Top 10 Causes of Shoulder Pain: Understanding Your Symptoms
Top 10 Causes of Shoulder Pain: Understanding Your Symptoms
If you read my posts on lower back and neck pain, you already know that understanding your symptoms is the first step to recovery.
In this article, I will concentrate on another common problem: shoulder pain and its possible causes.
Now, shoulder pain and neck pain often happen together and some of the symptoms might overlap and have common causes.
Poor posture is definitely high on the list of possible causes of shoulder pain and dysfunction. But I am getting ahead of myself.
Let’s find out what causes shoulder pain and then we will be in a much better position to do something about it!
Fair warning: this article contains many specialized terms. I will do my best to decipher the medical jargon and explain the terminology as we move along.
As discussed in the post "Sciatica and Herniated Disks: What You Need to KnowPart 2", different symptoms mean different causes. Different causes mean different treatment approaches.
I will give you an example.
How I failed to fix my shoulder
Many years ago, I injured my shoulder while lifting weights. It hurt a lot. I could not put a shirt on without grimacing and cursing.
Over time, with rest and ice, the pain started to subside. Being a physical therapist, I “knew” the right exercises to do: strengthen my rotator cuff of course!
The rotator cuff is a group of muscles and tendons that attach the shoulder blade to the upper arm bone.
These muscles include
1. Supraspinatus: This muscle is located on the top of the shoulder blade and helps to lift the arm away from the body. It is commonly injured and can cause pain with overhead activities.
2. Infraspinatus: This muscle is located on the back of the shoulder blade and helps to rotate the arm outward. It is important for throwing and other activities that involve rotating the shoulder. This muscle commonly develops trigger points – sore spots or knots in the muscle – that can produce referred pain to the front of the shoulder or down the arm.
3. Teres minor: This muscle is located on the back of the shoulder blade and also helps to rotate the arm outward.
4. Subscapularis: This muscle is located on the front of the shoulder blade and helps to rotate the arm inward. It is the largest of the rotator cuff muscles and is important for lifting and pushing movements. The tightness and trigger points in this muscle can produce deep pain that could be referred as far as the thumb.
As I started doing those exercises, the pain immediately got worse. I had to stop exercising and rest and ice again. This cycle repeated two or three times before I started to think that maybe I misdiagnosed myself.
So, I finally gave in and went to see an orthopedic surgeon. He took an x-ray which was not conclusive and told me that he was going to give me a shot of cortisone (an anti-inflammatory) and lidocaine (a numbing drug).
He explained that if the injection helped, it would mean I had shoulder bursitis.
Well, the injection helped for maybe 2 or 3 days. I went back to an orthopedist and he said that he suspected I have a labrum tear.
<a href="https://www.injurymap.com/free-human-anatomy-illustrations">Injurymap</a>
The shoulder labrum is a piece of rubbery tissue that surrounds the edge of the shoulder socket to help keep the upper arm bone in place. It acts like a bumper or cushion to protect the shoulder joint and keep it stable during movement. A labrum tear happens when this tissue gets damaged, either from a sudden injury or from repetitive motions over time. The tear can cause pain, weakness, and instability in the shoulder, and may require different types of treatment depending on how severe it is.
A light bulb went on in my head! Of course, it was a labrum tear! How did I not see it right away? All symptoms were pointing to it:
A feeling of instability or "catching" in the shoulder joint
Clicking sound in the shoulder joint during movement
Worsening pain and weakness when I tried to lift my arm with my palm facing up (like in trying to open a window)
Immediate strong and deep pain while reaching forward
Worsening symptoms when doing the most famous rotator cuff exercise – external rotation (sometimes called “outward rotation”, see picture below)
But I assumed my injury was a result of
· Shoulder Impingement - This occurs when the tendons or bursae (bursae are small sacs of fluid that cushion the joints) in the shoulder become compressed or pinched, causing pain and limited range of motion.
or
· rotator cuff tendinitis (inflammation of one or more tendons of the rotator cuff muscles)
or
· bursitis (a condition in which bursae become inflamed, typically due to overuse or injury; this inflammation can cause pain and swelling)
because most of the shoulder patients I had treated up to that time had these conditions.
Needless to say, the exercises I was doing were making my problem worse!
Ok, time to dive deeper into various conditions that cause shoulder pain. Four of these conditions we have already discussed above in the very sad story about my shoulder injury.
It is worth knowing that, left untreated, these injuries might lead to a rotator cuff tear. A rotator cuff tear occurs when one or more of the tendons or muscles that comprise the rotator cuff become damaged or torn.
There are two main types of rotator cuff tears:
1. Partial-thickness tear: This type of tear damages the tendon but does not completely sever it.
2. Full-thickness tear: This type of tear goes completely through the tendon or muscle, causing a complete separation. The tear could be small or large, involving the entire rotator cuff tendon.
<a href="https://www.injurymap.com/free-human-anatomy-illustrations">Injurymap</a>
The next cause of shoulder pain is a somewhat mysterious condition named Frozen Shoulder.
This condition causes the tissues around the shoulder joint to thicken and tighten, limiting mobility and causing pain.
The condition typically develops slowly over time and progresses through three stages: freezing, frozen, and thawing.
During the freezing stage, the shoulder becomes progressively stiffer and more painful.
During the frozen stage, the pain may decrease but shoulder movements become even more restricted, making it difficult to do regular daily activities.
During the thawing stage, the shoulder gradually becomes less stiff and painful, eventually returning to normal.
The exact cause of a Frozen Shoulder is unknown, but certain factors can increase the risk of developing the condition, such as diabetes, thyroid problems, and previous shoulder injuries or surgeries.
Frozen shoulder is more prevalent in women than men. Women are two to three times more likely to develop this debilitating condition than men. The reason for this is not well understood, but it is thought that hormonal changes, such as those occurring during menopause, may play a role.
A frozen shoulder can also be caused by an injury, such as a strain or a sprain.
I remember treating a patient whose shoulder got injured when his dog suddenly pulled on the leash.
The patient told me he had aching pain in the shoulder for about a week. Then the pain eventually went away but a couple of weeks later, he woke up and could not lift his arm above shoulder level.
This patient had textbook symptoms of a frozen shoulder: he could not reach the back of his head or behind his back.
Over my career, I have treated many patients with frozen shoulder.
It used to be a prevalent treatment to try to loosen up the joint by any means possible: deep massage, stretching, joint mobilization, and manipulation.
Unfortunately, these treatments frequently produced the opposite effect: the shoulder joint would tighten even more, and all the pain patient went through was for naught.
If you are suffering from this condition, my advice is to treat it gently:
· No aggressive stretching.
· Use moist heat, gentle range of motion exercises, and rest.
· Gentle massage might help as well.
· There is evidence that acupuncture can reduce soreness and help recovery.
· Being in the pool might also be beneficial to your ailing shoulder.
Your shoulder pain may also be caused by two types of Arthritis: Osteoarthritis and Rheumatoid Arthritis. Both can cause pain and inflammation in the shoulder joint.
Osteoarthritis (OA) is a degenerative joint disease typically affecting older adults. It is caused by wear and tear on the joints over time, leading to the breakdown of cartilage and bone. Symptoms of OA include pain, stiffness, and limited range of motion in the affected joint.
Rheumatoid arthritis (RA), on the other hand, is an autoimmune disease in which the immune system mistakenly attacks the body's own tissues, including the joints. RA can affect people of any age and is more common in women than men. Symptoms of RA include joint pain, swelling, stiffness, and fatigue. RA can be treated with medications that suppress the immune system and reduce inflammation.
Another reason for shoulder pain might be a Pinched Nerve: A nerve that runs through the shoulder can become pinched or compressed, causing pain and numbness in the shoulder, arm, or hand.
A pinched nerve in the neck can cause Referred Pain.
Nerves can get compressed by herniated disks, tight muscles, inflammation in the surrounding tissues, or tumors.
As we discussed in the post “Neck Pain: Causes, Symptoms, and Simple Solutions”, the location of a compressed nerve will determine the location and quality of the symptoms.
Various traumas, such as collarbone fractures, upper arm bone fractures, or shoulder dislocation, can all cause shoulder pain.
Underlying Causes of Shoulder Pain
The underlying causes for all these injuries, aside from trauma, can usually be traced to:
· Overuse
· Repetitive motions
· Poor posture
· Combination of the three above
How Poor Posture Can Lead to Shoulder Injury
The shoulder function is especially influenced by posture.
This is due to the anatomy of the shoulder joint. The head of the upper arm bone (the humerus) has to move freely within the joint socket. When the head of the humerus is stuck forward, such as in a posture with rounded shoulders, your arm can’t travel up through the full range of motion.
As you attempt to lift your arm above your head while keeping your shoulders rounded, the tendons of the rotator cuff get pinched between the top of the shoulder blade and the head of the humerus.
If you continue to perform such a motion repetitively, these tendons will get irritated and, eventually, inflamed, causing shoulder impingement.
You can demonstrate this to yourself by trying to lift the arm while slouching and rounding your shoulders. You will find that you can’t lift the arm through the full range of motion. Now stand up straight, stick your chest forward, and bring your shoulder blades back. Raise the arm above your head. You can see that now the arm goes up freely.
When the muscles, such as the pectorals, that pull your shoulders into a rounded position are tight, while the rotator cuff muscles are weak, this muscle imbalance can create shoulder problems over time.
Treatment of Shoulder Injuries
If your injury has just happened, your best course of action is to
Rest your arm in the most comfortable position
Ice the shoulder. You can apply a cold pack to the shoulder every two hours and keep it on for about 20 minutes.
As much as possible, avoid movements and positions that worsen the pain. Frequently, sleeping on the affected side will make your symptoms worse
You might try wearing a shoulder sling to prevent painful arm movements.
Do passive arm pendulums.
This exercise involves bending forward at the waist and letting the injured arm hang freely. Rock your body back and forth, allowing gravity to pull the shoulder down and create a pendulum-like movement. Keep your arm as relaxed as possible. Passive means that you don’t attempt to move the arm but let it be moved by the motion of your body.
As your condition improves, you should feel less pain and more stiffness. When that happens, you can start doing active pendulums. As you progress, you can begin stretching the shoulder, being careful not to create pain. Once the pain is gone, it is time to strengthen your shoulder. I will describe the specific exercises and their sequence in a separate post.
There you have it:
Top 10 Conditions That Cause Shoulder Pain
1. Rotator Cuff tendinitis
2. Shoulder Impingement
3. Shoulder Bursitis
4. Rotator Cuff Tear
5. Labrum Tear
6. Frozen Shoulder
7. Osteoarthritis
8. Rheumatoid arthritis
9. Pinched Nerve
10. Trauma
I hope this post helped your understanding of the complicated subject of shoulder pain.
Remember, if your pain does not surrender with the treatments I described above, do your shoulder a favor and seek professional help.
Understanding the mechanism of shoulder pain will speed up your recovery and put you in control of your shoulder health.
Disclaimer
Although we strive to provide the most accurate information possible, please note that all of the content found on ReliefSolutions4you.com, including text, audio, video, and/or other formats are provided for informational purposes only. The content on ReliefSolutions4you.com is not a substitute for professional medical treatment, advice, and/or diagnosis. Always seek out the advice of a physician or other qualified health provider when seeking information for a medical condition or before engaging in physical training. The information on ReliefSolutions4you.com is not to be taken as medical advice. Always consult with your physician when starting a new physical training regimen and/or diet.
