You can’t truly appreciate how important our shoulders are until one of them starts to hurt. Activities as simple as brushing your teeth or hair becomes very difficult. And don’t even try reaching behind your neck or overhead.
My shoulder hurts, now what?
If you experience shoulder pain, it’s not always possible to figure out the cause. Sometimes problems in other parts of the body are actually the source of the pain, such as a pinched nerve, disc herniation, arthritis in the facet joints of the spine in the neck and even trigger points causing pain that radiates to your shoulder.
Other common types of shoulder pain include rotator cuff tears, subacromial bursitis, frozen shoulder, and arthritis of the shoulder joint (gleno-humeral joint). Shoulder specific pain can result from an acute or immediate injury or trauma such as having the shoulder twisted, pulled, hit, or from repeat overuse of the shoulder. If you are experiencing a lot of pain or know you injured yourself, it’s best to see a doctor right away to have your shoulder condition diagnosed.
But if you have mild shoulder pain, try reducing your activities that involve your shoulder, taking nonsteroidal anti-inflammatory drugs, and performing mild stretches to see if the pain improves on its own. Try to avoid movements that keep your arms over your head. If the pain gets worse or doesn’t go away after a 2-3 weeks, its time to consult your doctor.
What are some causes of direct shoulder pain?
- Rotator cuff injuries: Your rotator cuff is a group of 4 muscles and tendons that help keep your shoulder in the socket and allow you to move it in a circular motion. The shoulder has very good range of motion, but it sacrifices stability. The rotator cuff system keeps the shoulder stable during its full rotation of movements. The supraspinatus tendon is most at risk because it travels under a bony prominence called the acromion. A bursa which is a sack of fluid that cushions the tendon against this bone. It is most affected when you raise your arms to the side or raise your arms over your head.
- Rotator cuff tendons tears: Can show up as pain, weakness of the shoulder and arm, and stiff shoulder. A partial tear often is more painful than a compete one. A tear usually occurs at the tendon where it attaches to the bone. Risk of a tear increases with age and general wear and tear. Common sudden causes include falls unto the shoulder or a dog suddenly pulling on the leash. Small tears can be healed with regenerative therapies without surgery. Larger tears may require surgery to repair.
- Rotator cuff impingement (with tendinitis and/or bursitis): A rotator cuff impingement happens when there is irritation, inflammation, or compression of the tendons or bursa (the fluid-filled sac that sits between bones) in the shoulder. An impingement can be caused by an injury, but it can also just result from general wear and tear. This can cause pain while laying on the shoulder side as well as raising the shoulder as in overhead movements. It gets worse with activity. The shoulder may be tender to the touch especially the outside and front areas. This can be treated with steroid injections to decrease inflammation. It is important to use image guidance since the subacromial bursa is very thin and studies have shown that up to 70% of the time, blind injections, that is injections without image guidance, do not hit the mark. We prefer to use ultrasound guidance to ensure 100 % success to guiding the needle to the correct area.
- Biceps tendonitis: This inflammation can occur from overuse of the biceps over time. Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity. Pain or achiness that moves down the upper arm. An occasional snapping sound or sensation in the shoulder. This can be treated conservatively with NSAID medications. It is important that if steroids are injected, that they not be injected into the tendon as it can lead to tendon tearing. This is why using ultrasound guidance by an experienced injector is so important.
- Frozen shoulder also known as Adhesive capsulitis. This is caused by a thickening and stiffening of the tissues around the shoulder joint. This leads to inability to move the shoulder at all due to pain and stiffness. It can occur after a rotator cuff impingement, a tendon tear, minor injury, or no reason at all. This can resolve on its own, but it can take years. Steroid injections into the shoulder joint may help. Physical therapy may be too painful without a steroid injection first.
- Osteoarthrtis: It is the same as any other joint with cartilage. By definition it is the destruction of the cartilage leading to bone on bone joint pain. Pain is often worse after inactivity such as first thing in the morning after a night of rest, but gets better with movement throughout the day. It is important to continue moving the joint despite the pain to avoid muscle stiffness and muscle shortening. Steroid injections may help with the pain as do regenerative therapies.
- Calcific tendinitis.Calcium deposits into tendons of the rotator cuff. It is often a result of chronic inflammation and the cycle of tearing and repair of the tendon tissue. The condition causes sudden, severe pain that often starts in the morning. It’s more common in middle-aged and older adults and those who have diabetes. The calcium deposits can be broken up with a needle if the deposits are not too thick. Steroid injections here can help as well as physical therapy.