Our shoulder joint is the most flexible and allows for the widest range of motion of the body. This enables us to do our daily tasks like writing and cooking and also sports like reaching for the next far spot in rock climbing.

Just as it is the most flexible, it is also the most susceptible to damage chronically over time due to overuse and age and also from sports or accidents, such as a bad fall.

We provide diagnosis, treatment and managing Joint Pain related problems.

Anatomy of the Shoulder

The collarbone (clavicle), the upper arm bone (humerus) and the shoulder blade (scapular) are the 3 bones that make up the shoulder.

The head of the humerus fits into the glenoid, a rounded hollow in the scapula. A synthesis of tendons and muscles keep the humerus fixed in the glenoid. Rotator cuff are the tissues overlying the head of the humerus to form a joint capsule, which keeps the humerus to the scapula and the shoulder stable. A lubricant for the shoulder joint – synovial fluid – is secreted from the inner layer of the joint capsule.

Causes of Shoulder Pain

A list of common reasons of shoulder pain are as follows:

·         Instability. When the head of the humerus is pushed completely out of the shoulder socket due to a sudden impact, shoulder dislocation results. A partial dislocation or subluxation is when the ball of the humerus is only half out of the socket. Dislocations may happen repeatedly when the muscles, ligaments and tendons around the shoulder become worn or limp.  Frequent dislocations and subluxations can result in higher risk of arthritis. Repeated dislocations is also painful when one moves his arm away from the body or raising it.

·         Rotator cuff injury. Tendinitis can be due to over time use and ageing or acute heavy lifting or overhead arm movements putting undue stress on the rotator cuff tendons and eventually tendinitis. As a result of tendinitis, rotator cuff tearing have a higher probability of occurrence and such tears can cause weakness to raise arm, regardless it is a partial or complete tear.

·         Osteoarthritis (OA). OA usually happens after injuries. It is a chronic condition of wear and tear of the cartilage that buffer the ends of the bones. OA causes the bones to grind against each other, resulting in loss of movement in the join, stiffness and pain.

·         Impingement syndrome. This is a condition when the swollen tendons get pressed or caught by the edge of the shoulder blade. It is due to rotator cuff tendinitis and is coined as the painful arc, resulting as sharp pain experienced during movement or arm raising

·         Referred pain from the neck. Impingement of nerves that passes through the shoulder to the arm and hand, such as prolapsed intervertebral disc in the neck, can be a shoulder pain that stem from the neck.

·         Bursitis. With movement, bursitis may result in inflammation and pain in the Bursae. Small fluid-filled pockets that help in buffering pressure points and reducing friction between the tendons or ligaments and bones is called Bursae.

·         Fracture. The most common fracture areas in the shoulder are the head of the humerus and the clavicle. It can be very painful with bruises. A shoulder fracture happens after a fall or trauma.

·         Frozen shoulder. Frozen shoulder happens between the ages of 40 to 60, and usually after a tendon tear, simple and small injury or rotator cuff impingement. This condition is characterized  by seriously restricted shoulder movement due to a lack of synovial fluid to lubricate the joint, with abnormal bands of tissue (called adhesions) growing out as a result. Frozen shoulder can be self-healed over a period of three years.

Tests

With a detailed physical checkup of the shoulder and thorough consultation, the following tests may be done to help in diagnosis:

Laboratory tests

Blood tests such as rheumatoid factor, full blood count or inflammatory markers.

Imaging

Ultrasound scan. A good visualisation of the soft tissues and is hence useful for diagnosing soft tissue injuries.

X-ray. A cheap and reliable way to diagnose many shoulder issues. It is a two-dimensional view of the shoulder joint.

Magnetic resonance imaging (MRI) scan. This is the test with the most details. It highlights the various blood vessels, tendons, rotator cuff muscles, nerves and other soft tissues.

Computed tomography (CT) scan. This is a three dimensional test that gives more detailed visualisation of some soft tissues and bones and better than X-ray.

Signs and Symptoms

There are some early symptoms and warning signs accompanying shoulder pain. Depending on the underlying causes, the severity and location may vary:

·         “Pop” out feeling of the shoulder

·         Swelling

·         Inability and limited motion range to lift the arm above the head

·         Stiffness

·         Fragility and insensitivity of the arm

Treatments for Shoulder Pain

Treatments will depend on the diagnosis of shoulder pain:

Surgery

Possible procedures like total shoulder replacement, Bankart repair for shoulder instability or arthroscopic rotator cuff repair may be required, depending on the diagnosis.

Physiotherapy

Resistance training for the rotator cuff muscles

Straightening of shoulder, spine and neck postures

Exercises to improve the range of motion and relieving stiffness

Intra-articular injections

An immediate yet short three months relief – Cortiosteroid injections – for the severe shoulder pains.

Medications

Symptomatic relief using oral and topical painkillers

Oral supplements which can aid in reducing inflammation and soft tissue degeneration Swelling and soft tissue degeneration reducing oral supplements.