Shoulder Pain 101 (What causes it & how to treat it)
What is shoulder pain?
You feel shoulder pain most often when the tissue around the shoulder (joints, muscles, nerves, etc) is under threat of damage. The most common cause is strain of the muscles & tendons in the area. This can happen suddenly or over a long period of time. However, pain is a symptom and may be disproportionate to any actual shoulder damage, or even unrelated to the shoulder at all (e.g. referred pain). You can experience it on one or both shoulders in the front, side, or back. Shoulder pain can also extend into the neck and/or arms/s (especially if a nerve is being irritated). It is very rarely an emergency but seek help immediately if you have a fever, a red and swollen joint, arm/hand weakness, and/or difficulty breathing.
Why does it happen?
The most common causes of shoulder pain fall into the categories of:
Muscle & tendon disorders – overload to the muscles or tendons (aka active stabilisers) can cause breakdown and/or inflammation e.g. rotator cuff strains or tears, tendinosis, bursitis, impingement.
Instability – loose joints (aka ligamentous laxity) due to trauma/genetics creates instability and pain.
Arthritis – gradual changes in the bone and cartilage in the AC joint (aka acromioclavicular) and/or shoulder ball & socket joint (aka glenohumeral joint) impede movement and cause pain.
Fracture – traumatic injury most frequently affects the clavicle, AC joint. and the ball of your upper arm bone (aka humeral head).
Frozen Shoulder (aka Adhesive Capsulitis) – unknown factors cause pain followed by significant loss of movement due to thickening of surrounding ligaments
You can also experience shoulder pain due to issues in the bicep tendon, neck, top of ribcage (aka thoracic outlet), or fibromyalgia, and is also rarely caused by infection, nerve injury (brachial plexus, supraspinatus nerve), or tumour.
What causes my shoulder pain?
Age – older patients are more likely to develop rotator cuff tears, arthritis, and frozen shoulder.
Trauma – can cause instability or muscle tears.
Diabetes/thyroid disease – associated with frozen shoulder.
Occupation (particularly requiring overhead activity) – can lead to rotator cuff issues.
Sports (particularly overhead or collision sports) – associated with instability and/or arthritis.
How do I find out what the problem is?
Though I respect the power of self-education and the internet, your best bet is to consult a professional. The most appropriate are probably chiropractors and physiotherapists, but biokineticists, occupational therapists, and general practitioners are also trained to assess you. Assessment will likely involve an interview (Q&A) and examination.
When do I need more testing?
Acute and uncomplicated shoulder pain does not usually need further testing. If the pain has lasted longer than six months then X-rays may aid diagnosis of arthritis, fractures, or large rotator cuff tears. If the diagnosis is unclear further testing may be necessary, which could include:
MRI is useful for rotator cuff disorders
CT is good for bone disorders
MRA is the gold standard for labral (“capsule”) pathology
Diagnostic ultrasound is also useful for rotator cuff pathology (when done by an experienced technician) and significantly cheaper than MRI.
How do I treat my shoulder pain?
Your treatment depends on your pattern of symptoms as well as your particular causes. That usually includes a combination of:
activity modification,
active treatments (stretching, mobilising, and strengthening),
manual therapy (muscle massage, joint mobilisation/manipulation),
symptom relief (heat/cold, gels/patches, dry needling, medication, etc)
learn more about your condition and get treatment for any other physical and/or mental health issues.
More chronic cases may need an interdisciplinary approach (multiple practitioners e.g. chiro/physio, pharmacist, specialist, psychologist). This allows us to manage all aspects of your condition simultaneously. This seems to produce better and faster results than trying one, then another, then another, etc.
What happens if I don’t treat my shoulder pain?
The pain (and cause/s) may go away on its own with time and without any intervention. Your body is programmed to heal and adapt. But if you don’t/can’t remove the cause, it has a moderate to high chance of happening again. The more severe the pain, the more it affects your life, and the longer it goes on, the less likely it is to “fix itself”. In some, it can become steadily worse and eventually disabling. Chronic or recurrent pain can worsen mental health and reduce activity levels which are associated with an increased risk of metabolic diseases such as diabetes or heart disease.
Summary
Shoulder pain is a common area of pain especially in older and/or athletic populations
The most common cause is muscle/joint strain
It can be felt in one or both shoulders in the front, side, or back and can extend into the neck and/or arms/s (especially if a nerve is being irritated)
Seek help immediately if you have a fever, a red and swollen joint, arm/hand weakness, and/or difficulty breathing
Shoulder pain can have a negative effect on various other aspects of your health
Diagnosis is often based on an interview and examination, but only sometimes requires other tests such as x-rays, blood tests, or nerve conduction studies
Shoulder pain is manageable, and we recommend a comprehensive treatment plan – this may include physical therapy, medication, and lifestyle changes, and more chronic cases require more than one healthcare practitioner e.g. GP, physiotherapist, trainer, psychologist, rheumatologist, etc.
Only very specific types of shoulder pain may require surgical intervention
