Why Do We Get Shoulder Pain and How To Treat It

Shoulder pain can be a huge nuisance to everyday life. It can distract you from work and it won’t let you get a good night’s rest. Shoulder pain can be due to a physical injury or it could be a manifestation of a condition that has developed over time.

There are a number of causes of shoulder injuries that lead to pain. This includes muscle sprains and strains. It also includes fractures and dislocations. Discomfort in your shoulder can also be as a result of rotator cuff tears and labral tears. There are also two important conditions associated with shoulder pain and these are frozen shoulder and shoulder impingement syndrome.

Frozen Shoulder:

Frozen shoulder is a pathology caused when the joint capsule surrounding the bones and tendons becomes irritated. It is a two year process from the starting of the symptoms to resolving of the disease. It starts off with pain when there is movement in any direction. The inflammation then proceeds until the capsule scars or ‘freezes’ i.e. tightens up. This severely limits movement. The condition most of the time resolves by itself as the shoulder thaws out and one regains back lost movement.

Treatment:

The best option here is to let time runs its course since it is a mostly self-resolving condition. Physical therapy can also provide some relief but it is limited in its application as it does not have much benefit. Research has shown that early cortisol treatment can minimize and shorten the duration of the symptoms. This can be done either by oral steroids or injected corticosteroids.

Shoulder Impingement Syndrome:

Shoulder Impingement Syndrome is a condition where tendons of the rotator cuff muscles become impinged leading to pain, weakness and loss of movement. It is a form of tendonitis. It often occurs as a result of continuous intensive physical work involving repetitive throwing or overhead activity. It can also occur gradually over time, where a sudden course of physical activity may exacerbate it.

Treatment:

It is a two-step process:

• The first course of action is to treat of the inflammation. This can be done by a wide variety of methods such as using heat and/or cold to lessen the pain. The use of modalities such as electricity, lasers and DP ultrasound is also useful. Other times soft tissue massages can help reduce inflammation. Rest is also a vital tool.
• The second step is to find the cause of the impingement and treat it. Shoulder Impingement Syndrome occurs when the shoulder is out of normal position which leads to pinching of the tendons. This could be due to an overpowering muscle group leading to muscle imbalance or due to a part of the shoulder being too tight. Physical therapy is then used to tighten and strengthen the muscles.

Reoccurrence:

This condition is often not a one-time problem and can reoccur again, either in the same or different shoulder. This can be because the physical activity that was the initial cause was not ceased. This often occurs in the case of athletes who put repetitive strain on their shoulders over time while playing. It can also be due to non-compliance to exercises or other doctor mandated changes. Sometimes though, it’s just because treatment is not enough and they are genetically pre disposed to have these conditions. Smoking, diabetes and obesity are other predisposing factors.

Who is at greatest risk for these conditions?

Working in certain professions makes one more likely to develop shoulder injuries and inflammation. Athletes that are involved in a sport that requires overhead movement especially throwing such as in volleyball, basketball and football are at risk of developing shoulder impingement syndrome. They are also more vulnerable to rotator cuff injuries.

Handymen who do a lot work involving shoulder activity are also the at risk population. These include painters who paint ceilings, electricians who do overhead wiring and even factory workers that need to keep their arms extended at most times.

Prevention

The best way preventive measure is to catch the conditions as early as possible in its initial stages. If there is shoulder pain for more than a week and at home treatments such as heat/cold and stretching do not help, then it is time to pay a doctor a visit. If health insurance permits a physical therapist consultation, without approval from a primary care physician, then pay them a visit too.

Treatment Options:

1. Ice and/or Heat: Ice is to be used when the condition is in its acute stages and have lasted less than a week. It is used when there is discomfort following physical activity. Heat is used when the condition is chronic and has been for greater than a week. It is used when there is stiffness and pain at the end of the day or in the morning. However, these are just general and its best to do what suits the patient the most.
2. Physical Therapy: It is customized according to the shoulder injury.

• Shoulder Impingement Syndrome: A general evaluation is followed by corrective measures that stretch and strengthen where needed. Then normal movement patterns are carried out to reduce the pressure on the tendons.
• Rotator Cuff Injuries: First there is a stage of active rest where there is no activity to encourage healing. Next, stretches are carried out to restore the range of movement. Lastly, there is focus on strengthening the muscles after the risk of further injury can be ruled out.

1. Surgery: This is the last resort and often times not recommended. This is because it usually cannot treat the injury. Any benefits that it may provide are heavily outnumbered against the risks involved in the surgery. It is often only used when physical therapy alone cannot fix fractures and rotator cuff injuries.

In an era that is becoming more and more sedimentary, where people rush in from working in cubicles crouched in front of a computer to coming home and sitting in front of the television, there is a greater risk of injuries. This lifestyle contributes to shoulder pain. To correct and prevent this, we need to better our postures to prevent our bones from putting strain on our tendons. We also need to stretch and strengthen muscles groups to prevent imbalances that lead to these conditions.