Shoulder Pain Clinic @ SG Shoulder
By Orthopaedic and Neurology Singapore
Your shoulder is a complex, highly mobile structure made up of several components. There are two joints:
- glenohumeral 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).
Strong connective tissue forms your shoulder capsule. This keeps the head of the humerus in place in the joint socket. The joint capsule is lined with a synovial membrane. It produces synovial fluid which lubricates and nourishes the joint.
Strong tendons, ligaments and muscles also support your shoulder and make it stable.
What are some causes related to shoulder pain?
The common shoulder injuries are:
- Dislocation. If your shoulder is pulled back too hard or rotated too far, the top of your arm might pop out of its socket. You will feel pain and weakness in your shoulder. You may also have swelling, numbness and bruising.
- Separation. This injury affects the joint where your collarbone and shoulder blade come together. A fall or hard blow tears the ligaments holding it together. This is where you may feel pain in the front of the shoulder. If your collarbone gets pushed out of place, you’ll have a bump on top of your shoulder.
- Fracture. A bone can break or crack if you fall or take a hard hit. The most common breaks are to the clavicle (collarbone) and the humerus (arm bone closest to your shoulder). If your collarbone is broken, your shoulder can sag and you might not be able to lift your arm.
- Cartilage tear. You can injure the cartilage (the rubbery padding) that goes around the rim of your shoulder joint. It can happen after doing the same motion over and over. You can also hurt it in a fall or anytime your shoulder absorbs a lot of force. With this type of injury, you might feel pain when you reach over your head, and your shoulder could seem weak. It might also feel like it’s catching, locking, or grinding.
- Rotator cuff tear. Your rotator cuff is the group of muscles and tendons in your shoulder that hold your arm in place and let you lift your arm overhead. You can damage it through overuse or in a fall. It also begins to show wear and tear as you age. Your shoulder may hurt at night and when you try to lift things. You might hear a crackling sound when you move it.
- Frozen shoulder. This condition limits how much your joint will move. Abnormal bands of tissue (adhesions) build up in the joint and keep your shoulder from moving freely. Your shoulder might “freeze” because pain or surgery have made you use it less, allowing the adhesions to build up.
- Impingement syndrome. Impingement syndrome is caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain associated with the syndrome is a result of an inflamed bursa (lubricating sac) over the rotator cuff, and/or inflammation of the rotator cuff tendons, and/or calcium deposits in tendons due to wear and tear. Shoulder impingement syndrome can lead to a torn rotator cuff.
- Bursitis. The bursa (a fluid-filled sac that cushions in your joint) can get swollen and irritated if you repeat the same motions over and over again. But it can also be caused by a fall or another injury. If you have bursitis, you may notice the pain most when you move your shoulder.
Osteoarthritis. This degenerative joint disease can affect the shoulder joint, leading to pain, stiffness, and reduced range of motion. It usually occurs with age or as a result of wear and tear on the joint.
Fractures. A broken collarbone (clavicle), humerus, or shoulder blade (scapula) can cause significant shoulder pain. Fractures may occur due to falls, accidents, or sports injuries.
Tendinitis. Inflammation of the tendons in the shoulder can cause tendinitis. Overuse, repetitive motions, or sudden injuries can contribute to this condition, resulting in pain and limited shoulder function.
Nerve impingement. Conditions like cervical radiculopathy or thoracic outlet syndrome can cause compression or irritation of the nerves that travel through the shoulder region, leading to pain, numbness, or tingling sensations.
Other causes: Other potential sources of shoulder pain include muscle strains, shoulder joint infections, tumors, referred pain from the neck or upper back, and certain systemic conditions like fibromyalgia or lupus.
The information provided here is for general knowledge, and if you’re experiencing shoulder pain, it’s best to consult with our Orthopaedic Specialist for an accurate diagnosis and 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.”
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What types of diagnosis?
Since there are many potential causes of shoulder pain, our Specialist will do a careful review of your symptoms, physical examination, and sometimes imaging tests to make a proper diagnosis.
After reviewing your symptoms and medical history, he will perform a thorough exam of your shoulder. He will press on different areas of your shoulder to evaluate it for tenderness or deformity. He will also test your arm strength and your shoulder range of motion.
Our doctor may also examine other areas of your body, like your neck or abdomen, to rule out non-shoulder-related causes of your pain.
You might need one or more of the following:
- X-ray: A shoulder X-ray can visualize bone injuries or subtle problems, like bone spurs, that could suggest a diagnosis of osteoarthritis.
- Magnetic resonance imaging (MRI): This test provides detailed images of the tendons, ligaments, and muscles that surround the shoulder joint. For instance, an MRI can provide information about the location, size, and relative age of a rotator cuff tear.
- Electromyogram (EMG): A test to evaluate nerve and muscle function
While it seems logical that shoulder pain would stem from the shoulder, this is not always the case. Pain in the general shoulder area, often difficult to pinpoint, can sometimes be related to a herniated disc in the neck or gallbladder disease.
In rare cases, shoulder pain can be a symptom of a heart attack or bleeding from the liver or spleen.
If our doctor has concerns about another cause that’s outside your shoulder joint, they may focus on that diagnosis.
For example, an electrocardiogram (ECG) may be ordered for a suspected heart attack. An abdominal ultrasound may be ordered for suspected gallbladder disease.
Possible treatment methods for Shoulder Pain?
The treatment of shoulder pain depends entirely on the cause of shoulder pain. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment.
Non-invasive shoulder pain treatment
Treatment typically involves a period of rest and avoidance of activities that aggravate the pain.
Our Specialist may also recommend applying heat or ice to the injury for shoulder pain relief, as well as placing pressure on the area to reduce swelling. Physical therapy improves shoulder strength and flexibility. Our Therapist will design specific exercises and stretches to strengthen your shoulder muscles, improve range of motion, and alleviate pain. She may also use techniques like ultrasound, heat, or electrical stimulation for pain relief.
Slings can be helpful in managing shoulder dislocations, separations, and fractures, as they keep the structures of the joint in position. Before applying a sling, our doctor will have to put the bones back into place.
Our Specialist may prescribe medication to reduce pain and inflammation. This may include oral medications or injection of numbing medicine directly into the shoulder to relieve pain.
Invasive treatment for shoulder pain
Some injuries require surgery for treatment. For example, rotator cuff tears and adhesive capsulitis do not always improve with rest and medicine. Severe rotator cuff tear or recurrent dislocations may warrant early surgical consultation rather than a trial of at-home management. This would requires detailed consultation on the procedure of the surgery as well as the risk involve for individuals.