Shoulder pain affects activities of daily living. The shoulder joint contains bones held in place by tendons, muscles, and ligaments. The tough cords (tendons) hold the shoulder muscles to the bones. Tendons also help the muscles move the shoulder. Ligaments are structures that hold the three shoulder bones (humerus, scapula, and clavicle) together to stabilize the shoulder joint.
What causes shoulder pain?
There are a number of causes for shoulder pain. These include:
Frozen shoulder – This painful condition reduces normal joint movement and sometimes prevents shoulder movement altogether.
Poor posture – Slumping forward can contribute to shoulder strain.
Rotator cuff disorders – The rotator cuff is a group of tendons and muscles surrounding the shoulder joint. These structures help keep the shoulder joint stable.
Shoulder instability – An unstable shoulder is often referred to as subluxation, and this causes hypermobility (unusually large range of motion).
Acromioclavicular joint disorders – Osteoarthritis affects the acromioclavicular joint, which is at the top area of the scapula (shoulder blade).
Fracture – A broken upper arm bone (humerus) or shoulder blade can contribute to shoulder pain.
Who gets shoulder pain?
Shoulder pain is common, affecting 3 out of 10 adult Americans at any time. Shoulder pain may be acute (short-term), or it can persist chronically (long-term). Frozen shoulder syndrome and rotator cuff disorders affect middle-aged and older adults, whereas fractures are more common among younger persons.
How common is shoulder pain?
Around 7.5 million people go to see a primary care provider for shoulder pain. In addition, 4 million of these visits are related to rotator cuff problems. Shoulder injuries are caused by repetitive activities, such as excessive overhead motion (swimming, pitching, tennis, weight-lifting). Shoulder pain is associated with around 33% of office visits to primary care physicians, according to a recent study, and men and persons age 52 and younger often present with shoulder pain related to a previous injury.
How are shoulder problems treated?
Shoulder problems are treated with rest, ice, and elevation at first. Compression (mild pressure) is used to reduce swelling and provide support. Other treatment options include:
Dislocation – This occurs when the ball at the top of the humerus in the upper arm jumps out of socket. This happens when the shoulder is pulled hard or twisted. Treatment includes wearing a sling, rest, ice, and physical therapy.
Separation – Shoulder separation occurs when ligaments are torn. Treatment involves wearing a sling, ice, physical therapy, and surgery (when tears are severe).
Rotator cuff disease – Treatment involves nonsteroidal anti-inflammatory medications, ice, rest, and physical therapy. Corticosteroid injections are used when the pain does not improve. Surgery is done for severe tears.
Frozen shoulder syndrome – With chronic pain, rheumatic disease, and other problems, the bands of tissue in the joint restrict motion. Lack of fluid contributes to loss of motion. Treatment include heat therapy, pain medicines, anti-inflammatory agents, electrical stimulation, cortisone injections, and surgery when other treatments are not effective.
Fracture – Pain medicines are given initially, and the arm is placed in a sling. The bones may need to be realigned or “set”. After the bones heal, the physical therapist works with the patient to learn strengthening exercises. Surgery may be required if the fracture is severe.
Shoulder arthritis – Nonsteroidal anti-inflammatory drugs (NSAIDs) are given for pain short-term. Depending on the severity of the condition, injections of corticosteroids are given.
Wofford JL, Mansfield RJ, & Watkins RS (2005). Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey. BMC Musculoskeletal Disorders, 6(4).
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