While we are all aware about certain possible causes of shoulder pain like arthritis, fracture, etc., most of us are unaware of the other conditions which may affect the shoulder. The blog throws light on the lesser-known causes.
The shoulder is one of the most movable joints in the human body. Every day we use our shoulder joints for several normal activities – be it carrying grocery bags, lifting things, throwing something or reaching for something, all of these movements involve our shoulder joint. Only when our shoulder movement is compromised do we realize how extensively we were unconsciously using our shoulder.
The Joints of the Shoulder
- The shoulder complex is made up of four joints and a number of muscles, tendons and ligaments which support it.
- These muscles, tendons and ligaments comprise the rotator cuff. The rotator cuff plays an important role in the stability of the joint.
- The chief joint is the glenohumeral joint – a ball and socket joint, that makes a wide array of movements possible.
- The glenohumeral joint is called so because the ball end of the humerus (the upper arm) fits into the socket of the glenoid fossa of the scapula (shoulder blade).
- The uniqueness of this joint lies in the fact that the ball part is larger than the socket into which it fits, which is what makes the wide range of movements possible.
- However, this does result in the joint being prone to instability.
Shoulder Pain – Causes
When a person complains of shoulder pain, he means pain felt around the shoulder joint. Shoulder pain may be caused by a number of conditions like arthritis, fracture, etc. Here, we will discuss a few conditions many people may be unaware of.
Rotator Cuff Tendonitis
- This condition, also known as impingement syndrome, is a common cause of shoulder pain.
- Here, the tendons of the rotator cuff are rubbed against by the shoulder blade or trapped by the shoulder blade, leading to pain.
- When the rotator cuff is irritated, it swells thus narrowing the space available for it.
- This leads to further rubbing against the shoulder blade and a vicious cycle follows.
- If bone spurs are present, they aggravate the problem further.
- Rotator cuff tendonitis can be caused by a number of factors – sleeping on one arm consistently, keeping the shoulder in the same position for a while, work or sport activities which need the arm to be lifted over the head, etc.
- For most people, the condition resolves and movement is regained. Initial treatment involves rest, icing and NSAIDs.
- Physical therapy to relieve pain and regain movement is recommended.
- If the pain does not subside, then steroid injections may be given.
- Surgery is the last option if nothing else works. After surgery, most patients recover completely and regain the lost mobility.
- Bursae are fluid-filled sacs present in the parts of the body that are prone to friction (like in-between tendons and bones) to allow friction-free movement.
- The bursae are normally very thin but when excessive friction occurs, they get inflamed and produce more fluid to handle the friction.
- As a result, they swell up and bursitis results.
- Sometimes, the fluid in the bursae could get infected by bacteria.
- Bursitis causes pain and inflammation with the affected area usually being warm to touch.
- It can be classified into 3 types: chronic bursitis, infected bursitis and traumatic bursitis.
- Chronic bursitis occurs due to the bursa being subjected to increased pressure for a long duration. Infected bursitis results when the bursa gets infected and traumatic bursitis is caused by injury.
- Treatment depends on the type of bursitis and may range from rest, icing and immobilization to bursa aspiration and treatment with antibiotics.
- Surgery is rarely required to treat bursitis.
- In this condition, the ball end of the upper arm comes out of the socket into which it fits.
- The dislocation can be complete or partial.
- A dislocation is accompanied by intense pain, swelling, and sometimes a visible deformation can be seen.
- The person will not be able to move his shoulder and should seek immediate medical attention.
- It is important to not try and push the shoulder back into place as this could make the condition worse.
- The doctor will perform a closed reduction in which he will gently guide the dislocated joint back into place.
- This will be followed by rest, medication and rehabilitation.
- Surgery is required only in rare cases.
- The shoulder is a joint that is prone to dislocation due to its high mobility.
- However, it is not easy to dislocate a shoulder joint and only force of quite a magnitude can do it.
- Causes of shoulder dislocation may include a fall on the shoulder, a road traffic accident or an injury while playing contact sports.
Shoulder Labral Tear
- The labrum is a rubbery cartilage that lines the socket of the shoulder joint.
- Doing a particular movement repeatedly, some kind of trauma, a fall or a sudden pull can injure or tear the labrum.
- While a labral tear is usually accompanied by pain, the person might also experience a locking sensation at the shoulder; mobility is reduced and the shoulder might feel unstable and weak.
- To diagnose a labral tear, the doctor will first do a physical examination to test the shoulder’s range of motion and to determine the exact area of pain.
- The doctor should also be informed about any history of injury.
- While an x-ray cannot show a labral tear, it will be useful in eliminating other conditions.
- An MRI will confirm a labral tear diagnosis.
- Treatment involves pain medication and physical therapy to strengthen surrounding muscles.
- Surgery is the last option and will be performed arthroscopically. During the procedure, the surgeon will repair or reattach the torn labrum.
- Unlike a dislocation, a shoulder separation happens in the area around the shoulder blade and the collar bone.
- A fall is the most common cause of shoulder separation which could either injure the ligaments around this joint or tear the ligaments completely leading to shoulder separation.
- In the case of a complete separation, a bulge over the shoulder will be visible.
- A physical examination with an x-ray will help to confirm diagnosis.
- Icing, medication and using a sling will help manage the pain.
- Even with a visible bulge, surgery is hardly ever required. Surgery will be considered only if the pain does not subside or the deformity is very bad.