The shoulder joint is a ball and socket joint which allows us to move our arm easily in all directions. The shoulder is held together and stabilized by small internal ligaments, a capsule, and the muscles that overlay these internal structures, namely the rotator cuff.
Shoulder joint is the most common joint to become affected with pain and discomfort for many people, as it is a joint that is used dynamically in our everyday lives.
Due to the crucial role the shoulder plays in our daily tasks, the presence of pain can be very hindering in an individual’s life.
How Does the Shoulder Work?
The shoulder joint (also known as the glenohumeral joint) is composed of 3 important bones: the humerus, the scapula and the clavicle.
We obtain our full range of motion in the shoulder when these 3 bones work together harmoniously and synchronously. The fragile nature of the connection of these bones heavily relies on the surrounding ligaments, capsules and muscles to create stability and control.
If there is an issue in the joint biomechanics or an issue with any of the soft tissue structures that control shoulder mobility, we may notice pain, achiness, stiffness or even reduced mobility and flexibility in the glenohumeral joint.
What Exactly is Shoulder Pain?
Shoulder pain is a generalized term often used by patients to describe a hindrance to function with regards to the shoulder.
This dysfunction can be a feeling of stiffness, reduced mobility and flexibility, dull ache or sharp shooting pain at rest or with movement as well as a feeling of weakness, numbness and tingling locally or radiating down the arm.
Common Causes of Shoulder Pain
Shoulder pain is a common problem that can be caused by a variety of factors. Some of the most common causes of shoulder pain include:
Rotator Cuff Tear/Injury
These injuries can be chronic and acute and can affect all age groups to varying degrees.
High risk factors for rotator cuff injuries are repetitive overuse such as overhead work, age related degeneration or trauma.
A rotator cuff tear is an injury to your rotator cuff that can cause shoulder pain and the inability to use your arm.
Your rotator cuff is a group of muscles and tendons in your shoulder. They help you lift and move your arms away from your body.
Interestingly, smoking is also associated with higher incidence of rotator cuff tears.
Arthritis or Inflammation of the Joint
Degenerative arthritis refers to “wear and tear” of the joint. It is associated with age and can result in extra bone growth or narrowing of joint spaces that affect mobility at that joint and can be accompanied by pain and stiffness.
There are also other types of arthritis that are related to immune dysfunction such as rheumatoid or psoriatic arthritis. Although arthritis has no cure, there are strategies to assist in reduction of pain and conservative management of the condition.
Frozen Shoulder or Adhesive Capsulitis
Frozen shoulder refers to a condition where the shoulder loses its natural range of motion and becomes increasingly “stuck” for a period of time ranging from a few months to over a year.
Adhesive Capsulitis is not fully understood however, we know there are 3 stages associated with this diagnosis and they include the freezing stage, frozen stage and the thawing phase also known as stage 1-3.
The condition presents initially with pain and discomfort that increasingly worsens accompanied by stiffness and loss of mobility in the affected joint.
This condition most commonly affects females over 40 and is more prevalent in those with previous shoulder pain, stiffness, trauma or past shoulder surgery.
Dislocations of the shoulder can occur either at the glenohumeral joint (GHJ) or at the acromioclavicular joint (ACJ).
GHJ dislocations are often associated with trauma, rotator cuff tear or a ligament tear. Symptoms are swelling, weakness and numbness.
ACJ dislocations are associated with trauma or heavy lifting over a period of time. There are 6 types of AC joint dislocations that range in severity and warrant a different clinical approach.
For those patients with a type III dislocation and higher, surgical consultation and management may be indicated. It is best to have this condition assessed by your practitioners and collaborate with your medical doctors for best treatment outcomes.
Because the shoulder joint is a mobile joint, it is stabilized by many ligaments and tendons that surround the joint.
These structures have to work together in a synchronous pattern to allow for the pain free movement of the shoulder.
Repetitive overuse, heavy lifting and overhead work can strain tendons and result in tendon inflammation also known as tendinitis.
Shoulder injuries are certainly more common in racquet sports such as Tennis, Badminton and Lacrosse but also in Volleyball players that play overhead majority of the time.
Sports related injuries are often acute and most commonly involve tendinitis of the rotator cuff.
A common impingement condition of the shoulder is called subacromial impingement and results when there is a narrowing space between the coracoacromial arch and the humeral tuberosity that causes compression of the soft tissues of the shoulder.
Shoulder impingement occurs when the top outer edge of your shoulder blade, called the acromion, rubs against (“impinges on”) or pinches your rotator cuff beneath it, causing pain and irritation.
This compression can result in pain when the arm is elevated and is common in workers with heavy overhead work such as electricians.
The condition often results in sharp pain when trying to elevate the shoulders forward or sideways and results in inability to fully raise the arms overhead.
Bursa are fluid filled sacs around the shoulder joint. There are 3 types of bursitis including:
Chronic bursitis: Chronic bursitis results from sustained pressure and irritation of a bursal sacs.
Infected bursitis and Traumatic bursitis: Traumatic bursitis results from sudden trauma or a fall of the shoulder irritating the bursa.
In certain cases, if the bursa becomes infected with bacteria, it is known as infected bursitis.
The symptoms of bursitis vary with type and intensity, however, generally they include swelling, excessive warmth at the site accompanied by tenderness and pain/fever. In the shoulder, the bursa often becomes inflamed but not swollen.
Spinal conditions can range from mild to severe and can involve nerves to varying degrees.
Proper movement of the joints are fundamental to ensuring optimal alignment and function throughout the whole body.
In chronic shoulder injuries, spinal restrictions are common, scapular mobility is affected which also affects our neck and mid back regions in terms of stiffness and pain.
Symptoms of Shoulder Pain
Symptoms can vary person to person when it comes to shoulder pain. This is because shoulder pain can have varying causes and underlying dysfunction.
Each diagnosis can present with varying symptoms. Therefore, it is important to note that not all shoulder pains are the same and effective treatment of shoulder pain requires a thorough assessment and examination.
Common signs and symptoms of shoulder joint problem that may result in shoulder pain are:
Inflammation and Swelling
Sensation of Stiffness
Altered Body Alignment
Local or Spreading Numbness and Pins and Needles
These symptoms usually mean different things to help practitioners understand the underlying cause of what is going on.
Let’s talk about a few of them.
Swelling and Inflammation
Presence of swelling and inflammation suggests an acute condition. This may be due to trauma, a fall or sudden impact.
Conditions such as acute tendinitis or bursitis may present with swelling and inflammation at the site.
Presence of Pain
Pain is certainly an indicator that the shoulder joint requires attention. Pain can be dull and achy but it can also be sharp and shooting in quality.
Furthermore, pain can be at rest or only with movement.
Answers to these questions are important in order to allow your practitioner to evaluate the shoulder and arrive at a diagnosis for your shoulder pain.
Often people may start to notice their shoulder mobility has become affected. For example, they can not reach as high or as wide as they used to in the past.
Reduced mobility is a strong indicator of shoulder dysfunction and when left alone, it may further reduce in range over time. Reduced mobility may or may not present with pain.
Feeling of Tightness
Feeling of tightness or stiffness is commonly described by patients in the shoulder joint.
This condition often presents itself alongside neck pain and upper back pain, and is common in those who have desk jobs or those who have to work overhead for prolonged periods of time.
Tightness often relates to muscular tension and can be quickly resolved with proper active release technique, stretching and massage therapy.
When people start to experience reduced shoulder mobility, they tend to compensate by bending their torso or rotating more through their ribs or sticking their neck out to try to get the shoulder to move more.
However, this is an excellent example of compensatory actions that create poor movement patterns in the long term. Poor posture is one symptom of chronic shoulder dysfunction.
Numbness and Tingling Locally or Radiating
One symptom of shoulder pain and discomfort may also be presence of numbness and tingling experienced at the shoulder joint or radiation of it down the arm.
It is important that the source of the numbness and tingling is determined as it may originate from the neck or the scapular region.
A trained practitioner will be able to deduce the source and provide you with appropriate treatment strategy and stretches to help with the numbness and tingling.
Shoulder Pain Diagnosis Methods
The cause of the shoulder pain can be diagnosed through a thorough interview with the patient, understanding what led to the pain in the first place as well as orthopedic testing done by the practitioner in the office.
In cases of more complicated shoulder pain or those that do not respond favorably to a period of treatment, imaging modalities can be used to assist in finding the cause of the shoulder pain.
Common imaging modalities used are: Xray, CT scan, Ultrasound and MRI.
The imaging modality that will be used will depend on individual shoulder pain presentation and symptom as well as chronicity and onset.
If the practitioner suspects fractures, Xrays are typically ordered first, followed by CT scans if needed.
Ultrasounds and MRI are great for diagnosing soft tissue injuries such as rotator cuff partial or full tears. Ultrasound is more cost effective and faster, however it does not give us as many answers as an MRI would.
In summary, below are the most common methods of shoulder pain diagnosis used by chiropractors, physiotherapists, surgeons, and other practitioners:
Medical History and Physical Examination
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT) Scan
Best Treatment Options for Shoulder Pain
Shoulder pain or dysfunction is a sign that some aspect of your shoulder joint is not performing optimally.
It is critical that we address the shoulder joint dysfunction in its early stages. In most cases, the earlier treatment approaches can prevent worsening or even fully resolve the pain.
Oftentimes with any body parts such as the shoulder joint, leaving it untreated results in more stiffness, pain and loss of range of motion.
Effective approaches known for shoulder pain treatment include:
Treatments like physiotherapy, chiropractic care and massage therapy are all fantastic options for treating shoulder pain.
These treatments are all categorized under manual therapy techniques used as alternative treatment approach for various health conditions.
Chiropractors can assess your shoulder joint biomechanics as well as spinal mobility to ensure all three bones of the shoulder are working together coherently.
Furthermore, chiropractors and physiotherapists, in conjunction with massage therapists, can prescribe appropriate and specific exercises to assist in your home care and ensure your muscles are also being well taken care of.
More persistent shoulder pain from trauma or impact may require injections to help reduce inflammation and to facilitate the healing process such as in bursitis.
Injections are typically recommended after conservative therapy approaches are exhausted.
Surgery is often reserved for conditions of the shoulder that are full tear or fractures.
Choosing surgery as the treatment is not recommended for frozen shoulder or tendinitis conditions.
How Can I Prevent Shoulder Pain?
The shoulder joint is an extremely mobile joint which can come at a cost for stability.
Occupations such as having a desk job, working with shoulders elevated or arms overhead for prolonged periods of time can cause shoulders to become sore and painful.
Addressing shoulder pain in its early stages is important to ensure a quicker recovery and healing process.
Imaging can be used to gain more precise data for the structures affected in the shoulder joint.
Conservative therapy has been consistently shown to have great benefits for treating the majority of shoulder pain conditions.
Don’t ignore early signs of shoulder stiffness or lack of mobility and book your appointment with a qualified practitioners today.