If you follow Philadelphia sports closely, you’ll know that shoulder injuries frequently impact our favorite teams.
In June, Spencer Turnbull of the Phillies exited the Detroit series early with right shoulder soreness. C.J. Gardner-Johnson of the Eagles had a respectable first-season game in Brazil, but in August, he was dealing with his own shoulder injury. In a late March game against the Kings, the 76er’s Kelly Oubre Jr. was out with left shoulder soreness. And the Flyer’s Jamie Drysdale was out for portions of last season due to shoulder problems.
For the rest of us, according to population surveys, shoulder pain affects 18-26% of adults at any point in time. That makes it one of the most common sources of musculoskeletal pain.
The shoulder is unique in both its structure and function. Injuries can occur from an acute event or wear and tear over time. We’ll examine shoulder pain and what you need to know if it becomes an issue for you.
Shoulder Anatomy
The shoulder has the widest range of motion of all the joints in the body. It is comprised of a combination of bones and joints that enables it to accomplish this flexibility. Understanding this anatomy at a basic level is key before we discuss potential sources of pain.
The shoulder is made up of three bones:
- The upper arm bone, medically known as the humerus.
- The shoulder blade, medically known as the scapula.
- The collarbone, medically known as the clavicle.
These three bones form four joints:
- The ball-shaped upper end of the arm bone fits into the socket of the shoulder blade to form the glenohumeral joint. This is a ball-and-socket joint.
- The collarbone connects at the top of the chest to the breastbone (“sternum”) with the sternoclavicular joint.
- The upper rear tip of the shoulder blade (known as the “acromion”) connects with the collarbone with the AC joint (“acromioclavicular joint”).
- Where the shoulder blade glides across the rib cage in the back of the shoulder is the scapulothoracic joint.
These joints depend on soft tissue structures – such as muscles, tendons, ligaments, fibrous membranes, and cartilage – to keep the joints in place.
The “rotator cuff” is a group of muscles and tendons surrounding the shoulder joint (glenohumeral joint). It keeps the head of the upper arm bone firmly within the shoulder’s shallow socket.
Potential Sources of Shoulder Pain
Shoulder pain can arise from issues:
- inside the joints,
- in soft tissue structures that support joints such as muscles or tendons, or
- from problems unrelated to the shoulder, such as spine problems or heart conditions (known as “referred pain”).
Referred Pain
When shoulder pain originates from sources outside the shoulder, it is called referred pain. Why does this happen? Because the shoulder structure shares the same densely packed nerve pathways as other body parts.
When an injury or issue occurs in other parts of your body, your nerves don’t always tell your brain the correct location of your problem. When shoulder pain is referred, it often originates in the neck. This is one of the things that your medical professionals will consider as they work to distinguish the pain’s origin.
Common Conditions Within the Shoulder
Common conditions within the shoulder’s anatomy that may cause pain include rotator cuff injuries, shoulder impingement syndrome, bursitis of the shoulder, frozen shoulder, and arthritis.
Rotator Cuff Injuries
The rotator cuff surrounds the shoulder joint, the most flexible joint in the body. It enables arm movement and stability.
Common rotator cuff injuries include overuse syndrome, rotator cuff tears, shoulder sprains, and swimmer’s shoulder. Rotator cuff pain may feel like a dull, deep ache in your shoulder, sharp and stabbing pain, and arm weakness.
Shoulder Impingement Syndrome
Shoulder impingement syndrome may cause shoulder pain when a rotator cuff tendon rubs on nearby bone and tissue. It can result in weakness, loss of movement, and pain in the shoulder, arm, or near the top of the arm.
Bursitis of the Shoulder
Bursae are fluid-filled sacs that act as cushions to reduce friction between bones and soft tissues. They are found in all the joints around the shoulder.
Shoulder bursitis occurs when excess fluid builds up from inflammation in a bursa, the cushioning pad between bones and tissue in joints. Many people with shoulder bursitis also have shoulder tendinitis. The conditions cause pain and can affect arm mobility.
Frozen Shoulder
Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the glenohumeral ball-and-socket joint of the shoulder. Symptoms typically begin slowly and worsen as the shoulder becomes frozen with limited movement.
Arthritis
The most frequently occurring types of shoulder arthritis are osteoarthritis, inflammatory arthritis, osteonecrosis, and post-traumatic arthritis.
- Osteoarthritis: Wear and tear arthritis that occurs as some combination of use, genetics, microtrauma, and increased forces across the joint
- Inflammatory arthritis: Caused by multiple factors often related to the immune system, which leads to inflammation of the joint and joint lining and ultimately wearing away the cartilage surfaces.
- Osteonecrosis: This unusual condition, also known as avascular necrosis, occurs when the blood supply to a shoulder bone is interrupted. It can lead to death and the collapse of a segment of the bone.
- Post-traumatic arthritis: This can result from a fracture or damage to the typically smooth surface of the joint’s cartilage surface. Eventually, the damage may cause the cartilage to wear out and disappear.
When Should You See a Doctor for Shoulder Sprains, Strains, and Pain
Shoulder discomfort is normal, particularly with older individuals, due to arthritis and normal wear and tear from overuse. It can also affect younger people who participate in sports involving overhead movements, especially swimming, tennis, pickleball, and baseball. Temporary rest and over-the-counter pain relievers can provide some relief.
However, shoulder discomfort can lead to more serious issues if it persists and is left untreated. Severe shoulder injuries, such as fractures or dislocations, require immediate attention. If you experience ongoing shoulder pain, hear a pop, or feel a tearing sensation that makes it impossible to lift your arm, make an appointment to see a musculoskeletal specialist.
Diagnosis
To diagnose your shoulder condition, your doctor will conduct a thorough physical exam and review your medical history. They’ll evaluate your shoulder’s range of motion and strength and assess your level of discomfort while you move. They’ll look to identify where you feel pain and whether it is consistent, intermittent, or worsens during movement.
They’ll also ask about any prior injuries you may have had to your shoulder and any incident that may have occurred, such as a fall, which led to shoulder pain. You may also be asked how you use your arms during work or athletic activities that may stress your shoulder’s soft tissues.
Your doctor may also use X-rays, ultrasound, or an MRI scan to provide a clear view of your shoulder’s condition.
Remedies and Treatments for Shoulder Pain
If your shoulder pain isn’t severe, there are several options for self-care:
- Cold therapy: A cold compress can be an effective way to manage shoulder pain. Ice packs can help reduce inflammation, restrict blood flow, and arrest further damage to muscles and ligaments.
- Heat therapy: Heat therapy becomes appropriate after an injury stops increasing from cold treatment and begins to heal. Health therapy promotes the smooth flow of blood and oxygen, which helps heal cells in the injured area.
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling in the shoulder and assist the healing process. These painkillers and muscle relaxants can help in reducing inflammation and promote recovery. However, even though they are often over-the-counter, you should consult medical guidance before using them to ensure no significant side effects.
- Physical Therapy: Physical Therapy, which involves working with a physical therapist and guided exercise, can help you improve mobility in your shoulder joints. The goals of this therapy include building strength, improving flexibility, and gradually working toward alleviating the pain.
- Stretching and Strengthening Exercises: Stretching and strengthening exercises, done correctly, can be effective methods to alleviate shoulder pain. By increasing the flexibility and strength of the muscles, tendons, and ligaments surrounding the shoulder joint, you can reduce pressure on the joint. This, in turn, will help reduce inflammation, relieving pain.
Nonsurgical Treatment
Recent clinical studies have examined various treatment options for shoulder pain issues to determine the most effective. In many cases, these studies found that the first line of therapy should be to inject a steroid into the shoulder joint to reduce inflammation.
After diagnosis, your doctor will determine if a corticosteroid injection for shoulder pain is appropriate for your case.
Platelet-rich plasma (PRP) is another alternative that can help patients with partial thickness rotator cuff injuries, some labrum tears, arthritis, and bursitis in the shoulder.
PRP uses a high concentration of platelets and growth factors taken from a patient’s own blood. These platelets can decrease inflammation and, subsequently, pain, as well as heal and repair damaged areas within the shoulder. However, this treatment is not yet covered by most insurance plans.
Referral to an Orthopedist
If you see a physiatrist (a physical medicine and rehabilitation doctor) for treatment, they may determine that nonsurgical treatment options for a patient’s condition have been exhausted. In that case, they often refer the patient to an orthopedic surgeon to consider more aggressive treatment options.