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Shoulder Pain

Questions

SHOULDER PAIN

Shoulder pain is a common problem and there are many things that can cause shoulder pain. For most people, it will improve over time with appropriate treatment. Shoulder pain is common in our community. In younger people, pain is more likely to be due to an accident or injury. However as you age natural wear and tear occurs in the shoulder joint and the rotator cuff tendon. This may become persistently painful over time. Your shoulder is a complex, highly mobile structure made up of several components. When something goes wrong with your shoulder, it hampers your ability to move freely and can cause a great deal of pain and discomfort. There are two joints:

Glen humeral joint: where your upper arm bone (the humerus) connects with your shoulder blade (scapula)

Acromioclavicular joint: where the top of your shoulder blade meets your collarbone (clavicle).

You can injure your shoulder by performing manual labor, playing sports, or even by repetitive movement. Certain diseases can bring about pain that travels to the shoulder. These include diseases of the cervical spine (neck), as well as liver, heart, or gallbladder disease.

Causes of Shoulder pain

Several factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis. This is a condition characterized by swollen tendons. Another common cause of shoulder pain is impingement syndrome where the rotator cuff gets caught between the acromium (part of the scapula that covers the ball) and humeral head (the ball portion of the humerus).Sometimes shoulder pain is the result of injury to another location in your body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse when you move your shoulder.

Other causes of shoulder pain include:

·        Arthritis

·        Cervical myelopathy

·        Torn cartilage

·        Torn rotator cuff

·        Swollen bursa sacs or tendons

·        Bone spurs (bony projections that develop along the edges of bones)

·        Pinched nerve in the neck or shoulder

·        Broken shoulder or arm bone

·        Frozen shoulder

·        Dislocated shoulder

·        Injury due to overuse or repetitive use

·        Spinal cord injury

·        Heart attack

Risk factors

Shoulder impingement is a condition that causes pain and pinching sensation in the shoulder. It can also decrease a person’s range of motion. Anyone can get shoulder impingement, but people with certain risk factors are more likely to develop it. Some common risk factors associated with shoulder pain include:

Overuse. People who participate in sports that require frequent and repetitive use of the arms and shoulders, such as baseball, swimming, tennis, and football, are at higher risk of developing shoulder impingement.

Curved or hooked acromion. Some people’s natural anatomy makes them more likely to develop shoulder impingement. People who have curved or hooked acromion bones typically have a smaller sub acromial space than a person who has a flat acromion.

Prominent coracoid. The coracoid is a small projection from the shoulder blade. Like people who have hooked or curved acromions, some people have prominent coracoids. These people are more susceptible to another, less common type of shoulder impingement called sub coracoid impingement.

Shoulder instability. Shoulder instability refers to when shoulder muscles, tendons, and ligaments no longer secure the shoulder joint causing pain. As a result, the shoulder is prone to partial dislocation, dislocation, and other conditions, such as shoulder impingement.

Previous shoulder injuries. People who have sustained injuries to the shoulder joint, such as a torn labrum, may be at risk for developing shoulder impingement in the future.

Bone spurs. Bone spurs are projections that can cause the sub acromial space to narrow and become smaller. As a result, there is less room for tendons and other soft tissues, making impingement more likely.

Poor posture. Posture while reading, sitting at a desk, driving, or cooking, can play a role in the development of shoulder impingement. Hunching or slumping the shoulders can cause the narrowing of the space between the acromion and rotator cuff.

Age Shoulder impingement is most often seen in adults over the age of 50, although it can develop at any age.

Preventive measures

Shoulder can be caused due to varied reasons, usually due to abnormal body movements and posture. The good news is that shoulder problems often can be fixed without surgery. Still, it’s best to avoid the problem in the first place. Here are some ways to do that.

Listen to your body. If your shoulder gets sore after any activity, don’t ignore it. If the pain is serious and doesn’t go away, see your doctor. There’s no need to tough it out. You just might make things worse.

Stay in shape. Keep your body in good physical shape with regular exercise and a healthy diet. It’s a way to stay well and it can help you avoid injury.

Exercise the right way. Warm up before you work out. Start slowly if you haven’t done a sport or an activity in a while. Learn how to lift weights the right way. Don’t lift too much.

 Watch out at work. Make sure you don’t injure your shoulder on the job.

·        Use good posture when you sit or stand.

·        Follow the rules for safe lifting. Keep your back straight and use your legs.

·        Take a break for a couple of minutes every hour. Move around and stretch.

·        If you work at a desk, make sure your work station is set up so that you can comfortably use your computer.

Don’t strain to reach what you need. Use a step stool if you have to reach high places. Put the items you use in drawers or on lower shelves.

When to seek medical help?

You should contact your doctor if you experience fever, inability to move your shoulder, lasting bruising, heat and tenderness around the joint, or pain that persists beyond a few weeks of home treatment. If your shoulder pain is sudden and not related to an injury, call for medical help immediately. It may be a sign of a heart attack. Other signs of a heart attack include:

·        Trouble breathing

·        Chest tightness

·        Dizziness

·        Excessive sweating

·        Pain in the neck or jaw

Also, call for some medical help or go to an emergency room immediately if you injured your shoulder and are bleeding, swollen, or you can see exposed tissue.

Treatment Overview

Your doctor may ask how and when the pain started, whether it has occurred before and how it was treated, and other questions to help determine both your general health and the possible causes of your shoulder problem. A comprehensive examination will be required to find the causes of your shoulder pain. Your doctor will look for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas. He or she will observe your shoulder range of motion and strength.

Tests

Your doctor may order specific tests to help identify the cause of your pain and any other problems.

·        X-rays.

·        Magnetic resonance imaging (MRI) and ultrasound..

·        Computed tomography (CT) scan..

·        Electrical studies/EMG.Your doctor may order a test, such as an EMG (electromyogram), to evaluate nerve function.

·        Arthroscopy. In this surgical procedure, your doctor looks inside the joint with a fiber-optic camera. Arthroscopy may show soft tissue injuries that are not apparent from the physical examination, x-rays, and other tests. In addition to helping find the cause of pain, arthroscopy may be used to correct the problem.

Treatment

Activity Changes

Treatment generally involves rest, altering your activities, and physical therapy to help you improve shoulder strength and flexibility. Common sense solutions such as avoiding overexertion or overdoing activities in which you normally do not participate can help to prevent shoulder pain.

Medications

Your doctor may prescribe medication to reduce inflammation and pain. If medication is prescribed to relieve pain, it should be taken only as directed. Your doctor may also prescribe medication such as no steroidal anti-inflammatory medications (NSAIDs) or corticosteroids. Corticosteroids are powerful anti-inflammatory drugs that can be taken by mouth or your doctor can inject into your shoulder.

Surgery

Surgery may be required to resolve some shoulder problems. However, the large majority of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise, and medication.Certain types of shoulder problems, such as recurring dislocations and some rotator cuff tears, may not benefit from exercise. In these cases, surgery may be recommended fairly early.

Physiotherapy treatment for Shoulder Pain

Physiotherapy focuses on improving mobility for those with shoulder pain conditions or problems. It also restores the use of affected joints, reduces pain and strengthens muscles to support the joints. A physiotherapist will create an individualized treatment plan to improve flexibility, coordination and strength for maximum physical function. The main objective of PT in treating shoulder involves improving the mobility and re-establishing the functioning of affected joints. Physiotherapists are licensed professionals who strengthen affected joints by employing various therapies. Some of the common physiotherapy modalities for conditions who are mainly associated with shoulder pain:

·        Transcutaneous electric nerve stimulation

·        Soft  and joint issue Mobilization

·        Ultra Sound

·        IFC( Interferential Current)

·        Acupuncture

·        Massage

·        Strengthening and stretching exercises

Heat and Cold Therapies