Your shoulder has a lot going on in and around it; a few joints, plenty of muscles and tendons, and loads of ligaments. It’s difficult to pin-point the reason of pain in your shoulder; often there could be multiple reasons. The shoulder comprises several joints that combine with tendons and muscles to allow a wide range of motions in the arm, from scratching your back to proposing to your valentine on the coming Monday! Speaking of which, wish you all a Happy Valentine’s Day!

Shoulder mobility comes at a cost. Instability is the price you pay for it. Three bones make up the shoulder – the upper arm bone (Humerus); the shoulder blade (Scapula), and the collarbone (Clavicle). The head of the Humerus fits into a rounded socket in the Scapula. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. Four muscles collectively form the rotator cuff; three round the back of your shoulder blade and one round the front. These cover the head of your upper arm bone and attach it to your shoulder blade.

Being one of the most mobile joints, the shoulder muscles provide most of the strength to move your arm and also contribute to the stability of your shoulder joint. It’s first in line to get injured; if you feel pain on the outside or front of your upper arm (which intensifies when your lift your arm sideways or above your head), then you could have injured your rotator cuff.

There’s an increasing trend to first get MRI and/or X-ray done and then consult your physiotherapist. Most times, scans aren’t needed, unless prescribed by the physiotherapist. Scans display numerous features that part of the normal aging process, as well as things for even those in no pain! Your physiotherapist guides you by asking you questions about your symptoms, performing clinical examination procedures, and exploring other issues which could be contributing to your pain.

Most shoulder problems fall under four major categories: 1. Inflammation and/or Injury (tendonitis and/or tears, bursitis, etc.); 2. Instability and/or impingement; 3. Arthritis; and 4. Fracture (broken bone). Other less common causes of shoulder pain include tumors, infection and nerve-related problems.

Here are a few reasons for you to consult a Physiotherapist:

BURSITIS: Bursae are small, fluid-filled sacs located in joints, across the body, including the shoulder. These act as cushions between bones and overlying soft tissues, helping reduce friction between the gliding muscles and the bone. Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade. This causes the condition known as Subacromial Bursitis.

TENDINITIS: A tendon is a cord connecting muscle to bone. Tendinitis means inflammation in the tendon. It could be either Acute Tendinitis caused by excessive ball throwing or other overhead activities; or Chronic Tendinitis caused by degenerative diseases like arthritis or repetitive wear and tear due to age.

TENDON TEARS: Splitting and tearing of tendons caused by acute injury or degenerative changes in tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may entirely separate the tendon from the bone. Rotator cuff and biceps tendon injuries are common in these injuries.

IMPINGEMENT: Shoulder impingement occurs when the top of the shoulder blade puts pressure on the underlying soft tissues, when the arm is lifted away from the body. As the arm is lifted, it ‘impinges’ on the rotator cuff tendons and bursa.

INSTABILITY: The most common dislocations are of the shoulder joint. I have personally experienced shoulder dislocation in my sleep. You can understand how minimal a force is required for dislocating the shoulder. Dislocations are common in athletes and sportsmen. Many are able to relocate the shoulder by themselves in a couple of attempts, failing which, rush the patient to the hospital as the pain is excruciating. Shoulder dislocations can also be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.

ARTHRITIS: There are many types of arthritis, the most common arthritis in the shoulder is Osteoarthritis, also known as ‘wear and tear’ arthritis.

FRACTURE: Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade). Shoulder fractures in the elderly are often due to a fall from standing height. In younger patients, shoulder fractures are caused by a high energy injury, like a vehicle accident or contact sports injury.

Treatment For Shoulder Pain

The first step in planning the right treatment would be a thorough evaluation by your physiotherapist, in order to determine the cause of your shoulder pain. He will look for physical abnormalities, swelling, deformity, muscle strength and range, and check for tender areas, amongst other things. Clinical tests would further guide towards the right diagnosis. If needed specific investigations may be ordered.

Treatment generally involves rest, with icing, altering your activities, joint mobilization techniques and specific exercises. Medication could be initially prescribed to reduce inflammation and provide pain relief. If conservative treatments fail, surgery is considered as a last option.

I’m not sharing exercises for shoulder pain as the shoulder is very sensitive and needs individual-specific exercises, under supervision of a physiotherapist, as the slightest error or wrong exercise selection could easily complicate matters. It’s best to meet your physio in person, but more so, if it involves the shoulder joint.