Shoulder and elbow pain are some of the most common aches and pains people experience. Since the shoulder and elbow joints are some of the most frequently used in your body, pain and injury in these joints can happen more often and can significantly impact your daily life. However, many people aren’t sure when it’s time to see a doctor or even what type of doctor to see when experiencing shoulder discomfort. Let’s take a look at common causes for shoulder pain and treatment options to help you find relief!
WHAT IS SHOULDER PAIN
What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing your pup a tennis ball.
Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. Pain can range from mild to severe and can come on suddenly or build up over time. The pain may be temporary or it may continue and require medical diagnosis and treatment.
CAUSES OF SHOULDER PAIN
Considering your shoulder joint’s complex anatomy, there are many potential shoulder pain causes—from muscle tears and tendonitis to osteoarthritis.
The location of your shoulder pain can help your physician zero in on which part of the joint is affected. Most shoulder problems are due to the following conditions:
- Dislocated or separated shoulder
- Frozen shoulder
Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.
Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis or impingement syndrome.
Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.
Depending on the type of shoulder bursitis, treatment may include activity modification, immobilization with a splint, icing, injections, aspiration of the bursa (removing fluid with a syringe), and antibiotics or anti-inflammatory pain medication. Surgery is rarely needed to treat bursitis.
A tendon is a cord that connects muscle to bone. Most tendinitis is a result of inflammation in the tendon. Generally, tendinitis is one of two types:
- ACUTE: Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
- CHRONIC: Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.
Treatment goals for shoulder tendinitis include reduction in pain and inflammation, as well as preserving mobility and preventing disability and recurrence. Treatments may include a combination of rest, wrapping, and use of ice packs for recent or severe injuries. Aspirin and ibuprofen are used to reduce swelling. Physical therapy, which includes range of motion exercises, is also part of the treatment plan. If pain is constant and severe enough, a cortisone injection can also be given into the shoulder to relieve symptoms.
Surgery is considered if the rotator cuff or biceps tendon has been partially or completely torn and the symptoms do not improve with other treatments. Surgery repairs the damaged tendon or tendons and removes inflamed bursae that may also be irritating the shoulder.
Shoulder pain can also result from arthritis. Shoulder arthritis is damage to the cartilage inside the shoulder joint. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Symptoms such as swelling, pain, and stiffness, typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time. Osteoarthritis, may be related to sports or work injuries or chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining.
Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion. The initial treatment for shoulder arthritis often starts with range-of-motion exercises to keep the shoulder mobile. If your range of motion is not affected, then the goal is to prevent it from deteriorating. Loss of motion in the shoulder joint due to arthritis is often gradual and can be hard to notice. As the joint gets stiffer, the pain and the ability to be active may also worsen. It’s recommended to stretch for two to three minutes every day, whether you have a loss of motion or not.
Frozen shoulder, also referred to as “adhesive capsulitis”, is a painful condition that limits movement of the shoulder. The condition happens when the connective tissues surrounding the shoulder joint capsule become thick, tight, and inflamed, holding the joint in place.
Adults between the ages of 40 and 60 years old are most likely to suffer from frozen shoulder, with women having a higher risk. One of the most common causes of frozen shoulder is general immobility, often following injury or surgery.
Frozen shoulder occurs gradually, in three stages which can each last several months:
- Freezing stage: The shoulder become stiff and is painful to move. Pain may worsen at night. This stage lasts approximately 6 weeks to 9 months.
- Frozen stage: Pain may begin to subside, although the shoulder remains stiff, making it difficult to accomplish everyday tasks. This stage lasts 2 to 6 months.
- Thawing (recovery) stage: Pain continues to lessen and shoulder mobility begins to improve. Return to normal strength and movement may take 6 months to 2 years.
There are several treatments available for frozen shoulder. Treatment options include non-steroidal anti-inflammatory medications, gentle stretching, and physical therapy. A stretching or physical therapy routine will slowly loosen and strengthen the joint, improving overall mobility and reducing pain. For those with moderate symptoms, your doctor may administer a corticosteroid injection to provide temporary relief from symptoms. Surgery may be recommended for persistent or severe cases of frozen shoulder – most often during the “frozen stage”.
Dislocated or Separated Shoulder
A dislocated shoulder occurs when a fall, sports injury, or blow to the shoulder causes the upper arm bone to pop out of the cup-shaped socket that’s part of your shoulder blade. Because your shoulder is the most mobile joint in your body, dislocations can be common. But, despite their frequency, they are still a serious injury that requires prompt medical attention. That’s because once it’s dislocated, your shoulder joint may be unstable and prone to repeat injury.
While any injury to your shoulder may produce pain and discomfort, your shoulder being dislocated will be more intense. In some cases, a dislocated shoulder can cause numbness, weakness, or tingling near the injury — such as in the neck or arm. Your shoulder muscle may spasm and increase the intensity of your pain. The most common signs and symptoms of a dislocated shoulder include:
- A visibly deformed or out-of-place shoulder
- Swelling or bruising
- Intense pain
- Inability to move the joint
If you suspect your shoulder is dislocated, it’s important that you minimize shoulder movement as much as possible. Use a splint or sling on the shoulder joint in its current position and ice your shoulder while seeking and waiting for medical attention. It’s important that you seek immediate medical treatment so that you can get your shoulder put back into place before the muscles start healing.
On the other hand, a separated shoulder is when the ligaments between the collarbone and shoulder blade are torn. The shoulder blade (scapula) moves downward due to the weight of the arm, causing a bump above the shoulder. Shoulder separations can be caused by direct falls onto the shoulder, car accidents and sports injuries.
On the surface, symptoms of a separated shoulder appear similar to dislocation. However, dislocation is typically accompanied by severe or intense pain, while a separated shoulder tends to produce uncomfortable, yet milder pain at the very top of the shoulder.
- Tenderness in the shoulder and collarbone
- Swelling or bruising
- Arm weakness
- Limited shoulder movement
Nonsurgical treatments, such as a sling, cold packs, and medications can effectively help manage the pain in almost all patients. Rarely, a doctor may use more complicated supports to help lessen AC joint motion and pain. Most people with this injury return to normal function with nonsurgical treatments, even if there is a persistent, significant deformity/bump.
GETTING HELP FOR SHOULDER PAIN
Orthopedic doctors are specialists who treat shoulder elbow pain. An orthopedic specialist can examine your shoulder and order imaging studies like X-rays, MRIs, or ultrasounds. He or she will identify what kind of pain you are experiencing, as well as what treatments will help.
Our shoulder specialists at Raleigh Orthopaedic are fellowship-trained surgeons, and are experts on conditions of the shoulder. Our physicians offer surgical and non-surgical treatments to get you back to your normal activities!
Schedule an appointment at Raleigh Orthopaedic
The Raleigh Orthopedic physicians provide comprehensive and specialized care for a wide variety of shoulder conditions using the latest techniques. Our shoulder specialists are dedicated to achieving quality outcomes, and have many services available on-site to ensure that patients receive the most appropriate care for their orthopedic shoulder conditions. We also offer urgent care hours without an appointment for acute orthopaedic concerns.