Shoulder Pain

If you’re suffering from shoulder pain, there are ways to find relief. We discuss some of the most common causes of shoulder pain and the treatment approaches we use at Arizona Pain to help people manage pain in their shoulders.

What is shoulder pain?

Your shoulder is a ball and socket type of joint. The shoulder performs several different types of movements and plays a role in lifting weight. Because it’s capable of a wide range of motion and assists in so many of our daily activities, it’s uniquely susceptible to injury. Unfortunately, shoulder pain is very common. Most people experience this type of pain at some point in their lives.

Shoulder pain is discomfort involving the musculoskeletal tissues, nerves, or blood vessels in your shoulder area. This region includes the clavicle, upper humerus, and scapula. You’ll feel pain in your shoulders, but you’ll also likely feel accompanying pain in your upper back and neck.

Shoulder pain may be acute or chronic. Acute pain is the type of short-lived pain that usually follows an injury.

Chronic pain is pain that lasts for three months or more. You may experience chronic shoulder pain as an aching feeling or a sharp pain. It may also be accompanied by weakness or limited range of motion in more severe cases. For many, their pain will become worse when they move their shoulder or use it to lift weight.

As we’ll discuss, the most important thing is to diagnose the cause of your shoulder pain from the beginning. You’ll find the best relief only after you’ve identified the underlying cause of your pain.

What causes shoulder pain? 

The major shoulder pain causes include:

  • Arthritis
  • Overuse or injuries to your muscles, tendons, or ligaments
  • Bone fracture
  • Joint dislocation
  • Pinched nerve
  • Frozen shoulder

Less common causes of shoulder pain include:

  • Heart attack
  • Tumor
  • Infection

Overuse injuries 

Shoulder pain is a sign of damage to the local tissues or referred pain involving another area of the body. Overuse injury can affect the muscles, tendons, or ligaments of your shoulder. This can cause inflammation and pain.

One common injury is a torn rotator cuff. This injury involves the muscles and tendons that keep the humerus (arm bone) in your shoulder joint. Rotator cuff injuries may occur from the repetitive use of your arm, lifting excessive weight, or falling. A torn rotator cuff can be an acute injury or one that occurs from weakening of the tissues over time.

Shoulder injuries 

Fractured bones or dislocated joints can also cause shoulder pain, as in the case of broken collarbone or a broken arm. The collarbone (clavicle) attaches the sternum to the scapula (shoulder blade) and is a common site of injury in children and teenagers.

These types of injuries may occur from:

  • Falling
  • Physical trauma from a car accident
  • Sports injuries
  • Pulling and twisting of the arm
  • Abuse
  • Trauma

Arthritis

A type of arthritis–osteoarthritis–occurs from years of physical activity and wear and tear to the shoulder joint. This condition is marked by breakdown of cartilage in the joint, resulting in swelling, pain, and stiffness.

Rheumatoid arthritis is an autoimmune condition of chronic joint inflammation that can lead to pain.

Frozen shoulder 

Frozen shoulder (adhesive capsulitis) is a painful condition marked by stiffness and limited motion in the shoulder joint. The connective tissue surrounding the shoulder joint thickens, leading to restricted shoulder movement.

This condition generally progresses gradually until the shoulder is completely unable to move. It’s unclear why some individuals suffer from frozen shoulder and others do not. Patients who have undergone a surgery or arm fracture that required long-term immobilization of the shoulder may be more at risk for this condition. Those with diabetes, heart disease, thyroid conditions, or Parkinson’s disease may also be at a higher risk for frozen shoulder.

Pinched nerve

A pinched nerve results from a nerve impingement by bone, muscle, cartilage, or tendon within your shoulder area. This pressure impairs nerve impulses, which can lead to sensations of pain, numbness, tingling, or weakness.

Weakened tissues or swelling in the joint because of arthritis, repetitive actions, or a sports injury may also be responsible for a pinched nerve in the shoulder.

Why do I have shoulder pain?

As noted, when you’re experiencing shoulder pain, your first step is to get a diagnosis. Your doctor will start with a physical assessment and will ask you questions about your medical history. Before your appointment, try to track your symptoms so you can tell your doctor about the onset, characteristics, and symptoms accompanying your pain.

Your doctor may also order imaging studies to assess the anatomy of your shoulder and any accompanying damage. Tests may include:

  • X-ray
  • Computed tomography (CT)
  • Ultrasound
  • Magnetic resonance imaging (MRI)

Each study is capable of imaging different tissues, with X-ray being good for bone imaging and MRI helpful in understanding nerve or blood vessel issues. Electrodiagnostic studies, such as electromyography (EMG) or nerve conduction velocity (NCV), may also be ordered, especially if you’re experiencing numbness and tingling.

Which shoulder pain treatments could help me? 

The type of shoulder pain you’re experiencing will determine your treatment. Most often, shoulder pain occurs after a minor injury to the muscles, tendons, or ligaments and resolves after a short time of rest. Ice and over-the-counter pain medications or anti-inflammatories may also help decrease swelling and pain.

However, patients who experience redness, swelling, discomfort to touch, or warmth at the site should talk to their doctor as soon as possible. If you experience any of the following symptoms along with your shoulder pain, get immediate medical attention:

  • Sudden and severe onset of swelling, redness, or warmth in the area
  • Excruciating pain
  • The joint looks deformed or cannot be moved
  • Chest tightness
  • Shortness of breath

Injury treatment 

Treating a fracture begins with immobilizing the joint in a sling or figure eight strap for the collarbone or cast for the arm. The bone usually takes up to six weeks for children and up to 12 weeks for adults to heal.

Ice and over-the-counter pain relievers may also control pain and swelling. For more severe breaks, you may need surgery. Implanted screws, plates, or rods can help maintain position of your bone while it heals.

Initial treatments 

The cause of your pain will dictate the treatment approach your doctor uses. For example, the goal of arthritis treatment is to relieve your pain and improve your overall range of motion in the joint. Physical therapy and strengthening exercises may be helpful. Ice or heating pads may also relieve your pain.

For frozen shoulder, your doctor will work to control your pain and preserve movement and range of motion. Over-the-counter pain relievers and anti-inflammatory drugs can help make you more comfortable. Physical therapy is often important for maintaining mobility of the shoulder. Note that in most cases, frozen shoulder resolves on its own without further intervention within 12 to 18 months.

A pinched nerve is usually remedied with rest, but may respond positively to physical therapy exercises. These aim to increase flexibility of the muscles in the area and relieve pressure on the nerve. Learning to perform repetitive motions in a safe, ergonomic way may also help with a pinched nerve. Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, may also help manage your pain.

Shoulder pain medications

If your pain and immobility do not respond to these initial treatments, other approaches are available. Medications that may help with different causes of shoulder pain include:

  • Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen, which decrease pain and inflammation, and can be taken orally or applied as a cream to the site
  • Analgesics, such as acetaminophen, which provide pain relief but do not relieve inflammation
  • Corticosteroids, a class of drugs that decrease inflammation and have a suppressive effect on the immune system
  • Counterirritants, creams containing menthol or capsaicin, which inhibits the transmission of pain signals
  • Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Trexall) and hydroxychloroquine (Plaquenil), which act to weaken the immune system’s effort on destroying joint tissue and causing inflammation

Interventional procedures 

If you’re suffering from severe or chronic shoulder pain that doesn’t respond to other interventions, you have options. Corticosteroid joint injections may decrease inflammation and nerve irritation in the area. Further, a shoulder manipulation procedure can help loosen tightened tissues in the shoulder. This procedure is done under general anesthesia so the patient is unconscious and does not sense pain.

For the most severe cases, surgery may be required to remove adhesions and scar tissue that impedes movement of your shoulder. The majority of people, though, do not need surgery. You should only consider this approach if other treatments have failed.

Most shoulder pain cases resolve through a comprehensive pain management approach. At Arizona Pain, we focus on treating you as a whole person, not just your pain. That means we consider complementary and non-invasive approaches first. For more chronic and severe cases, we’ll continue to use these complementary approaches to manage your symptoms and underlying causes of pain, while also exploring more interventional approaches. This may include joint injections, medication, or surgery.

References

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