of arthritis also affect the shoulder. These are associated to rotator cuff tears, joint lining inflammation and infection. Wear and tear arthritis is another name for osteoarthritis as it is synonymous to work and sports injuries. It is accompanied by inflammation, stiffness and pain among other symptoms.

Osteoarthritis progresses gradually and the pain increases over time. It is not uncommon for individuals to avoid certain movements to minimize the pain. This curtails the normal range of motion as the shoulder joint’s soft tissues stiffen and tighten painfully.

Fractures: These occur when a bone in the shoulder is broken. The upper arm bone (humerus), the (scapula) shoulder blade and (clavicle) or collarbone are mostly involved. A fall from a normal upright height can result in a fracture in older patients. In younger patients a more vigorous  high impact injury like car crash or sports injury causes fractures. Usually bruising inflammation and sharp  shoulder pain  results from fractures.

Frozen Shoulder. This condition is common and is also known as adhesive capsulitis. It mainly results in a stiff joint. The condition is best handled by applying physical therapy and shoulder stretching treatment. Some other less common causes of  shoulder pain  include nerve related problems, tumors and infections.

Danger Signs and Diagnosis of  Shoulder Pain

Sometimes it is impossible to be sure of the exact cause of  shoulder pain.  The treatment options available may also be confusing. Seeking medical attention is always the wise thing to do.

If your shoulder injury deforms your joint, or your are unable to employ the services of your arm, its a danger sign. Other danger signs include inability to sleep through the night, pain that refuses to ease off after a few days or inability to lift your arm.  Fever, warmth, redness and other infection signs or unusual symptoms should prompt you to seek medical attention. These include significant bruises and swelling.

Shoulder Pain

Shoulder Pain

Your doctor will run many tests in order to determine the precise origin of pain. Before settling on the correct treatment your medical history will also be an important aspect of the evaluation. This will include when and how the pain started and similar past conditions.

The remedies employed and specific activities associated with your similar shoulder pain form part of your medical history. This is invaluable in pinpointing the cause of pain. Specific activities causing pain may be altered to other activities to relieve the pain.

A physical examination is necessary in establishing hidden causes of shoulder pain.Your doctor will look out for inflammation, deformity, muscle feebleness, tender areas and any abnormalities. The strength and range of your shoulder movements will also be observed.

Some tests will be necessary to identify and rule out causes of pain and other problems. These tests will include:

  • X-rays: This will provide pictures of any injuries in your shoulder anatomy.
  • Ultra Sound and Magnetic Resonance imaging (MRI): These provide high quality pictures of soft tissue. Any injuries to the tendons or ligaments in the shoulder joint will be detected easily.
  • Computed Tomography (CT) scan: This combines computer technology with X-rays to provide an extremely detailed image of the shoulder joint bones.
  • Electrical studies: In case your nerves are involved, an Electromyogram (EMG) will evaluate the functions of your nerves.
  • Arthrogram : In order to better scrutinize the X-ray pictures, The shoulder is injected with dye. This produces a clarified view of the tendons and muscles around the shoulder joint.
  • Arthroscopy: A fiber optic camera is used to gaze inside the joint in this procedure.  X-rays, physical examinations and other tests may not show soft tissue injuries that are clearly shown by Arthroscopy. This technology will be used not only in unmasking the cause but also in correcting the problem.

Treatments for Shoulder Pain

A thorough comprehension of the cause of your shoulder pain is crucial for any successful treatment plan. Your symptoms should be well studied before settling on a treatment option. Seeking medical advise is indispensable for accuracy in treatment.

  • Rest: Resting the joint is the first and most important part of any treatment. This allows the inflammation to ease. However, take care not to overindulge in rest as this may lead to a frozen shoulder.

    Shoulder Pain

    Shoulder Pain

  • Application of Ice and Heat: Ice packs are generally used for the first 72 hours. This is followed by the use of heating pads. Care should be exercised to avoid sleeping off when using ice packs to prevent frost bites.
  • Stretching: Stretching the shoulder tendons and muscles can ease some causes of shoulder pain.  A regular stretching routine should be developed preferably with the aid of a fitness expert. Avoid activities you seldom perform or overexerting yourself.
  • Physical Therapy: In nearly all orthopedic conditions, this is the most important mode of treatment. Different aspects are employed by physical therapists to regain mobility, boost strength and enable patients to attain all their pre-injury capabilities.
  • Shoulder pain  exercises may also strengthen the joint muscles and help alleviate most pain conditions. Most patients will respond to simple steps like change of activities, relaxation, medication and exercise.
  • Anti-Inflammatory-Medications: The most common form of these medications are the Non-Steroidal-Anti-Inflammatory pain medications. These are frequently targeted at patients with shoulder bursitis, arthritis and tendinitis injuries.
  • Cortisone Injections: These are powerful medications that are usually targeted at inflammation. Inflammation accompanies most  shoulder pain  problems. Other benefits associated with this medication should be discussed with your doctor.
  • Surgery: Although 90 percent of problems will be solved with other methods some shoulder pain  problems will require surgery. Recurring dislocation and rotator cuff tears are problems that are unlikely to respond to exercise. Such conditions require surgery early enough.
  • Shoulder arthroscopy during surgery is necessary to eliminate scar tissue or repair the torn tissue. The traditional  shoulder pain  procedures involve larger reconstructions and shoulder replacement surgery.
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