What is chronic shoulder pain?
Chronic shoulder pain can be caused by overuse, muscle strain, or repetitive movements. It can also develop with age, or can be caused by an underlying medical issue. Certain strategies can help reduce the onset of shoulder pain.
The shoulder is a complex joint with a wide freedom of movement. Shoulder problems can significantly hinder daily life and cause discomfort and pain and has been found to significantly impact quality of life (over other pain).[1]
The main shoulder joint is the glenohumeral joint, a ball-and-socket joint that connects between the scapula (shoulder blade) and humerus (arm bone). There are also other joints between the scapula, collarbone, and sternum that contribute to the function of the shoulder.
To complete all the directions of movement, the shoulder needs to be flexible as well as strong. The shoulder joint is therefore the most flexible joint in the body, but is well supported by muscles, ligaments, and soft tissue. In particular, there are four rotator cuff muscles that play a large role in the stability and function of the shoulder.
What are the symptoms of shoulder pain?
Shoulder pain can present in different ways for different people.
What causes shoulder pain?
There are many different causes of shoulder pain. Pain can occur suddenly, or may develop gradually over time. The severity can also range from mild to severe.
Common causes of shoulder pain may include
1. Rotator cuff tear
Rotator cuff injuries can develop gradually over time, from repetitive movements or muscle imbalances. It may also occur suddenly, due to blunt force trauma or lifting a heavy object awkwardly. The severity of a rotator cuff tear can range from a mild strain to a complete tear. In some cases, there can be a significant loss of movement that may require surgical input. If left untreated, it can limit activity, lead to significant disability and restrict normal participation in daily activities.[2]
2. Arthritis
Arthritis is more common in older adults.[3] Osteoarthritis is a condition where the joint surfaces degrade over time or due to injury. It can cause a sharp or dull ache, and may lead to difficulty with everyday tasks, such as reaching. There is no cure for arthritis, and it likely needs to be monitored and managed over time.
3. Injury
Injury is a common cause of shoulder pain. As the joint is so mobile, there is a significant risk of injury during repetitive movements, manual labour, or sport. High-impact sports or throwing athletes can have a high incidence of shoulder pain.
In some cases, shoulder pain can be a symptom of referred pain from another part of the body such as the neck. Musculoskeletal pain is common, especially with poor working posture or sitting for prolonged periods of time.
Other causes of shoulder pain include:
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Ligament damage
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Labral tear
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Musculoskeletal problems
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Bursitis
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Bony spurs
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Nerve compression
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Biomechanical weakness
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Frozen shoulder
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Referred pain
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Trauma
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Dislocation
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Fracture
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Infection
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Heart attack
Shoulder pain may be mild or benign, but it can also indicate a more serious underlying medical condition. It is important to see a doctor to get a diagnosis.
How is shoulder pain diagnosed?
A health professional can complete an assessment to assess the cause of the pain. This will likely include asking questions about any symptoms including: the location of pain, a description of the symptoms, mechanism of injury, if there is night pain, painful movements, other affected areas, the medical history including injuries, or any unusual symptoms.
A physical examination will help assess the strength and sensation in the shoulder. Certain movements and special tests can also be used to help rule out or rule in different conditions.
A doctor may request further imaging to further assess the structures in the shoulder, such as an X-ray or MRI. They may also send a referral to a specialist, such as an orthopaedic surgeon, for expert input.
There are many different causes of shoulder pain, therefore it is important to get the correct diagnosis before any treatment starts as treatment may worsen the symptoms, cause further damage, or have no effect.
When to see a doctor
A doctor should be consulted immediately if there are any ‘red flag’ symptoms.
This can include:
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Severe, persistent, or unrelenting pain
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Being unable to move the arm
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Swelling or fever
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Shortness of breath
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Chest pain or tightness
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Excessive sweating
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Neck or jaw pain
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Loss of consciousness.
In rare cases, shoulder pain can be a symptom of a heart attack. A heart attack is an emergency that requires immediate medical input.
How is shoulder pain treated?
Treatment will depend on the cause and severity of the shoulder pain.
Physiotherapy
Physiotherapy or occupational therapy can be beneficial for shoulder pain. A physiotherapist can assess the origin of the symptoms and prescribe certain exercises to strengthen or stretch the tissues in the joint. An occupational therapist can observe everyday activities and suggest aids or strategies to improve functional movement.
Medical treatments
A doctor may recommend one or a combination of treatments to resolve any symptoms and address the cause of the pain. This may include prescription medications, such as non-steroidal anti-inflammatory medications or a corticosteroid injection. A doctor may also recommend a review with a surgeon to discuss alternative options. In the case where there is an underlying medical condition or the pain is due to trauma or injury, surgery may be the first line of treatment.
Other treatments may include:
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Ice or heat therapy
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Pain relief
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Activity modification
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Aids, such as a handheld reaching tool
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A brace or sling for a period of time
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Limiting painful movements, such as reaching overhead
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Rest.
Preventing shoulder pain
Whilst all causes of shoulder pain may not be preventable, there are some key factors that can reduce the risk of developing shoulder pain.
This may include:
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Specific exercises to maintain the strength and flexibility of the shoulder joint
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A regular exercise regime
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Maintaining a healthy diet and weight
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Completing a warm-up before exercise
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Addressing any early signs of pain
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Introducing any new activities slowly
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Staying fit and active.
Key messages
Shoulder pain is a common condition, and can affect anyone. In many cases, shoulder pain may resolve on its own. However, therapies such as physiotherapy, or other medical treatments can help resolve symptoms and address the origin of the pain. Shoulder pain can also be a sign of a more serious underlying condition which may require immediate medical input.
