Shoulder problems are incredibly common with three out of ten people reporting pain in this important joint at any one time.[i]
The shoulder joint is the most mobile joint in the body[ii] consisting of a large ball and socket joint which allows a wide range of movement and a smaller joint where the top of the shoulder blade meets the collar bone. Muscles and tendons support the joints. Your shoulder supports the whole weight of your arms.
Shoulder pain may be due to an injury or an underlying condition and may start suddenly or more gradually. There are a number of common causes of shoulder pain, the most common of which is rotator cuff problems – this is the name for soreness, swelling or damage to the muscles and tendons in the shoulder. Four muscles make up the rotator cuff and they help with keeping the joint stable and allowing it to move. Experts estimate rotator cuff problems are the cause of 70 per cent of shoulder pain issues.[iii]
Other common causes of shoulder pain include poor posture (slumping at your desk, etc.), a frozen shoulder where the flexible tissue surrounding the shoulder becomes inflamed and thickened, and osteoarthritis of the acromioclavicular joint (a bone at the top of the shoulder joint) or a broken bone. Sometimes shoulder pain can be referred from a neck problem too.
More about rotator cuff problems
Rotator cuff problems are more common as you get older, with middle-aged and older people more likely to develop them.[iv]
The most common causes of rotator cuff injuries are either tendinopathy where tendons in the shoulder become pinched and inflamed or a rotator cuff tear, where one or muscles are torn either partially or completely due to a fall or wear and tear. This can be the result of injury or overuse of the shoulder joint for example where a person’s occupation involves lots of overhead movements or in sporting activities such as weight lifting, racket sports, golf, javelin throwing etc.
The pain can start suddenly if it’s due to an injury or builds up more slowly if an inflamed tendon is causing it.
A rotator cuff problem can be identified by assessment of your symptoms by your doctor, and an ultrasound scan can help confirm the diagnosis.
What are the symptoms of shoulder pain?
The exact nature and intensity of shoulder pain will vary according to what the underlying root cause is:
- Frozen shoulder symptoms: These include pain and stiffness on moving the shoulders and carrying out everyday activities such as driving, sleeping and carrying things.
- Rotator cuff symptoms: These vary depending on the type of rotator cuff problem but include pain that gets worse when the arm is raised above the shoulder, pain when you move your arm in an arc away from your body, plus pain on the front and side of your shoulder, pain at night when your sleep, and of weakness in your shoulder when you lift or move your arm around.
- Osteoarthritis symptoms: These may result from previous injuries or wear and tear stresses to the shoulder. The cartilage becomes thinner and spurs of extra bone may form which changes the shape of the joint and affects the way it moves, causing pain and restriction of movement (you may not be able to lift your arm above your head, for example).
- Polymyalgia rheumatica: Stiffness affects both shoulder joints and the hip joints too, and symptoms start suddenly usually within a week. You may also feel feverish and unwell. This condition needs prompt treatment as it can lead to complications.[v]
Diagnosing shoulder problems
Your doctor can diagnose the source of shoulder pain by taking a history of your symptoms and, if needed, ordering investigations including x-rays, ultrasound, CT and MRI scans.
Whilst x-rays are useful they have limitations because they can’t show up problems with muscles, tendons or cartilage. Ultrasound scans on the other hand can detect thickening of the soft tissues of the shoulder and identify fluid build-up and damage to tendon and muscles, so can be very helpful. Ultrasound scans can also reveal larger-sized tears in the rotator cuff.
Treating shoulder pain problems
Some shoulder problems including a frozen shoulder will usually resolve on their own. You can manage your symptoms in the short term with anti-inflammatory painkillers which reduce swelling and pain, avoiding activities which make your symptoms worse, or applying ice packs to reduce pain and inflammation. Other conditions may need physiotherapy, steroid injections or even surgery to resolve them though.
More about ultrasound investigations