Shoulder Pain

This article was written and contributed by some of Australia’s leading experts in the field of pain and shoulder pain. Our goal is to empower you with the appropriate knowledge to help you understand what may be causing shoulder pain and alleviate any worries or anxiety you may have about your injury.

If shoulder pain is something you’ve been dealing with over a long period of time, we hope to provide you with some new and fresh information that may help you overcome it.

Included in this article is a practical and actionable plan, backed by the latest medical research to treat your shoulder pain (including things you can do from home) and help you get back to feeling your best.

Please continue reading as we help you understand the different types of shoulder pain and help you to discover what type you may have.

What is shoulder pain?

Shoulder pain is a term used to describe conditions or issues that lead to discomfort around the shoulder joint. Injuries to structures, such as the joint, tendon and ligaments can give rise to shoulder pain. Examples of shoulder pain conditions include rotator cuff tears, osteoarthritis and tendonitis.

Shoulder pain is the third most common physical health problem in Australia. [1] According to the University of New South Wales, roughly 1% of Australian adults (~200,000 people) will suffer from shoulder pain. [1]. Rotator cuff muscles tears are very common and increase their frequency with age.[2]

Working is one of the most common ways to hurt your shoulder. Almost one in seven Australians experience pain in the shoulder [3] due to their occupation, including overhead athletes (e.g,. cricket, water polo, etc.), manual labourers and tradesmen. Despite being the most flexible joint in the body, the shoulder is also the least stable which poses a higher risk to injury.

Pain is categorised as either acute, subacute or chronic shoulder pain.

Acute shoulder pain: (0 days - 6 weeks)

Acute shoulder pain is usually an injury that is a result of minor trauma, or a slight injury. Acute shoulder injuries usually heal and recover quickly, with minimal fuss. Treatment and appropriate rest will accelerate the recovery process.

Subacute shoulder pain: (6 weeks - 3 months)

Sub-acute shoulder pain usually occurs when there is slightly more tissue damage and/or other complications. In sub-acute injuries, healing typically takes longer and there may be other factors that contribute to this.

Chronic shoulder pain: (3 months +)

Chronic shoulder pain is defined as pain that lasts beyond the three-month mark. There can be multiple causes for this, including serious tissue damage and injury, obesity, stress and anxiety or other pain problems. Focusing on all the relevant factors that lead to chronic pain are key to recovery.

What are the symptoms of shoulder pain?

Pain in the shoulder is the main symptom that results from an injury or condition within the shoulder joint. Symptoms vary from mild, dull aches, to sharp and burning pain. Shoulder pain can be accompanied by arm pain or neck pain, shoulder pain can also result in loss of movement, particularly elevation above your head.

Common complaints of pain in the shoulder

• Shoulder blade pain

• Neck and shoulder pain

• Pain when sleeping on the shoulder

• Right shoulder and arm pain

• Deltoid pain

• Pain with overhead activities

• Pain in the shoulder with sports

• A feeling of weakness with lifting

• Difficulty reaching behind to tuck in your shirt or undo your bra

• Pain with prolonged computer work

• Difficulty lifting household objects like a kettle

• Pain and discomfort when washing your hair

• Occasional clicking with movement

• Pain that radiates down the arm

People may experience

Pain areas: in the shoulder, arm and neck

Sensory: tingling or pins and needles in the arm

Also common: weakness or difficulty lifting

What causes shoulder pain?

Shoulder pain is usually caused by injury to one of the many muscles surrounding and supporting the shoulder joint and is usually mild in nature. More severe shoulder pain is caused by structural damage, arthritis or sometimes even injuries like frozen shoulder.

According to the Mayo clinic, shoulder pain is defined as "pain that arises from the shoulder joint itself or any of the many surrounding muscles, ligaments or tendons”. [4] Shoulder pain can result from a problem in one or several parts of the shoulder, including:

• Muscles (strain)

• Ligaments (sprain)

• Nerves

• Bone injuries - the bones of the shoulder include; the humerus (ball) and the scapula or shoulder blade (socket).

Common reasons why people experience pain in the shoulder

• Excessive computer work

• Sporting injuries

• Repeated overhead activities or work

• Falls

• Arthritic issues

• Throwing injuries

• Chronic inflammatory issues

Common injuries that cause shoulder pain

Rotator Cuff Tendinopathy

Rotator cuff tendinopathy is caused by overuse of the muscle groups around the shoulder. Rotator cuff tendinopathy is one of the most common shoulder injuries in both the general and athletic populations.

Shoulder bursitis

The bursa functions as a cushion to prevent friction between the bones and surrounding soft tissues. Overuse of the shoulder region can cause inflammation of the bursa, which causes swelling and pain,leading to shoulder bursitis.

Shoulder Impingement

The shoulder is a complex structure with different tendons, nerves and blood vessels running through the shoulder region. Shoulder impingement is where these soft tissues and structures get “caught” in the shoulder when lifting above head height. This can lead to pain and limitation of movements.

Frozen Shoulder

Frozen shoulder is also known as adhesive capsulitis and characterised by pain and stiffening of the shoulder joint. It occurs due to the tightening of the joint capsules resulting in restriction of shoulder movements.

Osteoarthritis

Just like any other joint in your body, the shoulder joint is prone to general wear and tear. Osteoarthritis leads to pain and stiffness of the soft tissues around the shoulder.

Fractures

Shoulder fractures typically result from a fall, motor vehicle accidents or during contact sports.

Tendon Tears

Rotator cuff and bicep tendon tears are common injuries seen in high impact sports such as throwing and weight lifting.

Cervical Radiculopathy

Cervical radiculopathy leads to spinal nerve roots becoming impinged, causing pain in the shoulder and down the arm.

Common conditions that cause shoulder pain

Various medical conditions can cause shoulder pain. If you have these conditions, you may also experience shoulder pain:

• Rheumatoid Arthritis

• Septic Arthritis

• Gout

In acute scenarios, shoulder pain can be a sign of a heart attack, if you suspect that you have had or are having a heart attack seek emergency medical advice immediately by calling 000.

Sports that increase the risk of shoulder pain

There are many sports that rely on the power of the arms, and can increase the risk of shoulder pain. Here is a list of the most common sports that result in shoulder pain:

• Swimming

• Tennis

• Baseball / Softball

• Football

• Volleyball

How is shoulder pain diagnosed?

There are several options available to you when it comes to diagnosing the underlying cause of your shoulder pain. One of the most common, and the one that is most frequently recommended by Australian GP’s, is an assessment from a physiotherapist.

Physiotherapists are specialised experts in the field of rehabilitation. They can effectively diagnose and treat musculoskeletal conditions and joint issues such as shoulder pain.

Like any other pain or injury, a physiotherapist will start with a detailed history of your activities and previous injuries. This includes an interview-like process that is usually referred to as a consultation. A typical session will last between 30-60 minutes, and during this time, you will discuss the specific issues you are having related to your shoulder pain.

After determining the background of your condition, the physiotherapist will perform physical movements and specific screening tests on your shoulder and other related regions to determine the root cause of your pain and rule out other conditions.

Once the whole process is complete, you will receive a specific treatment plan to guide you through your recovery.

You will also be given the details of your program. This will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and prevent complications

• Timeline for recovery

• Any further recommendations required.

How is shoulder pain treated?

Shoulder pain can be distressful and limitations in movement can really affect your daily life. That is why it is crucial to have your shoulder pain checked as soon as possible.

There are several options when it comes to treating shoulder pain. One of the more common treatment options that is referred by Australian GP’s is physiotherapy.

Shoulder pain is an injury that physiotherapists come across regularly, and the process of treating it is straight-forward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

When dealing with a shoulder injury, it is important to get the right advice. Physiotherapists are experts in the management and treatment of shoulder pain. From shoulder bursitis to rotator cuff tears, they can help you recover and get you pain-free.

Your treatment will focus on reducing the pain, restoring your mobility and strengthening vital structures to enable complete recovery and prevent future injuries.

Depending on the severity of your shoulder pain, a physiotherapist may provide you with a combination of the following types of treatments:

• Manual therapy - Hands-on physiotherapy, used to help reduce pain and increase range of motion

• Advice and Education - Speaking to a physiotherapist is essential in gaining the correct information regarding shoulder pain

• Dry needling - A technique used to help alleviate pain and reduce muscle tension

• Progressive exercise programs - Specific exercises tailored to improve your shoulder pain

• Stretching - Stretching will help lengthen muscles and increase range of motion.

• Soft tissue and joint mobilisation - Specific joint mobilisations are used to reduce stiffness in particular areas

• Therapeutic massage - Another hands-on-technique, primarily used to reduce muscle tension.

It is not uncommon to feel immediate relief after your initial session of physiotherapy.

Next step: Creating a treatment plan made for you.

Following your initial appointment, your physiotherapist will create a detailed treatment plan based on your goals and lifestyle to ensure that you get the most out of your recovery and get back to doing the things that you love to do.

Self-care strategies

If you are having shoulder pain, find the best things to do and avoid below.

Things to do:

• Hot Compress/Cold compress - Heat will promote blood flow towards the area. This will also relieve stiffness and will facilitate natural relaxation of the tensed muscles around your shoulders. Be careful not to apply too much heat as it may cause a burn.

If you are experiencing intense pain and swelling on the shoulder joint. Use a cold compress to minimise the swelling and control the pain.

• Gentle stretching exercises - It is vital to keep some movement in the shoulder as you don’t want it to become immobile. Do some gentle exercises each day that are, most importantly, pain-free.

• Rest - Most shoulder injuries are due to repetitive motion combined with a high load on the shoulder. Be sure to have sufficient rest from these heavier activities and allow your body to recover.

Things to avoid:

• Avoid activities that worsen the pain.

Take rest and let the symptoms subside. If you are working on a computer, be sure to take frequent rests in between and practice proper posture.

• Avoid repetitive movements of the shoulder

Shoulder pain can be aggravated due to overuse of the shoulder joint and its muscles.

Do I need a specialist or surgery?

Most shoulder injuries can be managed by conservative rehabilitation. But in some rare cases, surgery is required if conservative treatment fails.

Complete tear of the rotator cuff tendons, recurrent dislocations and labral tears may benefit from surgery.

Diagnostic imaging may be done such as X Rays, CT scan, or MRI to rule out fractures and ligament injuries.

Arthroscopy may show soft tissue injuries that are not apparent during the assessment.

Your doctor will coordinate with your physiotherapist if they determine that your condition can be treated conservatively.

What is the recovery time / prognosis for shoulder pain?

Recovery depends on the cause and severity of the underlying condition that is causing your shoulder pain.

Shoulder impingement and rotator cuff injuries can take about three to six months to heal completely. At the same time, other severe cases can take up to a year, such as frozen shoulder or biceps tendonitis.

Patients can speed up their recovery and improve overall function through physiotherapy.The key to your complete recovery is your consistency and compliance with your physiotherapy program.

Important factors in your recovery post-treatment:

• Sticking to the program given to you by your physiotherapist

• Listening to your body and taking it easy when necessary

• Resuming painful activities only when ready.

Other factors that may influence your recovery time:

1. The severity of injury - Minor injuries can heal incredibly quickly, more severe injuries require time and patience.

2. Age - The younger we are, the quicker our body will heal generally.

3. General health - A healthy inside will be reflected when you are injured. The better your general health, the quicker you will recover.

How can shoulder pain be prevented?

Guaranteeing prevention can be impossible, however, you can decrease the risk of shoulder pain through the use of some of these techniques:

• Ice for cooldown - Athletes use ice to cool down their muscles and prevent inflammation and swelling of their joints. You can apply a cold compress on your shoulder joint after intense activities or sports. Apply it for 15 to 20 mins to achieve maximum benefits.

• Stretching - Proper stretching of the shoulder muscles is essential in maintaining your flexibility. Flexible muscles are less likely to be torn or injured.

• Warm-up - Always warm up before engaging in high impact activities. Engage your shoulder muscles, especially the rotator cuff. Do a few repetitions of low impact exercise that would engage your shoulder muscles.

• Phase your activities - Most shoulder injuries are the result of overuse of the shoulder muscles and tendons. This is essentially an imbalance between activity and rest. Be sure to allocate proper rest time when you are doing sports or working.

Outlook and the main takeaways

The main message to take away from this article is that there are many types, causes and severities of shoulder pain. The most important thing you can do is listen to your body (you are receiving these pain signals for a reason). Book a time, and have your shoulder pain diagnosed by a physiotherapist today.

Anatomy of the shoulder

The shoulder joint is one of the most complex joints in your body. It is formed by the upper arm (humerus) and the shoulder blade (scapula). It is categorised as a ball and socket joint since it allows a wide range of movement for your arms.

Key structures of the shoulder joint:

• Rotator Cuff Muscles - is a group of muscles around the shoulder blades that primarily acts to stabilise the shoulder and allow movements of the arms.

1. Supraspinatus

2. Infraspinatus

3. Subscapularis

4. Teres Minor

• Bursa - is a small fluid-filled sac that acts as a cushion and protects the tendons around the shoulder, especially the rotator cuff muscles.

• Labrum - labrum is a rim of cartilage that reinforces the ball and socket joint of the shoulder.