Imagine standing on a tennis court, ready to hit the best shot- no less than Serena Williams’ winning shot at Wimbledon. You take the shot, and suddenly, your shoulder starts to scream in protest. Ouch! That must hurt. As we know, Shoulder pain is one of those things that can strike without a warning. Whether it’s a sports mishap, improper sleeping position, or just wear and tear from daily life, shoulder aches often leave people wondering- ‘Will this get better on its own?’
But here’s a thing, Granimals is on the journey to educate people more on common injuries and conditions like shoulder pain and how to navigate these situations like a pro, so we have got you covered. In this blog, we shall deep dive into details about the anatomy of the shoulder joints and muscles, possible causes of shoulder aches, symptoms, exercises, and treatment options for different conditions related to shoulder pain. Let’s get started!
It is not a hidden fact that our shoulders consist of one of the most intricate muscle structures and are one of the most flexible parts of our body. The complex formation of our shoulder’s joints includes tendons, ligaments, and other necessary components that work together to make your hands move and offer stability. To understand the anatomy of a shoulder joint better, here is an overview:
The shoulder contains of three bones: the clavicle, scapula and the humerus.
1. Clavicle: Also known as the collarbone, this bone joins the shoulder to the breastbone and the shoulder blade at the acromioclavicular joint, which is a joint in the shoulder, two bones meet here.
2. Scapula: Also known as the shoulder blade, it is a large triangular-shaped bone located at the back of the shoulder. It forms the socket part of the shoulder joint and provides different attachment points for muscles.
3. Humerus: It is a bone that fits into the scapula's socket, which makes the ball and socket joint for the shoulder.
There are four types of joints present in the shoulder joint:
1. The Scapulothoracic Joint
2. The glenohumeral joint
3. The sternoclavicular Joint
4. The Acromioclavicular Joint.
1. Glenohumeral Joint: This is the main joint of the shoulder and is a ball and socket joint made by the glenoid cavity and the head of the humerus. This joint allows a wide range of motions.
2. Acromioclavicular Joint (AC Joint): The joint where the acromion (the highest part of the scapula) meets the clavicle.
3. Sternoclavicular Joint: The joint where the sternum meets the clavicle.
4. Scapulothoracic Joint: This is not a true joint, but it is a functional one. It is present where the scapula hangs over the ribcage.
The shoulder has five types of muscles: the Rotator Cuff Muscles, the Deltoid, the Pectoralis Major, and the Latissumus dorsi.
1. Rotator Cuff Muscles: These are a group of muscles that are responsible for stabilising the shoulder and are also responsible for rotation and lifting the arm. Following are the Rotator cuff muscles:
2. Deltoid: This is a large triangular muscle that covers the shoulder joint. It allows flexion, arm abduction, and extension.
3. Pectoralis Major: This is a large muscle in the chest that allows shoulder adduction, flexion, and internal rotation.
4. Latissimus Dorsi: A broad back muscle that aids in shoulder extension, adduction, and internal rotation.
5. Trapezius: A large muscle extending from the neck to the mid-back, helping with shoulder elevation, retraction, and rotation.
The shoulder consists of multiple ligaments and tendons. Tendons are responsible for connecting muscles to bones, and the ligaments are responsible for connecting bone to bone to provide stability. Following are the tendons and ligaments present in the shoulder:
1. Rotator Cuff Tendons: Attach the rotator cuff muscles to the humerus.
2. Biceps Tendon: Attaches the biceps muscle to the shoulder and helps with shoulder and elbow movements.
3. Glenohumeral Ligaments: Strengthen the front of the glenohumeral joint.
4. Coracoacromial Ligament: Connects the coracoid process to the acromion.
5. Coracoclavicular Ligaments: Connect the clavicle to the coracoid process.
They are small sacs filled with fluids that reduce friction between the parts that move in the shoulder. They also cushion the rotator cuff tendons located below the acromion.
Here are the five common causes of shoulder pain:
It is a condition where inflammation of the synovial membrane occurs, which lines the joints containing cavities like the shoulder, causing synovitis. This membrane generates synovial fluid to lubricate and nourish the joint. Inflammation of the synovial membrane can result in significant discomfort, swelling, and rigidity in the shoulder. This condition can be initiated by various factors, such as injury, repetitive motion, or underlying inflammatory diseases like rheumatoid arthritis.
Swelling: Localized swelling around the joint.
Warmth: The affected area of the shoulder may feel warm to the touch.
Pain without Movement: Increased pain when moving the shoulder.
Osteoarthritis is a joint disease where cartilage, the protective tissue at the ends of bones, breaks down. In the shoulder, osteoarthritis can cause pain, stiffness, and decreased articulation as the cartilage wears away and bones start to rub with each other. This condition tends to progress slowly and is more prevalent in older adults, although it can also be influenced by factors like previous shoulder injuries or repetitive stress on the joint.
Chronic Pain: Persistent, aching pain that worsens with activity.
Stiffness: Notable in the morning or after periods of inactivity.
Grinding Sensation: A feeling of bones rubbing together.
Inflammation of the bursa, also known as bursitis, happens when the small sacs filled with fluid (bursae) that provide cushioning for the bones, muscles and tendons near the joints become inflamed. In the shoulder, this swelling typically impacts the subacromial bursa. Bursitis can lead to severe pain, particularly when moving or applying pressure to the affected area. It can be caused by repetitive movements, prolonged pressure on the shoulder, or direct injury.
1. Localised Pain: Sharp or burning pain at the top of the shoulder.
2. Pain at Rest: Pain may persist even when the shoulder is at rest.
3. Pain with Movement: Particularly when raising the arm.
Injuries to the shoulder, such as sprains, can cause harm to the ligaments, muscles, or tendons. Rotator cuff tears, labral tears, dislocations, and fractures are common shoulder injuries. These injuries can happen due to sudden trauma, like a fall or a blow to the shoulder, or due to overuse and repetitive strain. Symptoms usually involve intense pain, reduced strength, and decreased range of motion in the joint of the shoulder.
1. Sudden, Intense Pain: Following an injury or trauma.
2. Bruising: Discoloration around the shoulder area.
3. Weakness or Instability: The shoulder may feel weak or unstable
Neck and upper back problems can result in shoulder discomfort because these areas are interconnected. Issues like cervical radiculopathy (nerve compression in the neck), muscle tension, or bad posture can lead to referred pain in the shoulder. This pain type typically manifests as a persistent, throbbing feeling and may come with stiffness and limited movement in both the neck and shoulder.
1. Referred Pain: Pain that radiates from the neck or upper back to the shoulder.
2. Numbness or Tingling: Sensations in the shoulder, arm, or hand.
3. Muscle Spasms: Tightness or spasms in the neck and upper back muscles.
Shoulder pain can prevail in various ways depending on the underlying cause. Here are common symptoms associated with shoulder pain:
1. Pain: This can be a sharp, shooting pain or a dull, aching sensation. It may occur during movement or even at rest.
2. Stiffness: Difficulty in moving the shoulder or arm, especially reaching overhead or behind the back.
3. Weakness: Reduced strength in the shoulder, making it difficult to perform everyday tasks.
4. Swelling: Visible or palpable swelling in the shoulder area.
5. Tenderness: Sensitivity to touch or pressure on the shoulder.
6. Limited Range of Motion: Difficulty moving the shoulder through its full range of motion.
7. Clicking or Popping Sensation: Sensations of clicking, popping, or grinding when moving the shoulder.
Each shoulder issue presents its own set of symptoms that can assist your doctor or physical therapist in making a diagnosis. While most conditions result in pain when using or moving your shoulder, some can cause stiffness. Your physician or physical therapist will need to identify the most painful movements, as this can indicate the location of the issue. Typically, they will inquire about how the problem began, how it has progressed, and how it impacts your daily activities. If possible, try to jot down when and how the issue started and what exacerbates the discomfort before your appointment. This will facilitate a more accurate diagnosis.
When your condition has been diagnosed, your physical therapist or doctor can typically recommend the most suitable treatment plan. However, if they suspect that your problems stem from arthritis or a more complex condition, they may refer you for additional tests.
1. Blood Test: Most shoulder issues don't typically require blood tests, but they may occasionally be used to eliminate other conditions, including certain forms of arthritis.
2. X-rays: X-rays are effective in detecting bone problems and minor joint changes in the shoulder. Minor changes are normal and may not be the cause of the issue. X-rays can only visualise bones and other hard substances, not injuries to soft tissues such as muscles.
3. Ultrasound: An ultrasound scan can reveal swelling, damage, and issues with the tendons, muscles, or other soft tissues in the shoulder. It utilises high-frequency sound waves to examine and create images of the body's interior.
4. MRI: If your doctor suspects a more complex issue with the soft tissue in the shoulder, you may be sent for magnetic resonance imaging (MRI) scans. An MRI uses radio waves to generate an image that displays the condition of the bones and soft tissues, such as muscles and tendons, within your shoulder.
5. On occasion, dye is injected into the shoulder before an MRI to obtain a clearer image, particularly in cases of shoulder dislocation.
6. Nerve conduction studies can determine whether your issues are due to pinched or irritated nerves in your arm. They gauge the electrical activity in the muscles and nerves. This test may cause slight pain or discomfort, akin to a tapping sensation on the skin, but it is brief.
Here are some of the commonly used treatments for shoulder pain:
Physiotherapy involves utilising exercises and physical methods to improve shoulder strength, range of motion, and flexibility serving as a non-invasive treatment. It is commonly the initial approach for addressing shoulder pain and can be customised based on the specific pain cause. A physiotherapist might assist you with the following:
1. Stretching exercises: These aim to enhance flexibility and alleviate stiffness.
2. Strengthening exercises: They are designed to develop muscle around the shoulder joint, offering better support and lowering the risk of additional injury.
3. Manual therapy: This includes techniques like massage or joint mobilisation to alleviate pain and enhance mobility.
4. Posture correction: Advice and exercises to rectify posture issues that may be contributing to shoulder pain. Physiotherapy not only aids in pain reduction but also in averting future injuries by enhancing overall shoulder function.
Surgery may be considered when other treatments, such as physiotherapy and medication, have not been successful or in cases of severe injury, such as a rotator cuff tear, shoulder dislocation, or advanced osteoarthritis. Various types of shoulder surgeries include:
1. Arthroscopy: This is a minimally invasive process that involves using a small camera to repair tissues inside the shoulder joint.
2. Rotator Cuff Repair: This procedure involves reattaching the torn tendons of the rotator cuff.
3. Shoulder Replacement: This surgery involves replacing damaged parts of the shoulder joint with artificial components. It is typically used in cases of severe osteoarthritis.
4. Stabilization Surgery: This surgery involves repairing and tightening the ligaments if the shoulder is unstable or prone to frequent dislocations. Surgery can help bring back function and alleviate pain, but it usually requires a period of rehabilitation afterward.
Medication is utilised for the treatment of shoulder pain and inflammation. Common medications contain:
1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs, such as ibuprofen or naproxen, decrease inflammation and alleviate pain.
2. Pain Relievers: Over-the-counter options like acetaminophen can assist in managing mild to moderate pain.
3. Corticosteroid Injections: Potent anti-inflammatory medications administered directly into the shoulder joint to lessen severe inflammation and pain.
4. Muscle Relaxants: These are sometimes prescribed if shoulder pain is associated with muscle spasms. Medications can effectively manage symptoms but are often used alongside other treatments, such as physiotherapy.
Heating and cooling therapy are uncomplicated, noninvasive techniques for relieving shoulder discomfort and decreasing swelling. Depending on the nature of the discomfort, they can be utilised individually or in conjunction.
1. Cold Therapy: Utilizing an ice pack or chilly compress on the affected area, this method diminishes swelling and dulls the pain by narrowing blood vessels. It is particularly valuable within the initial 48 hours following an injury or to control sudden pain and inflammation.
2. Warm Therapy: This involves applying warmth to the shoulder using a heating pad, warm towel, or hot water bottle. It helps to ease tense muscles, enhance blood circulation, and alleviate rigidity. It is especially advantageous for persistent discomfort and stiffness, such as osteoarthritis or muscle tension. In some instances, alternating between heat and cold can be effective, but it is crucial to know when each therapy is appropriate.
Here are the top 5 exercises recommended for conditions like rotator cuff, injuries, tendinitis and general shoulder discomfort:
This exercise is effective for mobilising the shoulder joint gently and increasing the range of motion.
Steps to do Pendulum Stretch
1. You can do this exercise as you stand or sit by letting the affected arm hang down.
2. Swing your arm in small circles with about a foot in diameter. Do ten circles in each direction.
3. Increase the diameter of the circle gradually, keeping the pain level in check.
4. Repeat this exercise for 3-5 minutes and do this once or twice every day
This exercise is useful for stretching the shoulder muscles, specifically the deltoid and the rotator cuff.
Steps to do Cross-Body Arm Stretch
1. Sit or stand up straight
2. Bring your arm across the body, keeping it at the shoulder’s height
3. Use the opposite hand to pull the other arm gently closer towards your chest, stretching the shoulder
4. Hold the stretch for 15-20 seconds
5. Repeat the exercise 3-5 times
This exercise is useful for improving the stability of the shoulder by strengthening the muscles around the shoulder blade.
Steps to do Wall Angels
1. Stand straight with your back against the wall, and keep your feet a few inches away from the wall
2. Push your lower back, upper back and head against the wall
3. Lift your arm to shoulder height, elbows bent at a 90-degree angle, and drive your arms against the wall
4. Glide your arm up the wall as if making a snow angel. Keep your arm and back against the wall
5. Lower your arm back to its original position. Repeat the exercise 10-15 times
This exercise is useful for strengthening the rotator cuff muscles.
Steps to do Shoulder External Rotation with a resistance Band
1. Put the resistance band and attach it to a stable object like a doorknob at your elbow’s height
2. Hold the other end of the resistance band with your arm, elbows bent at 90-degree and close to your body
3. Keep your elbow close to your body and rotate the forearm away from the body, stretching the resistance band
4. Return to the starting position slowly. Repeat the exercise 10-15 times
This exercise is significant for improving the posture and the stability of the shoulder by strengthening the muscles between the shoulder blades.
Steps to do Scapular Squeezes
1. Stand or sit straight with your arm by your side
2. Compress your shoulder blades together like you would when trying to pinch a pencil between them
3. Hold the squeeze for 10-15 seconds
4. Repeat the exercise 10-15 times
Granimals offers a comprehensive program to manage chronic pain, including chronic shoulder pain. Our skilled physiotherapists have expertise in pain management and offer personalised rehab programs to address every patient’s needs and conditions. Book your initial consultation with Granimals and move on to a journey of pain-free life. Book your rehab consultation today!
Q1- What causes shoulder pain?
Answer: There are many reasons shoulder pain may occur; some of the most common reasons for shoulder pain are:
Q2- How to rest your shoulder?
Answer: One of the best ways to rest your shoulder is to sleep on your back or on your sides with the side that is not affected. Placing some pillows may also help. Seek professional help if the pain persists for more than two days.
Q3- Will my shoulder pain heal on its own?
Answer: For the majority of the population, shoulder pain generally heals on its own when taken proper rest, although if the pain persists longer that 2-3 days and if the pain is very sharp, seek professional help immediately.
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